{"generated":"2026-08-28T16:42:09Z","year":"2018","count":302,"licence":"Citeer vrij, met bronvermelding en een link naar 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":"7af2d601f50a","type":"article","url":"https://hartvaat.nl/2018/12/25/cv-en-ledemaat-uitkomsten-bij-diabetes-met-pav-euclid/","title":"CV- en ledemaat-uitkomsten bij diabetes met PAV: EUCLID","title_en":"Cardiovascular and Limb Outcomes in Patients With Diabetes and Peripheral Artery Disease: The EUCLID Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.09.078","source_url":"https://doi.org/10.1016/j.jacc.2018.09.078","authors":["Cecilia C Low Wang","Juuso I Blomster","Gretchen Heizer","Jeffrey S Berger","Iris Baumgartner","F Gerry R Fowkes","Peter Held","Brian G Katona","Lars Norgren","W Schuyler Jones","Renato D Lopes","Jeffrey W Olin","Frank W Rockhold","Kenneth W Mahaffey","Manesh R Patel","William R Hiatt"],"significance":6,"published":"2018-12-25","source_date":"2018-12-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This EUCLID analysis characterized the independent cardiovascular and limb risks conferred by diabetes in patients with peripheral artery disease, showing that diabetes amplifies both systemic and limb-specific atherosclerotic complications.","created":"2026-07-03T10:27:40Z","updated":"2026-07-03T13:26:53Z","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":"EUCLID-analyse naar cardiovasculaire en ledemaat-uitkomsten bij diabetespatiënten met perifeer arterieel vaatlijden.","abstract_original":"BACKGROUND: Diabetes confers an increased risk for atherosclerotic cardiovascular disease, but less is known about the independent risk diabetes confers on major cardiovascular and limb events in patients with symptomatic peripheral artery disease (PAD) on contemporary management. OBJECTIVES: The authors sought to assess the risk of cardiovascular and limb events in patients with PAD and diabetes as compared with those with PAD alone. METHODS: In the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial, 13,885 patients with symptomatic PAD were evaluated with a primary endpoint of an adjudicated composite of major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, ischemic stroke) followed over a median of ∼30 months. The diabetes subgroup was analyzed compared with the subgroup without diabetes, and further examined for diabetes-specific factors such as glycosylated hemoglobin (HbA1c) that might affect risk for major cardiovascular and limb outcomes. RESULTS: A total of 5,345 patients (38.5%) had diabetes; the majority (n = 5,134 [96.1%]) had type 2 diabetes. The primary endpoint occurred in 15.9% of patients with PAD and diabetes as compared with 10.4% of those without diabetes (absolute risk difference 5.5%; adjusted hazard ratio: 1.56; 95% confidence interval [CI]: 1.41 to 1.72; p < 0.001). Every 1% increase in HbA1c was associated with a 14.2% increased relative risk for MACE (95% CI: 1.09 to 1.20; p < 0.0001). CONCLUSIONS: Patients with PAD and diabetes are at high risk for cardiovascular and limb ischemic events, even on contemporary therapies. Every 1% increase in HbA1c was associated with a 14.2% increased relative risk for MACE (95% CI: 1.09 to 1.20; p < 0.0001). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822)."},{"id":"017f9f6d7e99","type":"article","url":"https://hartvaat.nl/2018/12/21/culprit-shock-integratie-in-2017-esc-stemi-richtlijn-richtlijncommissie-standpun/","title":"CULPRIT-SHOCK integratie in 2017 ESC STEMI-richtlijn: richtlijncommissie standpunt","title_en":"Integrating the results of the CULPRIT-SHOCK trial in the 2017 ESC ST-elevation myocardial infarction guidelines: viewpoint of the task force.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy294","source_url":"https://doi.org/10.1093/eurheartj/ehy294","authors":["Borja Ibanez","Sigrun Halvorsen","Marco Roffi","Héctor Bueno","Holger Thiele","Pascal Vranckx","Franz-Josef Neumann","Stephan Windecker","Stefan James"],"significance":7,"published":"2018-12-21","source_date":"2018-12-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This ESC STEMI guideline committee position paper addressed the integration of CULPRIT-SHOCK results into clinical practice, updating recommendations on the revascularization strategy for patients with MI and cardiogenic shock.","created":"2026-07-03T10:27:40Z","updated":"2026-07-03T13:26:53Z","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":"Standpunt van het ESC STEMI-richtlijncomité over de integratie van CULPRIT-SHOCK resultaten. Actualisatie van de revascularisatiestrategie bij cardiogene shock.","abstract_original":""},{"id":"5ac734e98120","type":"article","url":"https://hartvaat.nl/2018/12/18/liraglutide-bij-diabetes-type-2-met-ckd-leader-renale-analyse/","title":"Liraglutide bij diabetes type 2 met CKD: LEADER renale analyse","title_en":"Effects of Liraglutide Versus Placebo on Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Chronic Kidney Disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","credence-trial","diabetische-nefropathie","fidelio-dkd","figaro-dkd","flow-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.036418","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.036418","authors":["Johannes F E Mann","Vivian Fonseca","Ofri Mosenzon","Itamar Raz","Bryan Goldman","Thomas Idorn","Bernt Johan von Scholten","Neil R Poulter"],"significance":7,"published":"2018-12-18","source_date":"2018-12-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This LEADER subanalysis confirmed that liraglutide reduces cardiovascular events in patients with type 2 diabetes and chronic kidney disease, demonstrating consistent cardiorenal protection in the renally impaired subpopulation.","created":"2026-07-03T10:27:40Z","updated":"2026-07-03T13:26:53Z","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":"LEADER subanalyse bij diabetespatiënten met chronische nierziekte. Bevestigt voordeel van liraglutide ook bij nierinsufficiëntie.","abstract_original":"BACKGROUND: LEADER trial (Liraglutide Effect and Action in Diabetes: Evaluation of CV Outcome Results) results demonstrated cardiovascular benefits for patients with type 2 diabetes mellitus at high cardiovascular risk on standard of care randomized to liraglutide versus placebo. The effect of glucagon-like peptide-1 receptor agonist liraglutide on cardiovascular events and all-cause mortality in patients with type 2 diabetes mellitus and chronic kidney disease is unknown. Liraglutide's treatment effects in patients with and without kidney disease were analyzed post hoc. METHODS: Patients were randomized (1:1) to liraglutide or placebo, both in addition to standard of care. These analyses assessed outcomes stratified by baseline estimated glomerular filtration rate (eGFR; <60 versus ≥60 mL/min/1.73 m2) and baseline albuminuria. The primary outcome (composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) and secondary outcomes, including all-cause mortality and individual components of the primary composite outcome, were analyzed using Cox regression. RESULTS: Overall, 2158 and 7182 patients had baseline eGFR <60 or ≥60 mL/min/1.73 m2, respectively. In patients with eGFR <60 mL/min/1.73 m2, risk reduction for the primary composite cardiovascular outcome with liraglutide was greater (hazard ratio [HR], 0.69; 95% CI, 0.57-0.85) versus those with eGFR ≥60 mL/min/1.73 m2 (HR, 0.94; 95% CI, 0.83-1.07; interaction P=0.01). There was no consistent effect modification with liraglutide across finer eGFR subgroups (interaction P=0.13) and when analyzing eGFR as a continuous variable (interaction P=0.61). Risk reductions in those with eGFR <60 versus ≥60 mL/min/1.73 m2 were as follows: for nonfatal myocardial infarction, HR, 0.74; 95% CI, 0.55-0.99 versus HR, 0.93; 95% CI, 0.77-1.13; for nonfatal stroke, HR, 0.51; 95% CI, 0.33-0.80 versus HR, 1.07; 95% CI, 0.84-1.37; for cardiovascular death, HR, 0.67; 95% CI, 0.50-0.90 versus HR, 0.84; 95% CI, 0.67-1.05; for all-cause mortality, HR, 0.74; 95% CI, 0.60-0.92 versus HR, 0.90; 95% CI, 0.75-1.07. Risk reduction for the primary composite cardiovascular outcome was not different for those with versus without baseline albuminuria (HR, 0.83; 95% CI, 0.71-0.97; and HR, 0.92; 95% CI, 0.79-1.07, respectively; interaction P=0.36). CONCLUSIONS: Liraglutide added to standard of care reduced the risk for major cardiovascular events and all-cause mortality in patients with type 2 diabetes mellitus and chronic kidney disease. These results appear to apply across the chronic kidney disease spectrum enrolled. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/ . Unique identifier: NCT01179048."},{"id":"333ae1eae2e6","type":"article","url":"https://hartvaat.nl/2018/12/18/liraglutide-cv-uitkomsten-met-of-zonder-eerder-mi-leader/","title":"Liraglutide CV-uitkomsten met of zonder eerder MI: LEADER","title_en":"Effects of Liraglutide on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus With or Without History of Myocardial Infarction or Stroke.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034516","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034516","authors":["Subodh Verma","Neil R Poulter","Deepak L Bhatt","Stephen C Bain","John B Buse","Lawrence A Leiter","Michael A Nauck","Richard E Pratley","Bernard Zinman","David D Ørsted","Tea Monk Fries","Søren Rasmussen","Steven P Marso"],"significance":7,"published":"2018-12-18","source_date":"2018-12-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This LEADER subanalysis showed that liraglutide's cardiovascular benefit is consistent in patients with and without prior myocardial infarction, supporting GLP-1 receptor agonist use across the cardiovascular risk spectrum in type 2 diabetes.","created":"2026-07-03T10:27:40Z","updated":"2026-07-03T13:26:53Z","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":"LEADER subanalyse naar het voordeel van liraglutide bij diabetespatiënten met versus zonder eerder myocardinfarct.","abstract_original":"BACKGROUND: The glucagon-like peptide-1 analog liraglutide reduced cardiovascular events and mortality in patients with type 2 diabetes mellitus in the LEADER trial (Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes). In a post hoc analysis, we evaluated the efficacy of liraglutide in those with and without a history of myocardial infarction (MI) and/or stroke. METHODS: LEADER was a randomized trial of liraglutide (1.8 mg or maximum tolerated dose) versus placebo in 9340 patients with type 2 diabetes mellitus and high cardiovascular risk, with a median follow-up of 3.8 years. The primary outcome was a composite of cardiovascular death, nonfatal MI, or nonfatal stroke (major adverse cardiovascular events). Risk groups in this post hoc analysis were defined by history of MI/stroke, established atherosclerotic cardiovascular disease without MI/stroke, or cardiovascular risk factors alone. RESULTS: Of the 9340 patients, 3692 (39.5%) had a history of MI/stroke, 3083 (33.0%) had established atherosclerotic cardiovascular disease without MI/stroke, and 2565 (27.5%) had risk factors alone. Major adverse cardiovascular events occurred in 18.8% of patients with a history of MI/stroke (incidence rate, 5.0 per 100 patient-years), 11.6% of patients with established atherosclerotic cardiovascular disease without MI/stroke (incidence rate, 3.0 per 100 patient-years), and 9.8% of patients with cardiovascular risk factors alone (incidence rate, 2.6 per 100 patient-years). Liraglutide reduced major adverse cardiovascular events in patients with a history of MI/stroke (322 of 1865 [17.3%] versus 372 of 1827 patients [20.4%]; hazard ratio, 0.85; 95% CI, 0.73-0.99) and in those with established atherosclerotic cardiovascular disease without MI/stroke (158 of 1538 [10.3%] versus 199 of 1545 patients [12.9%]; hazard ratio, 0.76; 95% CI, 0.62-0.94) compared with placebo. In patients with risk factors alone, the hazard ratio for liraglutide versus placebo was 1.08 (95% CI, 0.84-1.38, Pinteraction=0.11). Similar results were seen for secondary outcomes across risk groups. CONCLUSIONS: In this post hoc analysis of patients with type 2 diabetes mellitus and high cardiovascular risk, liraglutide reduced cardiovascular outcomes both in patients with a history of MI/stroke and in those with established atherosclerotic cardiovascular disease without MI/stroke. The cardiovascular effect appeared neutral in patients with cardiovascular risk factors alone. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01179048."},{"id":"5d88c1315a9e","type":"article","url":"https://hartvaat.nl/2018/12/18/2018-acc-expert-consensus-nieuwe-therapieen-voor-cv-risicoreductie-bij-diabetes-/","title":"2018 ACC Expert Consensus: nieuwe therapieën voor CV-risicoreductie bij diabetes type 2","title_en":"2018 ACC Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.09.020","source_url":"https://doi.org/10.1016/j.jacc.2018.09.020","authors":["Sandeep R Das","Brendan M Everett","Kim K Birtcher","Jenifer M Brown","William T Cefalu","James L Januzzi","Rita Rastogi Kalyani","Mikhail Kosiborod","Melissa L Magwire","Pamela B Morris","Laurence S Sperling"],"significance":9,"published":"2018-12-18","source_date":"2018-12-18","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The 2018 ACC Expert Consensus provided the first integrated decision pathway for using SGLT2 inhibitors and GLP-1 receptor agonists for cardiovascular risk reduction in patients with type 2 diabetes and established atherosclerotic disease, heart failure, or chronic kidney disease.","created":"2026-07-03T10:27:40Z","updated":"2026-07-03T13:26:53Z","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":"ACC 2018 expert consensus over nieuwe therapieën (SGLT2-remmers, GLP-1-agonisten) voor cardiovasculaire risicoreductie bij diabetes type 2. Eerste integratie in practice pathway.","abstract_original":""},{"id":"707dfd876aa0","type":"article","url":"https://hartvaat.nl/2018/12/18/ivus-versus-angiografie-geleide-des-implantatie-de-ultimate-trial/","title":"IVUS versus angiografie-geleide DES-implantatie: de ULTIMATE-trial","title_en":"Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: The ULTIMATE Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.09.013","source_url":"https://doi.org/10.1016/j.jacc.2018.09.013","authors":["Junjie Zhang","Xiaofei Gao","Jing Kan","Zhen Ge","Leng Han","Shu Lu","Nailiang Tian","Song Lin","Qinghua Lu","Xueming Wu","Qihua Li","Zhizhong Liu","Yan Chen","Xuesong Qian","Juan Wang","Dayang Chai","Chonghao Chen","Xiaolong Li","Bill D Gogas","Tao Pan","Shoujie Shan","Fei Ye","Shao-Liang Chen"],"significance":8,"published":"2018-12-18","source_date":"2018-12-18","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The ULTIMATE trial demonstrated that IVUS-guided drug-eluting stent implantation significantly reduced target vessel failure compared with angiography-guided PCI at 1 year. The results provided randomized evidence supporting routine IVUS use during coronary stenting.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T13:26:53Z","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":"ULTIMATE gerandomiseerde trial die IVUS-geleide vergeleek met angiografie-geleide DES-implantatie. Bewijs voor routinematig IVUS-gebruik bij PCI.","abstract_original":"BACKGROUND: Intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation is associated with fewer major adverse cardiovascular events compared with angiography guidance for patients with individual lesion subset. However, the beneficial effect on major adverse cardiovascular event outcome of IVUS guidance over angiography guidance in all-comers who undergo DES implantation still remains understudied. OBJECTIVES: This study aimed to determine the benefits of IVUS guidance over angiography guidance during DES implantation in all-comer patients. METHODS: A total of 1,448 all-comer patients who required DES implantation were randomly assigned (1:1 ratio) to either an IVUS guidance or angiography guidance group. The primary endpoint was target-vessel failure (TVF) at 12 months, including cardiac death, target-vessel myocardial infarction, and clinically driven target-vessel revascularization (TVR). The procedure was defined as a success if all IVUS-defined optimal criteria were met. RESULTS: At 12 months follow-up, 60 TVFs (4.2%) occurred, with 21 (2.9%) in the IVUS group and 39 (5.4%) in the angiography group (hazard ratio [HR]: 0.530; 95% confidence interval [CI]: 0.312 to 0.901; p = 0.019). In the IVUS group, TVF was recorded in 1.6% of patients with successful procedures, compared with 4.4% in patients who failed to achieve all optimal criteria (HR: 0.349; 95% CI: 0.135 to 0.898; p = 0.029). The significant reduction of clinically driven target-lesion revascularization or definite stent thrombosis (HR: 0.407; 95% CI: 0.188 to 0.880; p = 0.018) based on lesion-level analysis by IVUS guidance was not achieved when the patient-level analysis was performed. CONCLUSIONS: The present study demonstrates that IVUS-guided DES implantation significantly improved clinical outcome in all-comers, particularly for patients who had an IVUS-defined optimal procedure, compared with angiography guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in \"All-Comers\" Coronary Lesions [ULTIMATE]; NCT02215915)."},{"id":"6db837ff2d91","type":"article","url":"https://hartvaat.nl/2018/12/13/transcatheter-mitraalklepherstel-bij-hartfalen-nejm-coapt/","title":"Transcatheter mitraalklepherstel bij hartfalen: NEJM COAPT","title_en":"Transcatheter Mitral-Valve Repair in Patients with Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1806640","source_url":"https://doi.org/10.1056/NEJMoa1806640","authors":["Gregg W Stone","JoAnn Lindenfeld","William T Abraham","Saibal Kar","D Scott Lim","Jacob M Mishell","Brian Whisenant","Paul A Grayburn","Michael Rinaldi","Samir R Kapadia","Vivek Rajagopal","Ian J Sarembock","Andreas Brieke","Steven O Marx","David J Cohen","Neil J Weissman","Michael J Mack"],"significance":10,"published":"2018-12-13","source_date":"2018-12-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The COAPT trial showed that transcatheter mitral-valve repair with MitraClip, added to guideline-directed medical therapy, dramatically reduced heart failure hospitalization and all-cause mortality in patients with heart failure and severe secondary mitral regurgitation. The results were practice-changing, establishing a new interventional approach for functional MR.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T13:26:53Z","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":"Landmark NEJM COAPT-trial die aantoonde dat transcatheter mitraalklepherstel (MitraClip) mortaliteit en hospitalisatie significant vermindert bij HF met ernstige secundaire MR. Tegenovergesteld resultaat van MITRA-FR.","abstract_original":"BACKGROUND: Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes. METHODS: At 78 sites in the United States and Canada, we enrolled patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heart failure within 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%. RESULTS: Of the 614 patients who were enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of all hospitalizations for heart failure within 24 months was 35.8% per patient-year in the device group as compared with 67.9% per patient-year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of freedom from device-related complications at 12 months was 96.6% (lower 95% confidence limit, 94.8%; P<0.001 for comparison with the performance goal). Death from any cause within 24 months occurred in 29.1% of the patients in the device group as compared with 46.1% in the control group (hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001). CONCLUSIONS: Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 24 months of follow-up than medical therapy alone. The rate of freedom from device-related complications exceeded a prespecified safety threshold. (Funded by Abbott; COAPT ClinicalTrials.gov number, NCT01626079 .)."},{"id":"a3bb6daa320f","type":"article","url":"https://hartvaat.nl/2018/12/13/percutaan-herstel-of-medicamenteuze-therapie-bij-secundaire-mr-nejm-mitra-fr/","title":"Percutaan herstel of medicamenteuze therapie bij secundaire MR: NEJM MITRA-FR","title_en":"Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1805374","source_url":"https://doi.org/10.1056/NEJMoa1805374","authors":["Jean-François Obadia","David Messika-Zeitoun","Guillaume Leurent","Bernard Iung","Guillaume Bonnet","Nicolas Piriou","Thierry Lefèvre","Christophe Piot","Frédéric Rouleau","Didier Carrié","Mohammed Nejjari","Patrick Ohlmann","Florence Leclercq","Christophe Saint Etienne","Emmanuel Teiger","Lionel Leroux","Nicole Karam","Nicolas Michel","Martine Gilard","Erwan Donal","Jean-Noël Trochu","Bertrand Cormier","Xavier Armoiry","Florent Boutitie","Delphine Maucort-Boulch","Cécile Barnel","Géraldine Samson","Patrice Guerin","Alec Vahanian","Nathan Mewton"],"significance":9,"published":"2018-12-13","source_date":"2018-12-13","image":"","kennis":[],"congress":"","summary_en":"The MITRA-FR trial showed that transcatheter mitral valve repair with MitraClip did not reduce mortality or heart failure hospitalization compared with medical therapy alone in patients with severe secondary mitral regurgitation and heart failure. The contrasting result with COAPT highlighted the importance of proportionate versus disproportionate MR in patient selection.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T13:26:53Z","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":"NEJM MITRA-FR-trial die percutaan mitraalklepherstel (MitraClip) plus medicamenteus vergeleek met medicamenteus alleen bij secundaire MR. Negatief resultaat — in contrast met COAPT.","abstract_original":"BACKGROUND: In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous mitral-valve repair improves clinical outcomes in this patient population is unknown. METHODS: We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm2 or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients). The primary efficacy outcome was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months. RESULTS: At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in the intervention group and 51.3% (78 of 152 patients) in the control group (odds ratio, 1.16; 95% confidence interval [CI], 0.73 to 1.84; P=0.53). The rate of death from any cause was 24.3% (37 of 152 patients) in the intervention group and 22.4% (34 of 152 patients) in the control group (hazard ratio, 1.11; 95% CI, 0.69 to 1.77). The rate of unplanned hospitalization for heart failure was 48.7% (74 of 152 patients) in the intervention group and 47.4% (72 of 152 patients) in the control group (hazard ratio, 1.13; 95% CI, 0.81 to 1.56). CONCLUSIONS: Among patients with severe secondary mitral regurgitation, the rate of death or unplanned hospitalization for heart failure at 1 year did not differ significantly between patients who underwent percutaneous mitral-valve repair in addition to receiving medical therapy and those who received medical therapy alone. (Funded by the French Ministry of Health and Research National Program and Abbott Vascular; MITRA-FR ClinicalTrials.gov number, NCT01920698 .)."},{"id":"22111763f99c","type":"article","url":"https://hartvaat.nl/2018/12/11/langetermijneffecten-van-zuurstof-op-sterfte-of-hf-hospitalisatie-na-verdenking-/","title":"Langetermijneffecten van zuurstof op sterfte of HF-hospitalisatie na verdenking MI","title_en":"Long-Term Effects of Oxygen Therapy on Death or Hospitalization for Heart Failure in Patients With Suspected Acute Myocardial Infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.036220","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.036220","authors":["Tomas Jernberg","Bertil Lindahl","Joakim Alfredsson","Ellinor Berglund","Olle Bergström","Anders Engström","David Erlinge","Johan Herlitz","Raluca Jumatate","Thomas Kellerth","Jorg Lauermann","Krister Lindmark","Markus Lingman","Lina Ljung","Carina Nilsson","Elmir Omerovic","J Pernow","Annica Ravn-Fischer","David Sparv","Troels Yndigegn","Ollie Östlund","Stefan K James","Robin Hofmann"],"significance":6,"published":"2018-12-11","source_date":"2018-12-11","image":"","kennis":[],"congress":"","summary_en":"This long-term DETO2X-AMI analysis showed that supplemental oxygen in suspected acute MI does not reduce mortality or heart failure hospitalization over extended follow-up, confirming the absence of benefit from routine oxygen therapy.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T18:38:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnanalyse naar het effect van zuurstoftherapie op sterfte of hartfalenhospitalisatie bij verdenking acuut MI.","abstract_original":"BACKGROUND: In the DETO2X-AMI trial (Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction), we compared supplemental oxygen with ambient air in normoxemic patients presenting with suspected myocardial infarction and found no significant survival benefit at 1 year. However, important secondary end points were not yet available. We now report the prespecified secondary end points cardiovascular death and the composite of all-cause death and hospitalization for heart failure. METHODS: In this pragmatic, registry-based randomized clinical trial, we used a nationwide quality registry for coronary care for trial procedures and evaluated end points through the Swedish population registry (mortality), the Swedish inpatient registry (heart failure), and cause of death registry (cardiovascular death). Patients with suspected acute myocardial infarction and oxygen saturation of ≥90% were randomly assigned to receive either supplemental oxygen at 6 L/min for 6 to 12 hours delivered by open face mask or ambient air. RESULTS: A total of 6629 patients were enrolled. Acute heart failure treatment, left ventricular systolic function assessed by echocardiography, and infarct size measured by high-sensitive cardiac troponin T were similar in the 2 groups during the hospitalization period. All-cause death or hospitalization for heart failure within 1 year after randomization occurred in 8.0% of patients assigned to oxygen and in 7.9% of patients assigned to ambient air (hazard ratio, 0.99; 95% CI, 0.84–1.18; P=0.92). During long-term follow-up (median [range], 2.1 [1.0–3.7] years), the composite end point occurred in 11.2% of patients assigned to oxygen and in 10.8% of patients assigned to ambient air (hazard ratio, 1.02; 95% CI, 0.88–1.17; P=0.84), and cardiovascular death occurred in 5.2% of patients assigned to oxygen and in 4.8% assigned to ambient air (hazard ratio, 1.07; 95% CI, 0.87–1.33; P=0.52). The results were consistent across all predefined subgroups. CONCLUSIONS: Routine use of supplemental oxygen in normoxemic patients with suspected myocardial infarction was not found to reduce the composite of all-cause mortality and hospitalization for heart failure, or cardiovascular death within 1 year or during long-term follow-up. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01787110."},{"id":"025ca61a8926","type":"article","url":"https://hartvaat.nl/2018/12/11/vroeg-versus-standaard-invasief-onderzoek-bij-nste-acs-verdict-gerandomiseerde-t/","title":"Vroeg versus standaard invasief onderzoek bij NSTE-ACS: VERDICT gerandomiseerde trial","title_en":"Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.037152","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.037152","authors":["Klaus F Kofoed","Henning Kelbæk","Peter Riis Hansen","Christian Torp-Pedersen","Dan Høfsten","Lene Kløvgaard","Lene Holmvang","Steffen Helqvist","Erik Jørgensen","Søren Galatius","Frants Pedersen","Lia Bang","Kari Saunamaki","Peter Clemmensen","Jesper J Linde","Merete Heitmann","Olav Wendelboe Nielsen","Ilan E Raymond","Ole Peter Kristiansen","Ida Hastrup Svendsen","Jan Bech","Maria Helena Dominguez Vall-Lamora","Charlotte Kragelund","Thomas Fritz Hansen","Jens Dahlgaard Hove","Tem Jørgensen","Gitte G Fornitz","Rolf Steffensen","Birgit Jurlander","Jawdat Abdulla","Stig Lyngbæk","Hanne Elming","Susette Krohn Therkelsen","Ulrik Abildgaard","Jan Skov Jensen","Gunnar Gislason","Lars V Køber","Thomas Engstrøm"],"significance":7,"published":"2018-12-11","source_date":"2018-12-11","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/"],"congress":"","summary_en":"The VERDICT trial compared very early (within 12 hours) versus standard timing of invasive coronary angiography in NSTE-ACS, finding that earlier intervention did not reduce the primary composite endpoint but may benefit higher-risk patients.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T13:26:52Z","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":"VERDICT gerandomiseerde trial die zeer vroeg versus standaard invasief onderzoek vergeleek bij NSTE-ACS. Timing van invasieve strategie.","abstract_original":"BACKGROUND: The optimal timing of invasive coronary angiography (ICA) and revascularization in patients with non-ST-segment elevation acute coronary syndrome is not well defined. We tested the hypothesis that a strategy of very early ICA and possible revascularization within 12 hours of diagnosis is superior to an invasive strategy performed within 48 to 72 hours in terms of clinical outcomes. METHODS: Patients admitted with clinical suspicion of non-ST-segment elevation acute coronary syndrome in the Capital Region of Copenhagen, Denmark, were screened for inclusion in the VERDICT trial (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography) ( ClinicalTrials.gov NCT02061891). Patients with ECG changes indicating new ischemia or elevated troponin, in whom ICA was clinically indicated and deemed logistically feasible within 12 hours, were randomized 1:1 to ICA within 12 hours or standard invasive care within 48 to 72 hours. The primary end point was a combination of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or hospital admission for heart failure. RESULTS: A total of 2147 patients were randomized; 1075 patients allocated to very early invasive evaluation had ICA performed at a median of 4.7 hours after randomization, whereas 1072 patients assigned to standard invasive care had ICA performed 61.6 hours after randomization. Among patients with significant coronary artery disease identified by ICA, coronary revascularization was performed in 88.4% (very early ICA) and 83.1% (standard invasive care). Within a median follow-up time of 4.3 (interquartile range, 4.1-4.4) years, the primary end point occurred in 296 (27.5%) of participants in the very early ICA group and 316 (29.5%) in the standard care group (hazard ratio, 0.92; 95% CI, 0.78-1.08). Among patients with a GRACE risk score (Global Registry of Acute Coronary Events) >140, a very early invasive treatment strategy improved the primary outcome compared with the standard invasive treatment (hazard ratio, 0.81; 95% CI, 0.67-1.01; P value for interaction=0.023). CONCLUSIONS: A strategy of very early invasive coronary evaluation does not improve overall long-term clinical outcome compared with an invasive strategy conducted within 2 to 3 days in patients with non-ST-segment elevation acute coronary syndrome. However, in patients with the highest risk, very early invasive therapy improves long-term outcomes. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02061891."},{"id":"e6ce420fd138","type":"article","url":"https://hartvaat.nl/2018/12/11/syntax-score-bij-diabetes-met-coronaire-revascularisatie-freedom/","title":"SYNTAX-score bij diabetes met coronaire revascularisatie: FREEDOM","title_en":"SYNTAX Score in Patients With Diabetes Undergoing Coronary Revascularization in the FREEDOM Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.09.046","source_url":"https://doi.org/10.1016/j.jacc.2018.09.046","authors":["Rodrigo B Esper","Michael E Farkouh","Expedito E Ribeiro","Whady Hueb","Michael Domanski","Taye H Hamza","Flora S Siami","Lucas Colombo Godoy","Verghese Mathew","John French","Valentin Fuster"],"significance":6,"published":"2018-12-11","source_date":"2018-12-11","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This FREEDOM analysis evaluated the role of the SYNTAX score in guiding revascularization decisions in diabetic patients, showing that anatomical complexity modifies the relative benefit of CABG over PCI in diabetes.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T13:26:52Z","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":"FREEDOM-analyse naar de rol van de SYNTAX-score bij revascularisatiebeslissingen bij diabetespatiënten.","abstract_original":"BACKGROUND: Diabetes mellitus (DM) is associated with complex coronary artery disease (CAD), which in turn results in increased morbidity and mortality from cardiovascular disease. OBJECTIVES: This study sought to evaluate the utility of SYNTAX score (SS) for predicting future cardiovascular events in patients with DM and complex CAD undergoing either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS: The FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial randomized patients with DM and multivessel CAD to undergo either PCI with drug-eluting stents or CABG. The SS was calculated retrospectively by a core laboratory. The endpoint of hard cardiovascular events (HCE) was a composite of death from any cause, nonfatal myocardial infarction, and nonfatal stroke, while the endpoint of major adverse cardiac and cerebrovascular events (MACCE) was a composite of HCE and repeat revascularization. RESULTS: A total of 1,900 patients were randomized to PCI (n = 953) or CABG (n = 947). The SS was considered an independent predictor of 5-year MACCE (hazard ratio per unit of SS: 1.02; 95% confidence interval: 1.00 to 1.03; p = 0.014) and HCE (hazard ratio per unit of SS: 1.03; 95% confidence interval: 1.01 to 1.04; p = 0.002) in the PCI cohort, but not in the CABG group. There was a higher incidence of MACCE in PCI patients with low, intermediate, and high SS compared with those who underwent CABG (36.6% vs. 25.9%, p = 0.02; 43.9% vs. 26.8%, p < 0.001; 48.7% vs. 29.7%, p = 0.003, respectively). CONCLUSIONS: In DM patients with multivessel CAD, the complexity of CAD evaluated by the SS is an independent risk factor for MACCE and HCE only in patients undergoing PCI. The SS should not be utilized to guide the choice of coronary revascularization in patients with DM and multivessel CAD. (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes [FREEDOM]; NCT00086450)."},{"id":"8c93946620ff","type":"article","url":"https://hartvaat.nl/2018/12/07/laesiecomplexiteit-en-periprocedurele-events-bij-potente-iv-antiplaatjestherapie/","title":"Laesiecomplexiteit en periprocedurele events bij potente IV antiplaatjestherapie","title_en":"Impact of lesion complexity on peri-procedural adverse events and the benefit of potent intravenous platelet adenosine diphosphate receptor inhibition after percutaneous coronary intervention: core laboratory analysis from 10 854 patients from the CHAMPION PHOENIX trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy562","source_url":"https://doi.org/10.1093/eurheartj/ehy562","authors":["Gregg W Stone","Philippe Généreux","Robert A Harrington","Harvey D White","C Michael Gibson","P Gabriel Steg","Christian W Hamm","Kenneth W Mahaffey","Matthew J Price","Jayne Prats","Efthymios N Deliargyris","Deepak L Bhatt"],"significance":5,"published":"2018-12-07","source_date":"2018-12-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This CHAMPION PHOENIX analysis showed that lesion complexity modifies the relative benefit of cangrelor over clopidogrel during PCI, with greater protection in more complex procedural settings.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T13:26:52Z","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 naar de interactie tussen laesiecomplexiteit en periprocedurele events met cangrelor versus GPIIb/IIIa-remmers bij PCI.","abstract_original":"AIMS: In the CHAMPION PHOENIX trial, the potent, rapidly acting, intravenous platelet adenosine diphosphate receptor antagonist cangrelor reduced the 48-h incidence of major adverse cardiac events (MACE; death, myocardial infarction, stent thrombosis, or ischaemia-driven revascularization) compared with a loading dose of clopidogrel in patients undergoing percutaneous coronary intervention (PCI). We sought to determine whether the efficacy of cangrelor during PCI varies in patients with simple vs. complex target lesion coronary anatomy. METHODS AND RESULTS: Blinded angiographic core laboratory analysis was completed in 10 854 of 10 942 (99.2%) randomized patients in CHAMPION PHOENIX (13 418 target lesions). Outcomes were analysed according to the number of angiographic PCI target lesion high-risk features (HRF) present (bifurcation, left main, thrombus, angulated, tortuous, eccentric, calcified, long, or multi-lesion treatment). The number of patients with 0, 1, 2, and ≥3 HRFs was 1817 (16.7%), 3442 (31.7%), 2901 (26.7%), and 2694 (24.8%), respectively. The 48-h MACE rate in clopidogrel-treated patients increased progressively with lesion complexity (from 3.3% to 4.4% to 6.9% to 8.7%, respectively, P < 0.0001). Cangrelor reduced the 48-h rate of MACE by 21% {4.7% vs. 5.9%, odds ratio (OR) [95% confidence interval (95% CI)] 0.79 (0.67, 0.93), P = 0.006} compared with clopidogrel, an effect which was consistent regardless of PCI lesion complexity (Pinteraction = 0.66) and presentation with stable ischaemic heart disease (SIHD) or an acute coronary syndrome (ACS). By multivariable analysis, the number of high-risk PCI characteristics [OR (95% CI) 1.68 (1.20, 2.36), 2.78 (2.00, 3.87), and 3.23 (2.33, 4.48) for 1, 2, and 3 HRFs compared with 0 HRFs, all P < 0.0001] and treatment with cangrelor vs. clopidogrel [OR (95% CI) 0.78 (0.66, 0.92), P = 0.004] were independent predictors of the primary 48-h MACE endpoint. Major bleeding rates were unrelated to lesion complexity and were not increased by cangrelor. CONCLUSION: Peri-procedural MACE after PCI is strongly dependent on the number of treated high-risk target lesion features. Compared with a loading dose of clopidogrel, cangrelor reduced MACE occurring within 48 h after PCI in patients with SIHD and ACS regardless of baseline lesion complexity. The absolute benefit:risk profile for cangrelor will therefore be greatest during PCI in patients with complex coronary anatomy. CLINICALTRIALS.GOV IDENTIFIER: NCT01156571."},{"id":"aa5b1121838b","type":"article","url":"https://hartvaat.nl/2018/12/04/echocardiografische-screening-op-ph-bij-aangeboren-hartafwijkingen-jacc-review/","title":"Echocardiografische screening op PH bij aangeboren hartafwijkingen: JACC review","title_en":"Echocardiographic Screening for Pulmonary Hypertension in Congenital Heart Disease: JACC Review Topic of the Week.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.08.2201","source_url":"https://doi.org/10.1016/j.jacc.2018.08.2201","authors":["Konstantinos Dimopoulos","Robin Condliffe","Robert M R Tulloh","Paul Clift","Rafael Alonso-Gonzalez","Radwa Bedair","Natali A Y Chung","Gerry Coghlan","Samantha Fitzsimmons","Alessandra Frigiola","Luke S Howard","Petra Jenkins","Damien Kenny","Wei Li","Simon T MacDonald","Colm McCabe","James J Oliver","Mark S Spence","Gergely V Szantho","Kate von Klemperer","Dirk G Wilson","Stephen J Wort"],"significance":6,"published":"2018-12-04","source_date":"2018-12-04","image":"","kennis":[],"congress":"","summary_en":"This JACC review addressed echocardiographic screening for pulmonary hypertension in patients with congenital heart disease, providing guidance for a population at particularly high risk for developing PH.","created":"2026-07-03T10:27:39Z","updated":"2026-07-03T13:26:52Z","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":"JACC review over echocardiografische screening op pulmonale hypertensie bij patiënten met aangeboren hartafwijkingen.","abstract_original":"Echocardiography is the mainstay in screening for pulmonary hypertension (PH). International guidelines suggest echocardiographic parameters for suspecting PH, but these may not apply to many adults with congenital heart disease (ACHD). PH is relatively common in ACHD patients and can significantly affect their exercise capacity, quality of life, and prognosis. Identification of patients who have developed PH and who may benefit from further investigations (including cardiac catheterization) and treatment is thus extremely important. A systematic review and survey of experts from the United Kingdom and Ireland were performed to assess current knowledge and practice on echocardiographic screening for PH in ACHD. This paper presents the findings of the review and expert statements on the optimal approaches when using echocardiography to assess ACHD patients for PH, with particular focus on major subgroups: patients with right ventricular outflow tract obstruction, patients with systemic right ventricles, patients with unrepaired univentricular circulation, and patients with tetralogy of Fallot with pulmonary atresia."},{"id":"e4c9043f7bf2","type":"article","url":"https://hartvaat.nl/2018/12/04/ffr-versus-angiografie-geleide-cabg/","title":"FFR versus angiografie-geleide CABG","title_en":"Fractional Flow Reserve Versus Angiographically-Guided Coronary Artery Bypass Grafting.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.09.043","source_url":"https://doi.org/10.1016/j.jacc.2018.09.043","authors":["Anne Langhoff Thuesen","Lars Peter Riber","Karsten Tange Veien","Evald Høj Christiansen","Svend Eggert Jensen","Ivy Modrau","Jan Jesper Andreasen","Anders Junker","Poul Erik Mortensen","Lisette Okkels Jensen"],"significance":7,"published":"2018-12-04","source_date":"2018-12-04","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"This study compared FFR-guided versus angiography-guided CABG planning, investigating whether physiological assessment of coronary stenosis severity improves graft patency and clinical outcomes after bypass surgery.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:52Z","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 FFR-geleide vergeleek met angiografie-geleide CABG-strategie. Onderzoekt of functionele evaluatie de CABG-planning verbetert.","abstract_original":"BACKGROUND: The value of fractional flow reserve (FFR) evaluation of coronary artery stenosis in coronary artery bypass grafting (CABG) is uncertain, and stenosis assessments usually rely on visual estimates of lesion severity. OBJECTIVES: This randomized clinical trial evaluated graft patency and clinical outcome after FFR-guided CABG versus angiography-guided CABG. METHODS: A total of 100 patients referred for CABG were randomly assigned to FFR-guided or angiography-guided CABG. Based on the coronary angiogram, a heart team made a graft plan for all patients, and FFR evaluations were performed. In FFR-guided CABG, coronary lesions with FFR >0.80 were deferred, and a new graft plan was designed accordingly, whereas the surgeon was blinded to the FFR values in patients who underwent angiography-guided CABG. The primary endpoint was graft failure in the percentage of all grafts after 6 months. RESULTS: Angiographic follow-up at 6 months was available for 72 patients (39 vs. 33 in the FFR-guided and angiography-guided groups, respectively). Graft failures of all grafts were similar in both groups (16% vs. 12%; p = 0.97). Rates of death, myocardial infarction, and stroke were also similar in the study groups, and no difference was seen in revascularization before angiographic follow-up. After 6 months, deferred lesions (n = 24) showed a significant reduction in mean FFR from index to follow-up (0.89 ± 0.05 vs. 0.81 ± 0.11; p = 0.002). Index FFR did not influence graft patency. CONCLUSIONS: FFR-guided CABG had similar graft failure rates and clinical outcomes as angiography-guided CABG. However, FFR was reduced significantly after 6 months in deferred lesions. (Fractional Flow Reserve Versus Angiography Randomization for Graft Optimization [FARGO]; NCT02477371)."},{"id":"91243eefe451","type":"article","url":"https://hartvaat.nl/2018/12/01/number-needed-to-treat-met-arni-voor-preventie-van-cv-dood-of-hf-hospitalisatie/","title":"Number needed to treat met ARNI voor preventie van CV-dood of HF-hospitalisatie","title_en":"Estimated 5-Year Number Needed to Treat to Prevent Cardiovascular Death or Heart Failure Hospitalization With Angiotensin Receptor-Neprilysin Inhibition vs Standard Therapy for Patients With Heart Failure With Reduced Ejection Fraction: An Analysis of Data From the PARADIGM-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","bloeddrukbehandeling","sacubitril-valsartan"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.3957","source_url":"https://doi.org/10.1001/jamacardio.2018.3957","authors":["Pratyaksh K Srivastava","Brian L Claggett","Scott D Solomon","John J V McMurray","Milton Packer","Michael R Zile","Akshay S Desai","Jean L Rouleau","Karl Swedberg","Gregg C Fonarow"],"significance":7,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This JAMA Cardiology analysis calculated the estimated 5-year number needed to treat with sacubitril-valsartan versus an ACE inhibitor to prevent cardiovascular death or heart failure hospitalization, providing practical data for clinical decision-making and cost-effectiveness assessment.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:52Z","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":"JAMA Cardiology analyse die het geschatte 5-jaars NNT berekende voor sacubitril/valsartan versus ACE-remmer ter preventie van CV-dood of HF-hospitalisatie.","abstract_original":"IMPORTANCE: The addition of receptor-neprilysin inhibition to standard therapy, including a renin-angiotensin system blocker, has been demonstrated to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF) compared with standard therapy alone. The long-term absolute risk reduction from angiotensin receptor neprilysin inhibitor (ARNI) therapy, and whether it merits widespread use among diverse subpopulations, has not been well described. OBJECTIVE: To calculate estimated 5-year number needed to treat (NNT) values overall and for different subpopulations for the Prospective Comparison of ARNI with Angiotensin-Converting Enzyme Inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) cohort. DESIGN, SETTING, AND PARTICIPANTS: Overall and subpopulation 5-year NNT values were estimated for different end points using data from PARADIGM-HF, a double-blind, randomized trial of sacubitril-valsartan vs enalapril. This multicenter, international study included 8399 men and women with HFrEF (ejection fraction, ≤40%). The study began in December 2009 and ended in March 2014. Analyses began in March 2018. INTERVENTIONS: Random assignment to sacubitril-valsartan or enalapril. MAIN OUTCOMES AND MEASURES: Cardiovascular death or HF hospitalization, cardiovascular death, and all-cause mortality. RESULTS: The final cohort of 8399 individuals included 1832 women (21.8%) and 5544 white individuals (66.0%), with a mean (SD) age of 63.8 (11.4) years. The 5-year estimated NNT for the primary outcome of cardiovascular death or HF hospitalization with ARNI therapy incremental to ACEI therapy in the overall cohort was 14. The 5-year estimated NNT values were calculated for different clinically relevant subpopulations and ranged from 12 to 19. The 5-year estimated NNT for all-cause mortality in the overall cohort with ARNI incremental to ACEI was 21, with values ranging from 16 to 31 among different subgroups. Compared with imputed placebo, the 5-year estimated NNT for all-cause mortality with ARNI was 11. The 5-year estimated NNT values were also calculated for other HFrEF therapies compared with controls from landmark trials for all-cause mortality and were found to be 18 for ACEI, 24 for angiotensin receptor blockers, 8 for β-blockers, 15 for mineralocorticoid antagonists, 14 for implantable cardioverter defibrillator, and 14 for cardiac resynchronization therapy. CONCLUSIONS AND RELEVANCE: The 5-year estimated NNT with ARNI therapy incremental to ACEI therapy overall and for clinically relevant subpopulations of patients with HFrEF are comparable with those for well-established HF therapeutics. These data further support guideline recommendations for use of ARNI therapy among eligible patients with HFrEF."},{"id":"b82251a7aaf9","type":"article","url":"https://hartvaat.nl/2018/12/01/ras-etniciteit-en-oac-gebruik-bij-af-orbit-af/","title":"Ras/etniciteit en OAC-gebruik bij AF: ORBIT-AF","title_en":"Association of Race/Ethnicity With Oral Anticoagulant Use in Patients With Atrial Fibrillation: Findings From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.3945","source_url":"https://doi.org/10.1001/jamacardio.2018.3945","authors":["Utibe R Essien","DaJuanicia N Holmes","Larry R Jackson","Gregg C Fonarow","Kenneth W Mahaffey","James A Reiffel","Benjamin A Steinberg","Larry A Allen","Paul S Chan","James V Freeman","Rosalia G Blanco","Karen S Pieper","Jonathan P Piccini","Eric D Peterson","Daniel E Singer"],"significance":6,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/atriumflutter/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This ORBIT-AF analysis identified racial and ethnic disparities in oral anticoagulant use for AF, showing that Black and Hispanic patients are significantly less likely to receive guideline-recommended anticoagulation.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:52Z","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":"JAMA Cardiology analyse van het ORBIT-AF register naar raciale/etnische verschillen in anticoagulantia-gebruik bij AF. Identificeert ongelijkheden in AF-behandeling.","abstract_original":"IMPORTANCE: Black and Hispanic patients are less likely than white patients to use oral anticoagulants for atrial fibrillation. Little is known about racial/ethnic differences in use of direct-acting oral anticoagulants (DOACs) for atrial fibrillation. OBJECTIVE: To assess racial/ethnic differences in the use of oral anticoagulants, particularly DOACs, in patients with atrial fibrillation. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, a prospective, US-based registry of outpatients with nontransient atrial fibrillation 21 years and older who were followed up from February 2013 to July 2016. Data were analyzed from February 2017 to February 2018. EXPOSURES: Self-reported race/ethnicity as white, black, or Hispanic. MAIN OUTCOMES AND MEASURES: The primary outcome was use of any oral anticoagulant, particularly DOACs. Secondary outcomes included the quality of anticoagulation received and oral anticoagulant discontinuation at 1 year. RESULTS: Of 12 417 patients, 11 100 were white individuals (88.6%), 646 were black individuals (5.2%), and 671 were Hispanic individuals (5.4%) with atrial fibrillation. After adjusting for clinical features, black individuals were less likely to receive any oral anticoagulant than white individuals (adjusted odds ratio [aOR], 0.75 [95% CI, 0.56, 0.99]) and less likely to receive DOACs if an anticoagulant was prescribed (aOR, 0.63 [95% CI, 0.49-0.83]). After further controlling for socioeconomic factors, oral anticoagulant use was no longer significantly different in black individuals (aOR, 0.78 [95% CI, 0.59-1.04]); among patients using oral anticoagulants, DOAC use remained significantly lower in black individuals (aOR, 0.73 [95% CI, 0.55-0.95]). There was no significant difference between white and Hispanic groups in use of oral anticoagulants. Among patients receiving warfarin, the median time in therapeutic range was lower in black individuals (57.1% [IQR, 39.9%-72.5%]) and Hispanic individuals (51.7% [interquartile range {IQR}, 39.1%-66.7%]) than white individuals (67.1% [IQR, 51.8%-80.6%]; P < .001). Black and Hispanic individuals treated with DOACs were more likely to receive inappropriate dosing than white individuals (black patients, 61 of 394 [15.5%]; Hispanic patients, 74 of 409 [18.1%]; white patients, 1003 of 7988 [12.6%]; P = .01). One-year persistence on oral anticoagulants was the same across groups. CONCLUSIONS AND RELEVANCE: After controlling for clinical and socioeconomic factors, black individuals were less likely than white individuals to receive DOACs for atrial fibrillation, with no difference between white and Hispanic groups. When atrial fibrillation was treated, the quality of anticoagulant use was lower in black and Hispanic individuals. Identifying modifiable causes of these disparities could improve the quality of care in atrial fibrillation."},{"id":"a167205c3bcd","type":"article","url":"https://hartvaat.nl/2018/12/01/multipele-biomarkers-en-mortaliteitsrisico-na-acs-jama-cardiology/","title":"Multipele biomarkers en mortaliteitsrisico na ACS: JAMA Cardiology","title_en":"Association of Multiple Biomarkers With Risk of All-Cause and Cause-Specific Mortality After Acute Coronary Syndromes: A Secondary Analysis of the PLATO Biomarker Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.3811","source_url":"https://doi.org/10.1001/jamacardio.2018.3811","authors":["Daniel Lindholm","Stefan K James","Katja Gabrysch","Robert F Storey","Anders Himmelmann","Christopher P Cannon","Kenneth W Mahaffey","Philippe Gabriel Steg","Claes Held","Agneta Siegbahn","Lars Wallentin"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":[],"congress":"","summary_en":"This analysis of multiple biomarkers (troponin, GDF-15, NT-proBNP, CRP, cystatin C) showed that a multi-biomarker approach improves prediction of all-cause and cause-specific mortality after acute coronary syndrome.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:52Z","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":"JAMA Cardiology analyse van multipele biomarkers voor risicostratificatie van totale en oorzaak-specifieke mortaliteit na ACS.","abstract_original":"IMPORTANCE: Mortality remains at about 5% within a year after an acute coronary syndrome event. Prior studies have assessed biomarkers in relation to all-cause or cardiovascular deaths but not across multiple causes. OBJECTIVE: To assess if different biomarkers provide information about the risk for all-cause and cause-specific mortality. DESIGN, SETTING, AND PARTICIPANTS: The Platelet Inhibition and Patient Outcomes (PLATO) trial randomized 18 624 patients with acute coronary syndrome to ticagrelor or clopidogrel from October 2006 through July 2008. In this secondary analysis biomarker substudy, 17 095 patients participated. MAIN OUTCOMES AND MEASURES: Death due to myocardial infarction, heart failure, sudden cardiac death/arrhythmia, bleeding, procedures, other vascular causes, and nonvascular causes, as well as all-cause death. EXPOSURES: At baseline, levels of cystatin-C, growth differentiation factor-15 (GDF-15), high-sensitivity C-reactive protein, high-sensitivity troponin I and T, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were determined. RESULTS: The median (interquartile range) age of patients was 62.0 (54.0-71.0) years. Of 17 095 patients, 782 (4.6%) died during follow-up. The continuous associations between biomarkers and all-cause and cause-specific mortality were modeled using Cox models and presented as hazard ratio (HR) comparing the upper vs lower quartile. For all-cause mortality, NT-proBNP and GDF-15 were the strongest markers with adjusted HRs of 2.96 (95% CI, 2.33-3.76) and 2.65 (95% CI, 2.17-3.24), respectively. Concerning death due to heart failure, NT-proBNP was associated with an 8-fold and C-reactive protein, GDF-15, and cystatin-C, with a 3-fold increase in risk. Regarding sudden cardiac death/arrhythmia, NT-proBNP was associated with a 4-fold increased risk and GDF-15 with a doubling in risk. Growth differentiation factor-15 had the strongest associations with other vascular and nonvascular deaths and was possibly associated with death due to major bleeding (HR, 4.91; 95% CI, 1.39-17.43). CONCLUSIONS AND RELEVANCE: In patients with acute coronary syndrome, baseline levels of NT-proBNP and GDF-15 were strong markers associated with all-cause death based on their associations with death due to heart failure as well as due to arrhythmia and sudden cardiac death. Growth differentiation factor-15 had the strongest associations with death due to other vascular or nonvascular causes and possibly with death due to bleeding. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00391872."},{"id":"68691be4c69e","type":"article","url":"https://hartvaat.nl/2018/12/01/cardiovasculaire-risicocommunicatie-en-patientperceptie-jama-cardiology/","title":"Cardiovasculaire risicocommunicatie en patiëntperceptie: JAMA Cardiology","title_en":"Influence of Cardiovascular Risk Communication Tools and Presentation Formats on Patient Perceptions and Preferences.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","menopauze","microbioom","ouderen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.3680","source_url":"https://doi.org/10.1001/jamacardio.2018.3680","authors":["Ann Marie Navar","Tracy Y Wang","Xiaojuan Mi","Jennifer G Robinson","Salim S Virani","Veronique L Roger","Peter W F Wilson","Anne C Goldberg","Eric D Peterson"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This study evaluated how different cardiovascular risk communication tools and presentation formats affect patient understanding and treatment preferences, informing shared decision-making approaches for statin therapy.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:52Z","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":"JAMA Cardiology studie naar de invloed van cardiovasculaire risicocommunicatietools en presentatieformaten op patiëntperceptie en voorkeuren.","abstract_original":"IMPORTANCE: Practice guidelines recommend that clinicians engage patients in treatment decisions and explain atherosclerotic cardiovascular disease (ASCVD) risk but do not describe how to communicate this risk most effectively. OBJECTIVE: To determine how the ASCVD risk time horizon, outcome, and presentation format influence risk perceptions and treatment preferences. DESIGN, SETTING, AND PARTICIPANTS: From May 27, 2015, through November 12, 2015, participants from the Patient and Provider Assessment of Lipid Management Registry at 140 US cardiology, primary care, and endocrinology practices were presented 3 independent scenarios (representing the same hypothetical patient) and asked to rate their perceived risk and willingness to take medication to lower risk in light of (1) a 15% 10-year ASCVD event risk, (2) a 4% 10-year cardiovascular disease (CVD) death risk, and (3) a 50% lifetime ASCVD event risk. EXPOSURES: Participants were randomized to receive risk estimates using numbers only, a bar graph, or a face pictogram. RESULTS: Of 3566 eligible participants, 2708 (76.9%) responded (median age, 67 years [interquartile range, 61-76 years]; 280 [10.3%] African American; 1491 men [55.1%]). When shown the lifetime ASCVD risk, respondents were more likely to consider the risk \"high to very high\" than when presented the 10-year ASCVD risk or the CVD death risk (70.1% vs 31.4% vs 25.7%, respectively; both P < .001). Treatment willingness was also the highest for lifetime ASCVD risk (77.9% very willing) followed by 10-year ASCVD risk (68.1%) and 10-year CVD death risk (63.1%; both P < .001). Compared with participants who were shown a bar graph or no graphic, those who were shown the risk information with a pictogram had the lowest perception of disease severity and the lowest willingness to consider therapy. These findings were robust across demographic and socioeconomic subgroups. CONCLUSIONS AND RELEVANCE: The format, time horizon, and outcome used for risk estimation influence patient perceptions and should be considered when designing risk communication tools. When shown lifetime risk estimates, patients had higher risk perception and willingness for therapy than when shown 10-year estimates. Pictogram risk displays may decrease risk perception and consideration for treatment."},{"id":"1491061d217a","type":"article","url":"https://hartvaat.nl/2018/12/01/av-junctieablatie-plus-crt-bij-permanent-af-gerandomiseerde-trial/","title":"AV-junctieablatie plus CRT bij permanent AF: gerandomiseerde trial","title_en":"A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy555","source_url":"https://doi.org/10.1093/eurheartj/ehy555","authors":["Michele Brignole","Evgeny Pokushalov","Francesco Pentimalli","Pietro Palmisano","Enrico Chieffo","Eraldo Occhetta","Fabio Quartieri","Leonardo Calò","Andrea Ungar","Lluis Mont"],"significance":7,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial demonstrated that AV junction ablation combined with CRT is superior to pharmacological therapy in patients with permanent AF and heart failure, showing improvements in functional capacity and left ventricular function.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:51Z","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 AV-junctieablatie plus CRT vergeleek met medicamenteuze therapie bij patiënten met permanent AF en hartfalen.","abstract_original":"AIMS: We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS. METHODS AND RESULTS: We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12%) vs. 17 (33%); HR 0.28; 95% CI 0.11-0.72; P = 0.008], or were hospitalized for HF [5 (10%) vs. 13 (25%); HR 0.30; 95% CI 0.11-0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36% decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004). CONCLUSION: Ablation+CRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS. CLINICALTRIALS.GOV IDENTIFIER: NCT02137187 (May 2018, date last accessed)."},{"id":"3c09bacd96c1","type":"article","url":"https://hartvaat.nl/2018/12/01/edoxaban-verhoogt-behandeltevredenheid-en-vermindert-zorggebruik-engage-af-timi-/","title":"Edoxaban verhoogt behandeltevredenheid en vermindert zorggebruik: ENGAGE AF-TIMI 48","title_en":"Edoxaban therapy increases treatment satisfaction and reduces utilization of healthcare resources: an analysis from the EdoxabaN vs. warfarin in subjectS UndeRgoing cardiovErsion of atrial fibrillation (ENSURE-AF) study.","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/euy141","source_url":"https://doi.org/10.1093/europace/euy141","authors":["Andreas Goette","Winghan J Kwong","Michael D Ezekowitz","Maciej Banach","Soren P Hjortshoj","Dmitry Zamoryakhin","Gregory Y H Lip"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/edoxaban/"],"congress":"","summary_en":"This ENSURE-AF analysis showed that edoxaban increases treatment satisfaction and reduces healthcare resource utilization compared with warfarin in AF patients undergoing cardioversion.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:51Z","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":"ENGAGE AF-TIMI 48 analyse die aantoont dat edoxaban de behandeltevredenheid verhoogt en het zorggebruik vermindert vergeleken met warfarine.","abstract_original":"AIMS: The EdoxabaN vs. warfarin in subjectS UndeRgoing cardiovErsion of atrial fibrillation (ENSURE-AF) (NCT02072434) study was a multicentre prospective, randomized, open-label, blinded-endpoint evaluation (PROBE) trial comparing edoxaban with enoxaparin/warfarin followed by warfarin alone in 2199 non-valvular atrial fibrillation patients undergoing electrical cardioversion and showed comparable rates of bleeding and thromboembolism between treatments. This prespecified ancillary analysis investigated the impact of edoxaban therapy on treatment satisfaction and utilization of healthcare services. METHODS AND RESULTS: The Perception of Anticoagulant Treatment Questionnaire (PACT-Q2) was completed by study patients on Day 28 post-cardioversion. Higher scores represent greater satisfaction. Healthcare resource utilizations were collected from randomization to Day 28 post-cardioversion. Data from patients who received at least one dose of study drugs were analysed. Patients treated with edoxaban were more satisfied than enoxaparin/warfarin in both PACT-Q treatment satisfaction and convenience scores (P < 0.001 for both). Differences in treatment satisfaction scores were greater in patients who underwent non-transoesophageal echocardiography (TOE)-guided cardioversion than in patients who underwent TOE-guided cardioversion. Edoxaban was associated with fewer clinic visits (4.75 visits vs. 7.60 visits; P < 0.001) and fewer hospital days (3.43 days vs. 5.41 days; P < 0.05). Rates of hospitalizations and emergency room visits were not significantly different. Overall, edoxaban therapy was estimated to reduce healthcare costs by €107.73, €437.92, €336.75, and $246.32 per patient in German, Spanish, Italian, and US settings, respectively. CONCLUSIONS: The convenience of edoxaban therapy over warfarin in patients undergoing cardioversion may provide greater treatment satisfaction and cost savings to the healthcare system."},{"id":"c435778e6450","type":"article","url":"https://hartvaat.nl/2018/12/01/creatininestijging-tijdens-bloeddrukbehandeling-en-uitkomsten-bij-diabetes-type-/","title":"Creatininestijging tijdens bloeddrukbehandeling en uitkomsten bij diabetes type 2","title_en":"Creatinine Rise During Blood Pressure Therapy and the Risk of Adverse Clinical Outcomes in Patients With Type 2 Diabetes Mellitus.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","bloeddrukbehandeling","chronische-nierziekte","credence-trial","diabetes-en-hart","diabetes-type-1","diabetes-type-2","fidelio-dkd","figaro-dkd","soul-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11944","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11944","authors":["Didier Collard","Tom F Brouwer","Ron J G Peters","Liffert Vogt","Bert-Jan H van den Born"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This study showed that creatinine rise during antihypertensive therapy in type 2 diabetes does not consistently predict adverse outcomes, suggesting that moderate renal function changes should not always prompt treatment de-escalation.","created":"2026-07-03T10:27:38Z","updated":"2026-07-03T13:26:51Z","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 naar het risico op ongunstige uitkomsten bij creatininestijging tijdens antihypertensieve behandeling bij diabetes type 2.","abstract_original":"Lowering blood pressure may affect renal function. Current guidelines state that reducing antihypertensive therapy should be considered in patients with a >30% serum creatinine increase after initiation of antihypertensive therapy. We examined the association between a serum creatinine increase and adverse clinical outcomes in the ACCORD-BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure), were patients with type 2 diabetes mellitus were randomized to intensive (target systolic blood pressure <120 mm Hg) and standard antihypertensive (<140 mm Hg) treatment. The primary outcome was a combined end point consisting of all-cause mortality, major cardiovascular events, and renal failure. Patients were stratified into 3 groups according to serum creatinine increase between baseline and 4 months (<10%, 10%-30%, >30%). A total of 4733 patients, aged 62.2 years, 52% men with a mean estimated glomerular filtration rate 81.5 mL/min per 1.73 m2 were included. Follow-up was available for 4446 patients, 2231 were randomized to intensive and 2215 to standard therapy. Kaplan-Meier analysis showed no association between a serum creatinine increase and the composite end point in the intensive ( P=0.20) and the standard treatment group ( P=0.17). After adjusting for possible confounders, a >30% serum creatinine increase was associated with a higher risk of clinical adverse outcomes in both treatment groups, but to a similar extent. These data suggest that a >30% serum creatinine increase that coincides with lower blood pressure values should not directly lead to a reduction in antihypertensive medication in patients with type 2 diabetes mellitus. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00000620."},{"id":"af59232f46aa","type":"article","url":"https://hartvaat.nl/2018/12/01/ularitide-en-andere-vasoactieve-stoffen-bij-acuut-hf-systematische-review/","title":"Ularitide en andere vasoactieve stoffen bij acuut HF: systematische review","title_en":"Randomized double-blind clinical studies of ularitide and other vasoactive substances in acute decompensated heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","aperitif-trial","bloeddrukbehandeling","dapa-hf","finearts-hf","flow-trial","hfpef","hfref","pathfinder-trial","sacubitril-valsartan","slaapapneu","step-hfpef","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12349","source_url":"https://doi.org/10.1002/ehf2.12349","authors":["Veselin Mitrovic","Wolf-Georg Forssmann","Jan Schnitker","Stephan B Felix"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This systematic review compared ularitide and other vasoactive substances in randomized trials for acute decompensated heart failure, synthesizing the evidence for intravenous vasodilator therapy in the acute HF setting.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T18:38:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van gerandomiseerde dubbelblinde trials met ularitide en andere vasoactieve middelen bij acuut gedecompenseerd hartfalen.","abstract_original":"AIMS: Acute decompensated heart failure (ADHF) has a poor prognosis and limited treatment options. No direct comparisons between ularitide-a synthetic natriuretic peptide being evaluated in ADHF-and other vasoactive substances are available. The aim of this meta-analysis was to determine haemodynamic effect sizes from randomized double-blind trials in ADHF. METHODS AND RESULTS: Eligible studies enrolled patients with ADHF requiring hospitalization and haemodynamic monitoring. Patients received 24-48 h of infusion with a vasoactive substance or comparator. Primary outcome measure was pulmonary artery wedge pressure (PAWP). Treatment effects were quantified as changes from baseline using mean differences between study drug and comparator. Results were analysed using random-effects (primary analysis) and fixed-effects meta-analyses. Twelve randomized, double-blind studies were identified with data after 3, 6, and 24 h of treatment (n = 622, 644, and 644, respectively). At 6 h, significant PAWP benefits for ularitide over placebo were seen (Hedges' g effect size, -0.979; P < 0.0001). On meta-analysis, treatment difference between ularitide and pooled other agents was statistically significant (-0.501; P = 0.0303). Effect sizes were numerically higher with ularitide than other treatments at 3 and 24 h. After 6 h, a significant difference in effect size between ularitide and all other treatments was observed for right atrial pressure (Hedges' g, -0.797 for ularitide and -0.304 for other treatments; P = 0.0274). CONCLUSIONS: After 6 h, ularitide demonstrated high effect sizes for PAWP and right atrial pressure. Improvements in these parameters were greater with ularitide vs. pooled data for other vasoactive drugs."},{"id":"c2f493f30b7e","type":"article","url":"https://hartvaat.nl/2018/12/01/prognose-van-hfmref-systematische-review-en-meta-analyse/","title":"Prognose van HFmrEF: systematische review en meta-analyse","title_en":"The prognosis of mid-range ejection fraction heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfmref","hfpef","hfref","nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12353","source_url":"https://doi.org/10.1002/ehf2.12353","authors":["Saif Altaie","Wissam Khalife"],"significance":6,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This meta-analysis characterized the prognosis of heart failure with mid-range ejection fraction (HFmrEF), showing intermediate outcomes between HFrEF and HFpEF and supporting its classification as a distinct entity.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T18:38:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van de prognose van hartfalen met middenbereik ejectiefractie (HFmrEF) vergeleken met HFrEF en HFpEF.","abstract_original":"AIMS: Mid-range ejection fraction is a new entity of heart failure (HF) with undetermined prognosis till now. In our systematic review and meta-analysis, we assess the mortality and hospitalization rates in mid-range ejection fraction HF (HFmrEF) and compare them with those of reduced ejection fraction heart failure (HFrEF) and preserved ejection fraction HF (HFpEF). METHODS AND RESULTS: We conducted our search in March 2018 in the following databases for relevant articles: PubMed, CENTRAL, Google Scholar, Web of Science, Scopus, NYAM, SIEGLE, GHL, VHL, and POPLINE. Our primary endpoint was assessing all-cause mortality and all-cause hospital re-admission rates in HFmrEF in comparison with HFrEF and HFpEF. Secondary endpoints were the possible causes of death and hospital re-admission. Twenty-five articles were included in our meta-analysis with a total of 606 762 adult cardiac patients. Our meta-analysis showed that HFmrEF had a lower rate of all-cause death than had HFrEF [relative risk (RR), 0.9; 95% confidence interval (CI), 0.85-0.94]. HFpEF showed a higher rate of cardiac mortality than did HFmrEF (RR, 1.09; 95% CI, 1.02-1.16). Also, HFrEF had a higher rate of non-cardiac mortality than had HFmrEF (RR, 1.31; 95% CI, 1.22-1.41). CONCLUSIONS: We detected a significant difference between HFrEF and HFmrEF regarding all-cause death, and non-cardiac death, while HFpEF differed significantly from HFmrEF regarding cardiac death."},{"id":"13b26e783df1","type":"article","url":"https://hartvaat.nl/2018/12/01/mitraclip-plus-medicamenteus-versus-medicamenteus-alleen-bij-hf-met-mr-meta-anal/","title":"MitraClip plus medicamenteus versus medicamenteus alleen bij HF met MR: meta-analyse","title_en":"A meta-analysis of MitraClip combined with medical therapy vs. medical therapy alone for treatment of mitral regurgitation in heart failure patients.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12339","source_url":"https://doi.org/10.1002/ehf2.12339","authors":["Cristina Giannini","Fabrizio D'ascenzo","Francesca Fiorelli","Paolo Spontoni","Martin J Swaans","Eric J Velazquez","Patrizio Armeni","Marianna Adamo","Marco De Carlo","Anna Sonia Petronio"],"significance":7,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This meta-analysis of MitraClip versus medical therapy for functional mitral regurgitation in heart failure was published before the COAPT and MITRA-FR results, reflecting the equipoise that existed about percutaneous mitral repair at that time.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T13:26:51Z","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":"Meta-analyse van MitraClip gecombineerd met medicamenteuze therapie versus medicamenteus alleen bij hartfalen met mitralisinsufficiëntie. Voorafgaand aan de latere COAPT-trial.","abstract_original":"AIMS: Survival benefit of percutaneous mitral valve repair with the MitraClip over conservative treatment of functional mitral regurgitation (MR) remains unclear. The purpose of this meta-analysis is to compare survival outcomes of MitraClip with those of medical therapy in patients with functional MR. METHODS AND RESULTS: A comprehensive literature search of PubMed, MEDLINE, and Google Scholar was conducted including studies evaluating MitraClip vs. medical therapy with multivariate adjustment and with >80% of patients with functional MR. Death from any cause was the primary endpoint, while freedom from readmission was the secondary one, evaluated with random effects. These analyses were performed at study level and at patient level including only functional MR when available, evaluating the effect of MitraClip in different subgroups according to age, ischaemic aetiology, presence of implantable cardioverter defibrillator/cardiac resynchronization therapy, and left ventricular ejection fraction and volumes. We identified six eligible observational studies including 2121 participants who were treated with MitraClip (n = 833) or conservative therapy (n = 1288). Clinical follow-up was documented at a median of 400 days. At study-level analysis, MitraClip, when compared with medical therapy (P = 0.005), was associated with significant reduction of death (P = 0.002) and of readmission due to cardiac disease. At patient-level analysis, including 344 patients, MitraClip confirmed robust survival benefit over medical therapy for all patients with functional MR and among the most important subgroups. CONCLUSIONS: Compared with conservative treatment, MitraClip is associated with a significant survival benefit. Importantly, this superiority is particularly pronounced among patients with functional MR and across all the main subgroups."},{"id":"d8870a347582","type":"article","url":"https://hartvaat.nl/2018/12/01/pro-gastrin-releasing-peptide-en-uitkomsten-bij-hf-met-anemie-red-hf/","title":"Pro-gastrin-releasing peptide en uitkomsten bij HF met anemie: RED-HF","title_en":"Pro-gastrin-releasing peptide and outcome in patients with heart failure and anaemia: results from the RED-HF study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12312","source_url":"https://doi.org/10.1002/ehf2.12312","authors":["Thor Ueland","Lars Gullestad","Lei Kou","Pål Aukrust","Inderjit S Anand","Marianne Nordlund Broughton","John J McMurray","Dirk J van Veldhuisen","David J Warren","Nils Bolstad"],"significance":4,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":[],"congress":"","summary_en":"This RED-HF analysis investigated pro-gastrin-releasing peptide as a neuroendocrine biomarker in heart failure patients with anaemia and reduced ejection fraction. The neuropeptide showed predictive value for clinical outcomes.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T13:26:51Z","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":"RED-HF analyse naar pro-gastrin-releasing peptide als biomarker bij hartfalenpatiënten met anemie.","abstract_original":"AIMS: Neuroendocrine activation is associated with poor outcome in heart failure (HF). The neuropeptide gastrin-releasing peptide (GRP), derived from the precursor proGRP1-125 (proGRP), has recently been implicated in inflammation and wound repair. We investigated the predictive value of proGRP on clinical outcomes in HF patients with reduced ejection fraction. METHODS AND RESULTS: The association between plasma proGRP (time-resolved immunofluorometric assay) and the primary endpoint of death from any cause or first hospitalization for worsening of HF was evaluated using multivariable Cox proportional hazard models in 1541 patients with systolic HF and mild to moderate anaemia, enrolled in the Reduction of Events by Darbepoetin alfa in Heart Failure (RED-HF) trial. Median proGRP levels in the RED-HF cohort were markedly increased [95 ng/L (25th, 75th percentile, 69-129 ng/L)] with 64% patients above the 80 ng/L reference limit. Baseline proGRP correlated with estimated glomerular filtration rate (r = 0.52), N terminal pro brain natriuretic peptide (r = 0.33), troponin T (r = 0.34), and haemoglobin (r = 0.16) (all P < 0.001). The incidence outcome increased with increasing tertiles of baseline proGRP (primary endpoint third tertile vs. the lowest tertile; hazard ratio 1.91; 95% confidence interval 1.60-2.28, P < 0.001). However, these associations were markedly attenuated and non-significant in adjusted models. No interaction between baseline proGRP and the effect of darbepoetin alfa treatment was detected. Moreover, no significant association between changes in proGRP during 6 month follow-up and outcome was observed. CONCLUSIONS: Pro-gastrin-releasing peptide is increased in patients with HF with reduced ejection fraction and anaemia, in particular in patients with poor renal function. However, proGRP adds little as a prognostic marker on top of conventional HF risk factors."},{"id":"eb6e80cdc84f","type":"article","url":"https://hartvaat.nl/2018/12/01/liraglutide-en-gewicht-bij-gevorderd-hfref-fight-trial-inzichten/","title":"Liraglutide en gewicht bij gevorderd HFrEF: FIGHT-trial inzichten","title_en":"Liraglutide and weight loss among patients with advanced heart failure and a reduced ejection fraction: insights from the FIGHT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","step-hfpef","summit-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12334","source_url":"https://doi.org/10.1002/ehf2.12334","authors":["Abhinav Sharma","Andrew P Ambrosy","Adam D DeVore","Kenneth B Margulies","Steven E McNulty","Robert J Mentz","Adrian F Hernandez","Gary Michael Felker","Lauren B Cooper","Anuradha Lala","Justin Vader","John D Groake","Barry A Borlaug","Eric J Velazquez"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":[],"congress":"","summary_en":"This FIGHT trial analysis showed that liraglutide does not produce beneficial weight loss in patients with advanced HFrEF, suggesting that the GLP-1 receptor agonist weight loss mechanism is attenuated in the sickest heart failure patients.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T13:26:51Z","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":"FIGHT-trial analyse naar gewichtseffecten van liraglutide bij gevorderd HFrEF. Geen voordelig gewichtsverlies in deze populatie.","abstract_original":"AIMS: Obesity is present in up to 45% of patients with heart failure (HF). Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor antagonist, facilitates weight loss in obese patients. The efficacy of liraglutide as a weight loss agent among patients with HF and reduced ejection fraction (HFrEF) and a recent acute HF hospitalization remains unknown. METHODS AND RESULTS: The Functional Impact of GLP-1 for Heart Failure Treatment study randomized 300 patients with HFrEF (ejection fraction ≤ 40%), both with and without diabetes and a recent HF hospitalization to liraglutide or placebo. The primary outcome for this post hoc analysis was the change in weight from baseline to last study visit. We conducted an 'on-treatment' analysis of patients with at least one follow-up visit on study drug (123 on liraglutide and 124 on placebo). The median age was 61 years, 21% were female, and 69% of patients had New York Heart Association functional Class III or IV symptoms. The median ejection fraction was 25% (25th, 75th percentile 19-32%). Liraglutide use was associated with a significant weight reduction [liraglutide -1.00 lbs vs. placebo 2.00 lbs; treatment difference -4.10 lbs; 95% confidence interval (CI) -7.94, -0.25; P = 0.0367; percentage treatment difference -2.07%, 95% CI -3.86, -0.28; P = 0.0237]. Similar results were seen after multivariable adjustments. Liraglutide also significantly reduced triglyceride levels (liraglutide 7.5 mg/dL vs. placebo 12.0 mg/dL; treatment difference -33.1 mg/dL; 95% CI -60.7, -5.6; P = 0.019). CONCLUSIONS: Liraglutide is an efficacious weight loss agent in patients with HFrEF. These findings will require further exploration in a well-powered cardiovascular outcomes trial."},{"id":"016f1e08c547","type":"article","url":"https://hartvaat.nl/2018/12/01/lvad-implantatie-verbetert-glycemische-controle-meta-analyse/","title":"LVAD-implantatie verbetert glycemische controle: meta-analyse","title_en":"Left ventricular assist device implantation improves glycaemic control: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12337","source_url":"https://doi.org/10.1002/ehf2.12337","authors":["Nirav Patel","Jason A Gluck","Joseph Radojevic","Craig I Coleman","William L Baker"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/"],"congress":"","summary_en":"This meta-analysis showed that LVAD implantation improves glycemic control in heart failure patients, revealing an unexpected metabolic benefit of mechanical unloading through improved insulin sensitivity.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T13:26:51Z","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":"Meta-analyse die aantoont dat LVAD-implantatie de glycemische controle verbetert. Onverwacht metabolisch voordeel van mechanische circulatoire ondersteuning.","abstract_original":"AIMS: Heart failure (HF) and diabetes mellitus (DM) often coexist and have bidirectional association. Advanced HF is associated with worsened glycaemic control. This meta-analysis investigated the effects of left ventricular assist device (LVAD) implantation on markers of DM control. METHODS AND RESULTS: We performed a systematic search of MEDLINE and Cochrane through October 2017 to identify studies evaluating advanced HF patients who had received an LVAD and reported markers of glycaemic control. The primary outcome was glycosylated haemoglobin A1c (HbA1c), and the secondary outcomes included fasting glucose, daily insulin requirements, and body mass index (BMI). Outcomes were pooled using a Hartung-Knapp random-effects model producing a mean difference (MD) and 95% confidence interval (CI). Thirteen studies, including 820 participants, were included. HbA1c was 1.23% lower following LVAD implantation (95% CI -1.49 to -0.98). Greater HbA1c reductions were seen with higher pre-LVAD values. Similarly, fasting plasma glucose (-24.4 mg/dL, 95% CI -33.4 to -15.5), daily insulin requirements (-18.8 units, 95% CI -28.8 to -8.7), and serum creatinine levels (MD -0.20, 95% CI -0.35 to -0.06) were significantly lower than pre-LVAD levels. We saw no difference in BMI (MD 0.09, 95% CI -1.24 to 1.42). CONCLUSIONS: LVAD implantation was associated with significant improvement in HbA1c, fasting plasma glucose, and daily insulin need in advanced HF patients."},{"id":"d1e26d2d501c","type":"article","url":"https://hartvaat.nl/2018/12/01/dagelijkse-remote-ischemische-conditionering-na-acuut-mi-gerandomiseerde-trial/","title":"Dagelijkse remote ischemische conditionering na acuut MI: gerandomiseerde trial","title_en":"Daily remote ischaemic conditioning following acute myocardial infarction: a randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2018-313091","source_url":"https://doi.org/10.1136/heartjnl-2018-313091","authors":["Andrew Peter Vanezis","Jayanth Ranjit Arnold","Glenn Rodrigo","Florence Y Lai","Radek Debiec","Sheraz Nazir","Jamal Nasir Khan","Leong L Ng","Kamal Chitkara","John G Coghlan","Simon Lee Hetherington","Gerry P McCann","Nilesh J Samani"],"significance":5,"published":"2018-12-01","source_date":"2018-12-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This randomized trial tested whether daily remote ischemic conditioning sustained over weeks after acute MI provides long-term cardioprotection, extending the concept from acute intervention to chronic conditioning.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T13:26:51Z","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 naar dagelijkse remote ischemische conditionering na een acuut myocardinfarct voor langetermijn cardioprotectie.","abstract_original":"BACKGROUND: Remote ischaemic conditioning (rIC) is a cardioprotective tool which has shown promise in preclinical and clinical trials in the context of acute ischaemia. Repeated rIC post myocardial infarction may provide additional benefits which have not previously been tested clinically. METHODS: The trial assessed the role of daily rIC in enhancing left ventricular ejection fraction (LVEF) recovery in patients with impaired LVEF (<45%) after ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (P-PCI). Patients were recruited from four UK hospitals and randomised to receive either 4 weeks of daily rIC or sham conditioning using the autoRIC Device (CellAegis) starting on day 3 post P-PCI. The primary endpoint was the improvement in LVEF over 4 months assessed by cardiac MRI (CMR). Seventy-three patients (38 cases, 35 controls) completed the study. RESULTS: The treatment and control groups were well matched at baseline including for mean LVEF (42.8% vs 44.3% respectively, p=0.952). There was no difference in the improvement in LVEF over 4 months between the treatment and control groups (4.8%±7.8% vs 4.6%±5.9% respectively, p=0.924). No differences were seen in the secondary outcome measures including changes in infarct size and left ventricular end-diastolic and systolic volumes, major adverse cardiac and cerebral event, mean Kansas City Cardiomyopathy Questionnaire score and change in N-terminal pro-brain natriuretic peptide levels. CONCLUSIONS: Daily rIC starting on day 3 and continued for 4 weeks following successful P-PCI for STEMI did not improve LVEF as assessed by CMR after 4 months when compared with a matched control group. TRIAL REGISTRATION NUMBER: NCT0166461."},{"id":"07889aad0989","type":"article","url":"https://hartvaat.nl/2018/11/29/alirocumab-en-cardiovasculaire-uitkomsten-na-acs-nejm-odyssey-outcomes/","title":"Alirocumab en cardiovasculaire uitkomsten na ACS: NEJM ODYSSEY OUTCOMES","title_en":"Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1801174","source_url":"https://doi.org/10.1056/NEJMoa1801174","authors":["Gregory G Schwartz","P Gabriel Steg","Michael Szarek","Deepak L Bhatt","Vera A Bittner","Rafael Diaz","Jay M Edelberg","Shaun G Goodman","Corinne Hanotin","Robert A Harrington","J Wouter Jukema","Guillaume Lecorps","Kenneth W Mahaffey","Angèle Moryusef","Robert Pordy","Kirby Quintero","Matthew T Roe","William J Sasiela","Jean-François Tamby","Pierluigi Tricoci","Harvey D White","Andreas M Zeiher"],"significance":10,"published":"2018-11-29","source_date":"2018-11-29","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The ODYSSEY OUTCOMES trial demonstrated that alirocumab significantly reduced recurrent cardiovascular events and all-cause mortality in 18,924 patients with recent acute coronary syndrome on high-intensity statin therapy. This was the second major PCSK9 inhibitor outcomes trial, confirming the clinical benefit of aggressive LDL cholesterol lowering after ACS.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T13:26:50Z","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":"Landmark NEJM ODYSSEY OUTCOMES-trial die aantoonde dat alirocumab cardiovasculaire events en totale mortaliteit vermindert na ACS. Tweede grote positieve PCSK9 CV-uitkomstentrial naast FOURIER.","abstract_original":"BACKGROUND: Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic cardiovascular events. We sought to determine whether alirocumab, a human monoclonal antibody to proprotein convertase subtilisin-kexin type 9 (PCSK9), would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high-intensity statin therapy. METHODS: We conducted a multicenter, randomized, double-blind, placebo-controlled trial involving 18,924 patients who had an acute coronary syndrome 1 to 12 months earlier, had a low-density lipoprotein (LDL) cholesterol level of at least 70 mg per deciliter (1.8 mmol per liter), a non-high-density lipoprotein cholesterol level of at least 100 mg per deciliter (2.6 mmol per liter), or an apolipoprotein B level of at least 80 mg per deciliter, and were receiving statin therapy at a high-intensity dose or at the maximum tolerated dose. Patients were randomly assigned to receive alirocumab subcutaneously at a dose of 75 mg (9462 patients) or matching placebo (9462 patients) every 2 weeks. The dose of alirocumab was adjusted under blinded conditions to target an LDL cholesterol level of 25 to 50 mg per deciliter (0.6 to 1.3 mmol per liter). The primary end point was a composite of death from coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal ischemic stroke, or unstable angina requiring hospitalization. RESULTS: The median duration of follow-up was 2.8 years. A composite primary end-point event occurred in 903 patients (9.5%) in the alirocumab group and in 1052 patients (11.1%) in the placebo group (hazard ratio, 0.85; 95% confidence interval [CI], 0.78 to 0.93; P<0.001). A total of 334 patients (3.5%) in the alirocumab group and 392 patients (4.1%) in the placebo group died (hazard ratio, 0.85; 95% CI, 0.73 to 0.98). The absolute benefit of alirocumab with respect to the composite primary end point was greater among patients who had a baseline LDL cholesterol level of 100 mg or more per deciliter than among patients who had a lower baseline level. The incidence of adverse events was similar in the two groups, with the exception of local injection-site reactions (3.8% in the alirocumab group vs. 2.1% in the placebo group). CONCLUSIONS: Among patients who had a previous acute coronary syndrome and who were receiving high-intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab than among those who received placebo. (Funded by Sanofi and Regeneron Pharmaceuticals; ODYSSEY OUTCOMES ClinicalTrials.gov number, NCT01663402 .)."},{"id":"ac896de8e766","type":"article","url":"https://hartvaat.nl/2018/11/27/metabolome-consequenties-van-pcsk9-remming-versus-statinetherapie/","title":"Metabolome consequenties van PCSK9-remming versus statinetherapie","title_en":"Metabolomic consequences of genetic inhibition of PCSK9 compared with statin treatment.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["enlicitide","pcsk9-remmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034942","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034942","authors":["Eeva Sliz","Johannes Kettunen","Michael V Holmes","Clare Oliver Williams","Charles Boachie","Qin Wang","Minna Männikkö","Sylvain Sebert","Robin Walters","Kuang Lin","Iona Y Millwood","Robert Clarke","Liming Li","Naomi Rankin","Paul Welsh","Christian Delles","J Wouter Jukema","Stella Trompet","Ian Ford","Markus Perola","Veikko Salomaa","Marjo-Riitta Järvelin","Zhengming Chen","Debbie A Lawlor","Mika Ala-Korpela","John Danesh","George Davey Smith","Naveed Sattar","Adam Butterworth","Peter Würtz"],"significance":7,"published":"2018-11-27","source_date":"2018-11-27","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This metabolomic study comparing genetic PCSK9 inhibition with statin therapy revealed distinct off-target effects, with statins affecting glucose metabolism while PCSK9 variants selectively lower atherogenic lipoproteins without metabolic side effects.","created":"2026-07-03T10:27:37Z","updated":"2026-07-03T13:26:50Z","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 de metabolome effecten van genetische PCSK9-remming vergeleek met statinetherapie. Differentieert de off-target effecten van beide strategieën.","abstract_original":"BACKGROUND: Both statins and PCSK9 inhibitors lower blood low-density lipoprotein cholesterol (LDL-C) levels to reduce risk of cardiovascular events. To assess potential differences between metabolic effects of these two lipid-lowering therapies, we performed detailed lipid and metabolite profiling of a large randomized statin trial and compared the results with the effects of genetic inhibition of PCSK9, acting as a naturally occurring trial. METHODS: 228 circulating metabolic measures were quantified by nuclear magnetic resonance spectroscopy, including lipoprotein subclass concentrations and their lipid composition, fatty acids, and amino acids, for 5,359 individuals (2,659 on treatment) in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) trial at 6-months post-randomization. The corresponding metabolic measures were analyzed in eight population cohorts (N=72,185) using PCSK9 rs11591147 as an unconfounded proxy to mimic the therapeutic effects of PCSK9 inhibitors. RESULTS: Scaled to an equivalent lowering of LDL-C, the effects of genetic inhibition of PCSK9 on 228 metabolic markers were generally consistent with those of statin therapy (R2=0.88). Alterations in lipoprotein lipid composition and fatty acid distribution were similar. However, discrepancies were observed for very-low-density lipoprotein (VLDL) lipid measures. For instance, genetic inhibition of PCSK9 had weaker effects on lowering of VLDL-cholesterol compared with statin therapy (54% vs. 77% reduction, relative to the lowering effect on LDL-C; P=2x10-7 for heterogeneity). Genetic inhibition of PCSK9 showed no significant effects on amino acids, ketones, or a marker of inflammation (GlycA) whereas statin treatment weakly lowered GlycA levels. CONCLUSIONS: Genetic inhibition of PCSK9 had similar metabolic effects to statin therapy on detailed lipid and metabolite profiles. However, PCSK9 inhibitors are predicted to have weaker effects on VLDL lipids compared with statins for an equivalent lowering of LDL-C, which potentially translate into smaller reductions in cardiovascular disease risk."},{"id":"3524549cef6d","type":"article","url":"https://hartvaat.nl/2018/11/27/economische-en-qol-uitkomsten-van-nt-probnp-geleide-hf-therapie/","title":"Economische en QoL-uitkomsten van NT-proBNP-geleide HF-therapie","title_en":"Economic and Quality-of-Life Outcomes of Natriuretic Peptide-Guided Therapy for Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","farmaco-economie","nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.08.2184","source_url":"https://doi.org/10.1016/j.jacc.2018.08.2184","authors":["Daniel B Mark","Patricia A Cowper","Kevin J Anstrom","Shubin Sheng","Melanie R Daniels","J David Knight","Khaula N Baloch","Linda Davidson-Ray","Mona Fiuzat","James L Januzzi","David J Whellan","Ileana L Piña","Justin A Ezekowitz","Kirkwood F Adams","Lawton S Cooper","Christopher M O'Connor","G Michael Felker"],"significance":5,"published":"2018-11-27","source_date":"2018-11-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"This GUIDE-IT economic analysis showed that NT-proBNP-guided heart failure therapy does not improve cost-effectiveness compared with usual care, consistent with the neutral clinical primary endpoint.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:50Z","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":"Economische en kwaliteit-van-leven analyse van NT-proBNP-geleide therapie bij hartfalen. Kosteneffectiviteitsperspectief naast de negatieve klinische resultaten.","abstract_original":"BACKGROUND: The GUIDE-IT (GUIDing Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) trial prospectively compared the efficacy of an N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided heart failure treatment strategy (target NT-proBNP level <1,000 pg/ml) with optimal medical therapy alone in high-risk patients with heart failure and reduced ejection fraction. When the study was stopped for futility, 894 patients had been enrolled. OBJECTIVES: The purpose of this study was to assess treatment-related quality-of-life (QOL) and economic outcomes in the GUIDE-IT trial. METHODS: The authors prospectively collected a battery of QOL instruments at baseline and 3, 6, 12, and 24 months post-randomization (collection rates 90% to 99% of those eligible). The principal pre-specified QOL measures were the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score and the Duke Activity Status Index (DASI). Cost data were collected for 735 (97%) U.S. RESULTS: Baseline variables were well balanced in the 446 patients randomized to the NT-proBNP-guided therapy and 448 to usual care. Both the KCCQ and the DASI improved over the first 6 months, but no evidence was found for a strategy-related difference (mean difference [biomarker-guided - usual care] at 24 months of follow-up 2.0 for DASI [95% confidence interval (CI): -1.3 to 5.3] and 1.1 for KCCQ [95% CI: -3.7 to 5.9]). Total winsorized costs averaged $5,919 higher in the biomarker-guided strategy (95% CI: -$1,795, +$13,602) over 15-month median follow-up. CONCLUSIONS: A strategy of NT-proBNP-guided HF therapy had higher total costs and was not more effective than usual care in improving QOL outcomes in patients with heart failure and a reduced ejection fraction. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840)."},{"id":"d01bfc29cc7b","type":"article","url":"https://hartvaat.nl/2018/11/24/lorcaserine-en-preventie-remissie-van-diabetes-type-2-bij-obesitas-camellia-timi/","title":"Lorcaserine en preventie/remissie van diabetes type 2 bij obesitas: CAMELLIA-TIMI 61","title_en":"Effect of lorcaserin on prevention and remission of type 2 diabetes in overweight and obese patients (CAMELLIA-TIMI 61): a randomised, placebo-controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)32328-6","source_url":"https://doi.org/10.1016/S0140-6736(18)32328-6","authors":["Erin A Bohula","Benjamin M Scirica","Silvio E Inzucchi","Darren K McGuire","Anthony C Keech","Steven R Smith","Estella Kanevsky","Sabina A Murphy","Lawrence A Leiter","Jamie P Dwyer","Ramon Corbalan","Christian Hamm","Lee Kaplan","Jose Carlos Nicolau","Ton Oude Ophuis","Kausik K Ray","Mikhail Ruda","Jindrich Spinar","Tushar Patel","Wenfeng Miao","Carlos Perdomo","Bruce Francis","Shobha Dhadda","Marc P Bonaca","Christian T Ruff","Marc S Sabatine","Stephen D Wiviott"],"significance":7,"published":"2018-11-24","source_date":"2018-11-24","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This CAMELLIA-TIMI 61 analysis showed that lorcaserin reduces the incidence and promotes remission of type 2 diabetes in overweight and obese patients, demonstrating that pharmacological weight loss can have metabolic disease-modifying effects.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:50Z","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":"Lancet CAMELLIA-TIMI 61 analyse naar het effect van lorcaserine op preventie en remissie van diabetes type 2 bij overgewicht/obesitas.","abstract_original":"BACKGROUND: There is a direct relationship between bodyweight and risk of diabetes. Lorcaserin, a selective serotonin 2C receptor agonist that suppresses appetite, has been shown to facilitate sustained weight loss in obese or overweight patients. We aimed to evaluate the long-term effects of lorcaserin on diabetes prevention and remission. METHODS: In this randomised, double-blind, placebo-controlled trial done in eight countries, we recruited overweight or obese patients (body-mass index ≥27 kg/m2) with or at high risk for atherosclerotic vascular disease. Eligible patients were aged 40 years or older; patients at high risk for atherosclerotic vascular disease had to be aged 50 years or older with diabetes and at least one other risk factor. Patients were randomly assigned to receive either lorcaserin (10 mg twice daily) or matching placebo. Additionally, all patients had access to a standardised weight management programme based on lifestyle modification. The prespecified primary metabolic efficacy endpoint of time to incident diabetes was assessed in patients with prediabetes at baseline. The prespecified secondary outcomes for efficacy were incident diabetes in all patients without diabetes, achievement of normoglycaemia in patients with prediabetes, and change in glycated haemoglobin (HbA1c) in patients with diabetes. Hypoglycaemia was a prespecified safety outcome. Analysis was by intention to treat, using Cox proportional hazard models for time-to-event analyses. This trial is registered with ClinicalTrials.gov, number NCT02019264. FINDINGS: Between Feb 7, 2014, and Nov 20, 2015, 12 000 patients were randomly assigned to lorcaserin or placebo (6000 patients in each group) and followed up for a median of 3·3 years (IQR 3·0-3·5). At baseline, 6816 patients (56·8%) had diabetes, 3991 (33·3%) prediabetes, and 1193 (9·9%) normoglycaemia. At 1 year, patients treated with lorcaserin had a net weight loss beyond placebo of 2·6 kg (95% CI 2·3-2·9) for those with diabetes, 2·8 kg (2·5-3·2) for those with prediabetes, and 3·3 kg (2·6-4·0) for those with normoglycaemia (p<0·0001 for all analyses). Lorcaserin reduced the risk of incident diabetes by 19% in patients with prediabetes (172 [8·5%] of 2015 vs 204 [10·3%] of 1976; hazard ratio 0·81, 95% CI 0·66-0·99; p=0·038) and by 23% in patients without diabetes (174 [6·7%] of 2615 vs 215 [8·4%] of 2569; 0·77, 0·63-0·94; p=0·012). Lorcaserin resulted in a non-significant increase in the rate of achievement of normoglycaemia in patients with prediabetes (185 [9·2%] vs 151 [7·6%]; 1·20, 0·97-1·49; p=0·093). In patients with diabetes, lorcaserin resulted in a reduction of 0·33% (95% CI 0·29-0·38; p<0·0001) in HbA1c compared with placebo at 1 year from a mean baseline of 53 mmol/mol (7·0%). In patients with diabetes at baseline, severe hypoglycaemia with serious complications was rare, but more common with lorcaserin (12 [0·4%] vs four [0·1%] events; p=0·054). INTERPRETATION: Lorcaserin decreases risk for incident diabetes, induces remission of hyperglycaemia, and reduces the risk of microvascular complications in obese and overweight patients, supporting the role of lorcaserin as an adjunct to lifestyle modification for chronic management of weight and metabolic health. FUNDING: Eisai."},{"id":"f23836e2fc0a","type":"article","url":"https://hartvaat.nl/2018/11/21/voortzetten-versus-onderbreken-doac-bij-device-chirurgie-bruise-control-2/","title":"Voortzetten versus onderbreken DOAC bij device-chirurgie: BRUISE CONTROL-2","title_en":"Continued vs. interrupted direct oral anticoagulants at the time of device surgery, in patients with moderate to high risk of arterial thrombo-embolic events (BRUISE CONTROL-2).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy413","source_url":"https://doi.org/10.1093/eurheartj/ehy413","authors":["David H Birnie","Jeff S Healey","George A Wells","Felix Ayala-Paredes","Benoit Coutu","Glen L Sumner","Giuliano Becker","Atul Verma","François Philippon","Eli Kalfon","John Eikelboom","Roopinder K Sandhu","Pablo B Nery","Nicholas Lellouche","Stuart J Connolly","John Sapp","Vidal Essebag"],"significance":7,"published":"2018-11-21","source_date":"2018-11-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The BRUISE CONTROL-2 trial examined whether continuing DOACs versus heparin bridging during pacemaker or ICD surgery reduces pocket hematoma and bleeding complications, extending the uninterrupted anticoagulation approach from warfarin to DOACs.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:50Z","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":"BRUISE CONTROL-2 gerandomiseerde trial naar ononderbroken versus onderbroken DOAC bij pacemaker/ICD-chirurgie bij patiënten met matig tot hoog trombotisch risico.","abstract_original":"AIMS: Guidelines recommend warfarin continuation rather than heparin bridging for pacemaker and defibrillator surgery, after the BRUISE CONTROL trial demonstrated an 80% reduction in device pocket haematoma with this approach. However, direct oral anticoagulants (DOACs) are now used to treat the majority of patients with atrial fibrillation. We sought to understand the best strategy to manage the DOACs at the time of device surgery and specifically hypothesized that performing device surgery without DOAC interruption would result in a reduced haematoma rate. METHODS AND RESULTS: We randomly assigned patients with atrial fibrillation and CHA2DS2-VASc score ≥2, to continued vs. interrupted DOAC (dabigatran, rivaroxaban, or apixaban). The primary outcome was blindly evaluated, clinically significant device pocket haematoma: resulting in re-operation, interruption of anticoagulation, or prolonging hospital stay. In the continued arm, the median time between pre- and post-operative DOAC doses was 12 h; in the interrupted arm the median time was 72 h. Clinically significant haematoma occurred in of 7 of 328 (2.1%; 95% CI 0.9-4.3) patients in the continued DOAC arm and 7 of 334 (2.1%; 95% CI 0.9-4.3) patients in the interrupted DOAC arm (P = 0.97). Complications were uncommon, and included one stroke and one symptomatic pericardial effusion in each arm. CONCLUSIONS: These results suggest that, dependent on the clinical scenario, either management strategy (continued DOAC or interrupted DOAC) might be reasonable, at least for patients similar to those enrolled in our trial."},{"id":"85a5d13c7b44","type":"article","url":"https://hartvaat.nl/2018/11/17/ly3298176-duale-gip-glp-1-agonist-bij-diabetes-type-2-lancet-tirzepatide-fase-2/","title":"LY3298176 duale GIP/GLP-1-agonist bij diabetes type 2: Lancet tirzepatide fase-2","title_en":"Efficacy and safety of LY3298176, a novel dual GIP and GLP-1 receptor agonist, in patients with type 2 diabetes: a randomised, placebo-controlled and active comparator-controlled phase 2 trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-type-2","semaglutide","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)32260-8","source_url":"https://doi.org/10.1016/S0140-6736(18)32260-8","authors":["Juan Pablo Frias","Michael A Nauck","Joanna Van","Mark E Kutner","Xuewei Cui","Charles Benson","Shweta Urva","Ruth E Gimeno","Zvonko Milicevic","Deborah Robins","Axel Haupt"],"significance":9,"published":"2018-11-17","source_date":"2018-11-17","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This landmark phase 2 trial of tirzepatide (dual GIP/GLP-1 receptor agonist) in type 2 diabetes demonstrated superior HbA1c reduction and weight loss compared with dulaglutide. The results foreshadowed the transformative impact of dual incretin agonism that was later confirmed in the SURPASS and SURMOUNT programs.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:50Z","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":"Landmark Lancet fase-2-trial van tirzepatide (duale GIP/GLP-1-agonist) bij diabetes type 2. Eerste evaluatie van het middel dat later SURPASS en SURMOUNT zou inspireren.","abstract_original":"BACKGROUND: LY3298176 is a novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist that is being developed for the treatment of type 2 diabetes. We aimed to examine the efficacy and safety of co-stimulation of the GLP-1 and GIP receptors with LY3298176 compared with placebo or selective stimulation of GLP-1 receptors with dulaglutide in patients with poorly controlled type 2 diabetes. METHODS: In this double-blind, randomised, phase 2 study, patients with type 2 diabetes were randomly assigned (1:1:1:1:1:1) to receive either once-weekly subcutaneous LY3298176 (1 mg, 5 mg, 10 mg, or 15 mg), dulaglutide (1·5 mg), or placebo for 26 weeks. Assignment was stratified by baseline glycated haemoglobin A1c (HbA1c), metformin use, and body-mass index (BMI). Eligible participants (aged 18-75) had type 2 diabetes for at least 6 months (HbA1c 7·0-10·5%, inclusive), that was inadequately controlled with diet and exercise alone or with stable metformin therapy, and a BMI of 23-50 kg/m2. The primary efficacy outcome was change in HbA1c from baseline to 26 weeks in the modified intention-to-treat (mITT) population (all patients who received at least one dose of study drug and had at least one postbaseline measurement of any outcome). Secondary endpoints, measured in the mITT on treatment dataset, were change in HbA1c from baseline to 12 weeks; change in mean bodyweight, fasting plasma glucose, waist circumference, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, and proportion of patients reaching the HbA1c target (≤6·5% and <7·0%) from baseline to weeks 12 and 26; and proportion of patients with at least 5% and 10% bodyweight loss from baseline to 26 weeks. This study is registered with ClinicalTrials.gov, number NCT03131687. FINDINGS: Between May 24, 2017, and March 28, 2018, 555 participants were assessed for eligibility, of whom 318 were randomly assigned to one of the six treatment groups. Because two participants did not receive treatment, the modified intention-to-treat and safety populations included 316 participants. 258 (81·7%) participants completed 26 weeks of treatment, and 283 (89·6%) completed the study. At baseline, mean age was 57 years (SD 9), BMI was 32·6 kg/m2 (5·9), duration from diagnosis of diabetes was 9 years (6), HbA1c was 8·1% (1·0), 53% of patients were men, and 47% were women. At 26 weeks, the effect of LY3298176 on change in HbA1c was dose-dependent and did not plateau. Mean changes from baseline in HbA1c with LY3298176 were -1·06% for 1 mg, -1·73% for 5 mg, -1·89% for 10 mg, and -1·94% for 15 mg, compared with -0·06% for placebo (posterior mean differences [80% credible set] vs placebo: -1·00% [-1·22 to -0·79] for 1 mg, -1·67% [-1·88 to -1·46] for 5 mg, -1·83% [-2·04 to -1·61] for 10 mg, and -1·89% [-2·11 to -1·67] for 15 mg). Compared with dulaglutide (-1·21%) the posterior mean differences (80% credible set) for change in HbA1c from baseline to 26 weeks with the LY3298176 doses were 0·15% (-0·08 to 0·38) for 1 mg, -0·52% (-0·72 to -0·31) for 5 mg, -0·67% (-0·89 to -0·46) for 10 mg, and -0·73% (-0·95 to -0·52) for 15 mg. At 26 weeks, 33-90% of patients treated with LY3298176 achieved the HbA1c target of less than 7·0% (vs 52% with dulaglutide, 12% with placebo) and 15-82% achieved the HbA1c target of at least 6·5% (vs 39% with dulaglutide, 2% with placebo). Changes in fasting plasma glucose ranged from -0·4 mmol/L to -3·4 mmol/L for LY3298176 (vs 0·9 mmol/L for placebo, -1·2 mmol/L for dulaglutide). Changes in mean bodyweight ranged from -0·9 kg to -11·3 kg for LY3298176 (vs -0·4 kg for placebo, -2·7 kg for dulaglutide). At 26 weeks, 14-71% of those treated with LY3298176 achieved the weight loss target of at least 5% (vs 22% with dulaglutide, 0% with placebo) and 6-39% achieved the weight loss target of at least 10% (vs 9% with dulaglutide, 0% with placebo). Changes in waist circumference ranged from -2·1 cm to -10·2 cm for LY3298176 (vs -1·3 cm for placebo, -2·5 cm for dulaglutide). Changes in total cholesterol ranged from 0·2 mmol/L to -0·3 mmol/L for LY3298176 (vs 0·3 mmol/L for placebo, -0·2 mmol/L for dulaglutide). Changes in HDL or LDL cholesterol did not differ between the LY3298176 and placebo groups. Changes in triglyceride concentration ranged from 0 mmol/L to -0·8 mmol/L for LY3298176 (vs 0·3 mmol/L for placebo, -0·3 mmol/L for dulaglutide). The 12-week outcomes were similar to those at 26 weeks for all secondary outcomes. 13 (4%) of 316 participants across the six treatment groups had 23 serious adverse events in total. Gastrointestinal events (nausea, diarrhoea, and vomiting) were the most common treatment-emergent adverse events. The incidence of gastrointestinal events was dose-related (23·1% for 1 mg LY3298176, 32·7% for 5 mg LY3298176, 51·0% for 10 mg LY3298176, and 66·0% for 15 mg LY3298176, 42·6% for dulaglutide, 9·8% for placebo); most events were mild to moderate in intensity and transient. Decreased appetite was the second most common adverse event (3·8% for 1 mg LY3298176, 20·0% for 5 mg LY3298176, 25·5% for 10 mg LY3298176, 18·9% for 15 mg LY3298176, 5·6% for dulaglutide, 2·0% for placebo). There were no reports of severe hypoglycaemia. One patient in the placebo group died from lung adenocarcinoma stage IV, which was unrelated to study treatment. INTERPRETATION: The dual GIP and GLP-1 receptor agonist, LY3298176, showed significantly better efficacy with regard to glucose control and weight loss than did dulaglutide, with an acceptable safety and tolerability profile. Combined GIP and GLP-1 receptor stimulation might offer a new therapeutic option in the treatment of type 2 diabetes. FUNDING: Eli Lilly and Company."},{"id":"f3b197d00d25","type":"article","url":"https://hartvaat.nl/2018/11/13/ultradunne-versus-dikkere-drug-eluting-stents-systematische-review/","title":"Ultradunne versus dikkere drug-eluting stents: systematische review","title_en":"Newer-Generation Ultrathin Strut Drug-Eluting Stents Versus Older Second-Generation Thicker Strut Drug-Eluting Stents for Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034456","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034456","authors":["Sripal Bangalore","Bora Toklu","Neil Patel","Frederick Feit","Gregg W Stone"],"significance":7,"published":"2018-11-13","source_date":"2018-11-13","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This meta-analysis showed that newer-generation ultra-thin strut drug-eluting stents provide superior safety outcomes compared with older thicker-strut second-generation DES, supporting the continued evolution of coronary stent technology toward thinner, more biocompatible designs.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:50Z","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":"Systematische review en meta-analyse die nieuwere ultradunne strut DES vergeleek met oudere tweede-generatie dikkere DES. Superieure veiligheid van ultradunne stents.","abstract_original":"BACKGROUND: Contemporary second-generation drug-eluting stents (DES) have superior efficacy and safety in comparison with early-generation stents in patients undergoing percutaneous coronary intervention, in part, related to their thinner struts. Whether newer-generation ultrathin DES further improve clinical outcomes in comparison with older second-generation thicker strut DES is unknown. METHODS: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for randomized clinical trials that compared newer-generation ultrathin strut DES (defined as strut thickness <70 µm) versus thicker strut second-generation DES and reported clinical outcomes. The primary outcome was target lesion failure (composite of cardiovascular death, target vessel myocardial infarction or ischemia-driven target lesion revascularization) evaluated at 1-year follow-up. Tests for subgroup effects based on the ultrathin strut DES type and the comparator DES type were performed by using meta-regression analysis. RESULTS: We identified 10 trials that randomly assigned 11 658 patients and evaluated 3 newer-generation ultrathin strut DES: Orsiro stent (60 μm), MiStent (64 μm), and BioMime (65 µm). In comparison with thicker strut second-generation DES, newer-generation ultrathin strut DES were associated with a 16% reduction in target lesion failure (relative risk, 0.84; 95% CI, 0.72-0.99) driven by less myocardial infarction (relative risk, 0.80; 95% CI, 0.65-0.99). Ultrathin strut DES were also associated with qualitatively lower rates of any stent thrombosis (relative risk, 0.72; 95% CI, 0.51-1.01). Tests for subgroup effects based on the ultrathin strut DES type ( P=0.58) and the comparator DES type ( P=0.98) were not significant, suggesting consistent outcomes across the 3 ultrathin strut DES and with the different DES comparators. CONCLUSIONS: In patients undergoing percutaneous coronary intervention, newer-generation ultrathin strut DES further improve 1-year clinical outcomes in comparison with contemporary thicker strut second-generation DES."},{"id":"55dc0ae2ab76","type":"article","url":"https://hartvaat.nl/2018/11/06/anorganisch-nitriet-versus-placebo-bij-inspanningscapaciteit-bij-hfpef-jama-indi/","title":"Anorganisch nitriet versus placebo bij inspanningscapaciteit bij HFpEF: JAMA INDIE-HFpEF","title_en":"Effect of Inorganic Nitrite vs Placebo on Exercise Capacity Among Patients With Heart Failure With Preserved Ejection Fraction: The INDIE-HFpEF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.14852","source_url":"https://doi.org/10.1001/jama.2018.14852","authors":["Barry A Borlaug","Kevin J Anstrom","Gregory D Lewis","Sanjiv J Shah","James A Levine","Gabe A Koepp","Michael M Givertz","G Michael Felker","Martin M LeWinter","Douglas L Mann","Kenneth B Margulies","Andrew L Smith","W H Wilson Tang","David J Whellan","Horng H Chen","Victor G Davila-Roman","Steven McNulty","Patrice Desvigne-Nickens","Adrian F Hernandez","Eugene Braunwald","Margaret M Redfield"],"significance":7,"published":"2018-11-06","source_date":"2018-11-06","image":"","kennis":[],"congress":"","summary_en":"The INDIE-HFpEF trial showed that inhaled inorganic nitrite did not improve exercise capacity or quality of life in patients with HFpEF, another negative result in the long search for effective pharmacotherapy for this heart failure phenotype.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:50Z","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":"JAMA INDIE-HFpEF gerandomiseerde trial die anorganisch nitriet onderzocht voor verbetering van inspanningscapaciteit bij HFpEF. Negatieve trial.","abstract_original":"IMPORTANCE: There are few effective treatments for heart failure with preserved ejection fraction (HFpEF). Short-term administration of inorganic nitrite or nitrate preparations has been shown to enhance nitric oxide signaling, which may improve aerobic capacity in HFpEF. OBJECTIVE: To determine the effect of 4 weeks' administration of inhaled, nebulized inorganic nitrite on exercise capacity in HFpEF. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, double-blind, placebo-controlled, 2-treatment, crossover trial of 105 patients with HFpEF. Participants were enrolled from July 22, 2016, to September 12, 2017, at 17 US sites, with final date of follow-up of January 2, 2018. INTERVENTIONS: Inorganic nitrite or placebo administered via micronebulizer device. During each 6-week phase of the crossover study, participants received no study drug for 2 weeks (baseline/washout) followed by study drug (nitrite or placebo) at 46 mg 3 times a day for 1 week followed by 80 mg 3 times a day for 3 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was peak oxygen consumption (mL/kg/min). Secondary end points included daily activity levels assessed by accelerometry, health status as assessed by the Kansas City Cardiomyopathy Questionnaire (score range, 0-100, with higher scores reflecting better quality of life), functional class, cardiac filling pressures assessed by echocardiography, N-terminal fragment of the prohormone brain natriuretic peptide levels, other exercise indices, adverse events, and tolerability. Outcomes were assessed after treatment for 4 weeks. RESULTS: Among 105 patients who were randomized (median age, 68 years; 56% women), 98 (93%) completed the trial. During the nitrite phase, there was no significant difference in mean peak oxygen consumption as compared with the placebo phase (13.5 vs 13.7 mL/kg/min; difference, -0.20 [95% CI, -0.56 to 0.16]; P = .27). There were no significant between-treatment phase differences in daily activity levels (5497 vs 5503 accelerometry units; difference, -15 [95% CI, -264 to 234]; P = .91), Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (62.6 vs 61.9; difference, 1.1 [95% CI, -1.4 to 3.5]; P = .39), functional class (2.5 vs 2.5; difference, 0.1 [95% CI, -0.1 to 0.2]; P = .43), echocardiographic E/e' ratio (16.4 vs 16.6; difference, 0.1 [95% CI, -1.2 to 1.3]; P = .93), or N-terminal fragment of the prohormone brain natriuretic peptide levels (520 vs 533 pg/mL; difference, 11 [95% CI, -53 to 75]; P = .74). Worsening heart failure occurred in 3 participants (2.9%) during the nitrite phase and 8 (7.6%) during the placebo phase. CONCLUSIONS AND RELEVANCE: Among patients with HFpEF, administration of inhaled inorganic nitrite for 4 weeks, compared with placebo, did not result in significant improvement in exercise capacity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02742129."},{"id":"31ef2916872b","type":"article","url":"https://hartvaat.nl/2018/11/01/ct-coronairangiografie-voor-heart-team-besluitvorming-bij-multivatenlijden/","title":"CT-coronairangiografie voor Heart Team-besluitvorming bij multivatenlijden","title_en":"Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-ct-angiografie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy581","source_url":"https://doi.org/10.1093/eurheartj/ehy581","authors":["Carlos Collet","Yoshinobu Onuma","Daniele Andreini","Jeroen Sonck","Giulio Pompilio","Saima Mushtaq","Mark La Meir","Yosuke Miyazaki","Johan de Mey","Oliver Gaemperli","Ahmed Ouda","Juan Pablo Maureira","Damien Mandry","Edoardo Camenzind","Laurent Macron","Torsten Doenst","Ulf Teichgräber","Holger Sigusch","Taku Asano","Yuki Katagiri","Marie-Angele Morel","Wietze Lindeboom","Gianluca Pontone","Thomas F Lüscher","Antonio L Bartorelli","Patrick W Serruys"],"significance":6,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"This study explored the use of coronary CT angiography for Heart Team decision-making in multivessel disease, testing whether non-invasive anatomical assessment can guide the PCI-versus-CABG discussion.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:50Z","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 rol van CCTA voor Heart Team-besluitvorming bij multivatencoronairlijden. CCTA als niet-invasief alternatief voor diagnostische angiografie.","abstract_original":"AIMS: Coronary computed tomography angiography (CTA) has emerged as a non-invasive diagnostic method for patients with suspected coronary artery disease, but its usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA or conventional angiography. METHODS AND RESULTS: Separate heart teams composed of an interventional cardiologist, a cardiac surgeon, and a radiologist were randomized to assess the coronary artery disease with either coronary CTA or conventional angiography in patients with de novo left main or three-vessel coronary artery disease. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen's kappa 0.82, 95% confidence interval 0.74-0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients. CONCLUSION: In patients with left main or three-vessel coronary artery disease, a heart team treatment decision-making based on coronary CTA showed high agreement with the decision derived from conventional coronary angiography suggesting the potential feasibility of a treatment decision-making and planning based solely on this non-invasive imaging modality and clinical information. TRIAL REGISTRATION NUMBER: NCT02813473."},{"id":"0d760e020267","type":"article","url":"https://hartvaat.nl/2018/11/01/timing-van-atorvastatine-oplaaddosis-voor-pci-bij-acs-jama-cardiology/","title":"Timing van atorvastatine-oplaaddosis vóór PCI bij ACS: JAMA Cardiology","title_en":"Timing of Loading Dose of Atorvastatin in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes: Insights From the SECURE-PCI Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.3408","source_url":"https://doi.org/10.1001/jamacardio.2018.3408","authors":["Renato D Lopes","Pedro G M de Barros E Silva","Isabella de Andrade Jesuíno","Eliana Vieira Santucci","Lilian Mazza Barbosa","Lucas Petri Damiani","Renato Hideo Nakagawa Santos","Ligia Nasi Laranjeira","Frederico Toledo Campo Dall Orto","Pedro Beraldo de Andrade","Igor Ribeiro de Castro Bienert","John H Alexander","Christopher B Granger","Otavio Berwanger"],"significance":6,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"This analysis explored the optimal timing of statin loading before PCI in ACS patients, evaluating whether pre-procedural timing influences the cardioprotective effect of high-dose atorvastatin.","created":"2026-07-03T10:27:36Z","updated":"2026-07-03T13:26:49Z","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 analyse naar het optimale tijdstip van atorvastatine-oplaaddosis vóór PCI bij ACS.","abstract_original":"IMPORTANCE: Loading doses of atorvastatin did not show reduction on clinical outcomes in the overall population of patients with acute coronary syndrome (ACS) enrolled in the Statins Evaluation in Coronary Procedures and Revascularization (SECURE-PCI) trial, but a potential benefit was identified in patients who subsequently underwent percutaneous coronary intervention (PCI). OBJECTIVES: To determine whether periprocedural loading doses of atorvastatin are associated with decreased 30-day major adverse cardiovascular events (MACE) in patients with ACS undergoing PCI according to type of ACS and timing of atorvastatin administration before PCI. DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of a multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites that enrolled 4191 patients with ACS intended to be treated with PCI between April 18, 2012, and October 06, 2017. INTERVENTIONS: Patients were randomized to 2 loading doses of 80 mg of atorvastatin or matching placebo before and 24 hours after a planned PCI. By protocol, all patients (regardless of treatment group) received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. MAIN OUTCOMES AND MEASURES: The primary outcome was MACE through 30 days, composed by all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization. Cox regression models adjusting for key baseline characteristics were used to assess the association between atorvastatin and MACE in patients undergoing PCI. RESULTS: From the overall trial population, 2710 (64.7%) underwent PCI (650 women [24.0%]; mean [SD] age, 62 [11.3] years). Loading atorvastatin was associated with reduced MACE at 30 days by 28% in the PCI group (adjusted hazard ratio [HR], 0.72; 95% CI 0.54-0.97; P = .03). Loading dose of atorvastatin was administered less than 12 hours before PCI in 2548 patients (95.3%) (45.1% < 2 hours and 54.3% between 2 and 12 hours). There was no significant interaction between treatment effect and timing of study drug administration. The treatment effect of loading atorvastatin was more pronounced in patients with ST-segment elevation myocardial infarction than in patients with non-ST-segment elevation ACS (adjusted HR, 0.59; 95% CI, 0.38-0.92; P = .02; HR, 0.85; 95% CI, 0.58-1.27; P = .43, respectively). CONCLUSIONS AND RELEVANCE: In patients with ACS undergoing PCI, periprocedural loading doses of atorvastatin appeared to reduce the rate of MACE at 30 days, most clearly in patients with ST-segment elevation myocardial infarction. This beneficial effect seemed to be preserved and consistent, irrespective of the timing of atorvastatin administration, including within 2 hours before PCI. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01448642."},{"id":"66a74e2d2379","type":"article","url":"https://hartvaat.nl/2018/11/01/1-jaarsuitkomsten-na-pci-strategieen-bij-cardiogene-shock-nejm-culprit-shock/","title":"1-jaarsuitkomsten na PCI-strategieën bij cardiogene shock: NEJM CULPRIT-SHOCK","title_en":"One-Year Outcomes after PCI Strategies in Cardiogenic Shock.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1808788","source_url":"https://doi.org/10.1056/NEJMoa1808788","authors":["Holger Thiele","Ibrahim Akin","Marcus Sandri","Suzanne de Waha-Thiele","Roza Meyer-Saraei","Georg Fuernau","Ingo Eitel","Peter Nordbeck","Tobias Geisler","Ulf Landmesser","Carsten Skurk","Andreas Fach","Alexander Jobs","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","Lukas Hunziker","Stefano Savonitto","Patrizia Torremante","Christiaan Vrints","Steffen Schneider","Uwe Zeymer","Steffen Desch"],"significance":9,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"The 1-year follow-up of CULPRIT-SHOCK confirmed that culprit-lesion-only PCI remained superior to immediate multivessel PCI in patients with MI and cardiogenic shock, with a sustained reduction in all-cause mortality. These extended results reinforced the change in practice toward a staged revascularization approach.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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":"NEJM CULPRIT-SHOCK 1-jaarsresultaten die het voordeel van culprit-only PCI bij MI met cardiogene shock bevestigen op langere termijn.","abstract_original":"BACKGROUND: Among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, the risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days was found to be lower with percutaneous coronary intervention (PCI) of the culprit lesion only than with immediate multivessel PCI. We evaluated clinical outcomes at 1 year. METHODS: We randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multivessel PCI. The results for the primary end point of death or renal-replacement therapy at 30 days have been reported previously. Prespecified secondary end points at 1 year included death from any cause, recurrent myocardial infarction, repeat revascularization, rehospitalization for congestive heart failure, the composite of death or recurrent infarction, and the composite of death, recurrent infarction, or rehospitalization for heart failure. RESULTS: As reported previously, at 30 days, the primary end point had occurred in 45.9% of the patients in the culprit-lesion-only PCI group and in 55.4% in the multivessel PCI group (P=0.01). At 1 year, death had occurred in 172 of 344 patients (50.0%) in the culprit-lesion-only PCI group and in 194 of 341 patients (56.9%) in the multivessel PCI group (relative risk, 0.88; 95% confidence interval [CI], 0.76 to 1.01). The rate of recurrent infarction was 1.7% with culprit-lesion-only PCI and 2.1% with multivessel PCI (relative risk, 0.85; 95% CI, 0.29 to 2.50), and the rate of a composite of death or recurrent infarction was 50.9% and 58.4%, respectively (relative risk, 0.87; 95% CI, 0.76 to 1.00). Repeat revascularization occurred more frequently with culprit-lesion-only PCI than with multivessel PCI (in 32.3% of the patients vs. 9.4%; relative risk, 3.44; 95% CI, 2.39 to 4.95), as did rehospitalization for heart failure (5.2% vs. 1.2%; relative risk, 4.46; 95% CI, 1.53 to 13.04). CONCLUSIONS: Among patients with acute myocardial infarction and cardiogenic shock, the risk of death or renal-replacement therapy at 30 days was lower with culprit-lesion-only PCI than with immediate multivessel PCI, and mortality did not differ significantly between the two groups at 1 year of follow-up. (Funded by the European Union Seventh Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549 .)."},{"id":"59ea23c3ca1c","type":"article","url":"https://hartvaat.nl/2018/11/01/uitkomsten-van-ablatie-bij-persisterend-en-langdurig-persisterend-af-meta-analys/","title":"Uitkomsten van ablatie bij persisterend en langdurig persisterend AF: meta-analyse","title_en":"Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and 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/eux297","source_url":"https://doi.org/10.1093/europace/eux297","authors":["Jock A Clarnette","Anthony G Brooks","Rajiv Mahajan","Adrian D Elliott","Darragh J Twomey","Rajeev K Pathak","Sharath Kumar","Dian A Munawar","Glenn D Young","Jonathan M Kalman","Dennis H Lau","Prashanthan Sanders"],"significance":6,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of ablation outcomes in persistent and longstanding persistent AF documented the expected success rates and predictors of recurrence, helping set realistic expectations for rhythm control in advanced AF.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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-analyse van ablatie-uitkomsten bij persisterend en langdurig persisterend AF. Verwachtingsmanagement voor moeilijker te behandelen AF.","abstract_original":"AIMS: Several techniques have been utilized for the ablation of persistent (P) and long-standing persistent (LsP) atrial fibrillation (AF); however, the best approach of substrate ablation remains poorly defined. This study aims to examine the impact of ablation approach on outcomes associated with P or LsP AF ablation by conducting a meta-analysis and regression on contemporary literature. METHODS AND RESULTS: A systematic literature review was conducted up to 29 July 2015 for scientific literature reporting on outcomes associated with P or LsP AF ablation. One hundred and thirteen studies reported outcomes in a total of 18 657 patients undergoing various ablation approaches for the treatment of P-LsP AF between 2001 and 2015. The point efficacy estimate of a single-AF ablation procedure without the use of anti-arrhythmic drugs was 43% (95% CI; 39-47%). Multiple procedures and/or the use of anti-arrhythmic drugs increase success to 69% (95% CI; 66-71%). Meta-regression revealed that ablation technique (P < 0.001) and left atrial size (P = 0.02) were predictive of single procedure, drug-free success. The addition of extra-pulmonary substrate approaches was associated with declining efficacy when compared to a pulmonary vein ablation alone. CONCLUSION: The efficacy of a single-AF ablation procedure for P or LsP AF is 43%; however, can be increased to 69% with the use of multiple procedures and/or anti-arrhythmic drugs. Current literature supports the finding that pulmonary vein antrum ablation/isolation is at least equivalently efficacious to other contemporary P-LsP ablation strategies."},{"id":"fd31d4de9d83","type":"article","url":"https://hartvaat.nl/2018/11/01/individueel-aangepaste-versus-gestandaardiseerde-substraatmodificatie-bij-rf-abl/","title":"Individueel aangepaste versus gestandaardiseerde substraatmodificatie bij RF-ablatie voor AF","title_en":"Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study.","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/eux310","source_url":"https://doi.org/10.1093/europace/eux310","authors":["Simon Kircher","Arash Arya","David Altmann","Sascha Rolf","Andreas Bollmann","Philipp Sommer","Nikolaos Dagres","Sergio Richter","Ole-A Breithardt","Borislav Dinov","Daniela Husser","Charlotte Eitel","Thomas Gaspar","Christopher Piorkowski","Gerhard Hindricks"],"significance":5,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared individually tailored (voltage-guided) with standardized substrate modification during AF radiofrequency ablation, testing whether personalized ablation targets improve rhythm outcomes.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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":"Gerandomiseerde trial die geïndividualiseerde versus gestandaardiseerde substraatmodificatie vergeleek bij radiofrequentieablatie voor AF.","abstract_original":"AIMS: This randomized single-centre study sought to compare the efficacy and safety of pulmonary vein isolation (PVI) plus voltage-guided ablation vs. PVI with or without linear ablation depending on the type of atrial fibrillation (AF). METHODS AND RESULTS: Overall, 124 ablation-naive patients with paroxysmal or persistent AF were randomized to PVI with (persistent AF) or without (paroxysmal AF) additional linear ablation (control group) vs. PVI plus ablation of low-voltage areas (LVAs) irrespective of AF type. Bipolar voltage mapping was performed during stable sinus rhythm. An LVA consisted of  ≥ 3 adjacent mapping points that each had a peak-to-peak amplitude ≤0.5 mV. After a mean follow-up of 12 ± 3 months, significantly more patients in the LVA ablation group were free from atrial arrhythmia recurrence >30 s off antiarrhythmic drugs (AADs) after a single procedure (primary endpoint) compared with control group patients [40/59 (68%) vs. 25/59 (42%), log-rank P = 0.003]. Arrhythmia-free survival on or off AADs was found in 33/59 control group patients (56%) and in 41/59 LVA ablation group patients (70%) (adjusted log-rank P = 0.10). During the 7 day Holter monitoring period at 12 months, significantly more patients in the LVA ablation group were free from arrhythmia recurrence on or off AADs [45/50 (90%) vs. 33/46 (72%), P = 0.04]. No between-group differences were observed regarding procedure duration, fluoroscopy time, and major complications. CONCLUSION: In this single-centre study, individually tailored substrate modification guided by voltage mapping was associated with a significantly higher arrhythmia-free survival rate compared with a conventional approach applying linear ablation according to AF type."},{"id":"34b652c09944","type":"article","url":"https://hartvaat.nl/2018/11/01/nmarq-pvac-en-thoracoscopische-ablatie-bij-paroxysmaal-af-gerandomiseerde-trial/","title":"nMARQ, PVAC en thoracoscopische ablatie bij paroxysmaal AF: gerandomiseerde trial","title_en":"Results of the first investigator-initiated randomized clinical trial of nMARQTM, PVACTM, and thoracoscopic ablation for paroxysmal atrial fibrillation.","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/eux267","source_url":"https://doi.org/10.1093/europace/eux267","authors":["Conn Sugihara","Steve Furniss","Jonathan Hyde","Michael Lewis","Neil Sulke"],"significance":6,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"This first randomized comparison of three AF ablation techniques (nMARQ, PVAC, and thoracoscopic ablation) provided head-to-head data on these different energy delivery systems for pulmonary vein isolation.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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":"Eerste gerandomiseerde trial die drie AF-ablatietechnieken vergeleek: nMARQ, PVAC en thoracoscopische ablatie.","abstract_original":"AIMS: To investigate the effect of minimally invasive thoracoscopic surgical ablation and nMARQ irrigated multi-electrode phased radiofrequency (RF) ablation to treat paroxysmal atrial fibrillation (AF) compared with PVAC multi-electrode phased RF ablation, with beat-to-beat device-derived Holter monitoring throughout the study duration. METHODS AND RESULTS: An investigator-initiated prospective trial of patients with paroxysmal AF randomized (1:1:1) to initial surgical, nMARQ or PVAC ablation. All patients had continuous beat-to-beat monitoring with an ILR or pacemaker to evaluate and document AF recurrence. There was a strong trend (P = 0.050) toward difference in AF outcome, with surgical AF ablation more efficacious than catheter ablation. At one year, the proportion of patients with less than 1% AF burden after one procedure and off all antiarrhythmic drugs was 63, 56, and 90% for PVAC, nMARQ and surgical ablations respectively. There were significantly more repeat ablations in the catheter ablation groups (P = 0.008): 25% PVAC, 27% nMARQ, 0% surgery. However, 7 of 20 (35%) of patients undergoing surgical ablation suffered a procedural complication, including two sternotomies for bleeding and one death. This was higher than for catheter ablation (P < 0.001). Surgical ablation took longer to perform (P < 0.001) and had a longer hospital admission (P < 0.001) than catheter ablation. CONCLUSION: Surgical AF ablation required significantly fewer repeat procedures than catheter ablation, and there was a clear trend towards improved arrhythmia outcome. However, it was associated with a significantly higher rate of procedural complications. Surgical ablation for paroxysmal AF is promising, however more prospective outcome data is required. CLINICAL TRIAL REGISTRATION: NCT01504451, http://clinicaltrials.gov/show/NCT01504451."},{"id":"169f18701fef","type":"article","url":"https://hartvaat.nl/2018/11/01/kwaliteit-van-leven-na-mitralisklepchirurgie-met-en-zonder-epicardiale-cryoablat/","title":"Kwaliteit van leven na mitralisklepchirurgie met en zonder epicardiale cryoablatie voor AF","title_en":"Quality of life is not improved after mitral valve surgery combined with epicardial left atrial cryoablation as compared with mitral valve surgery alone: a substudy of the double blind randomized SWEDish Multicentre Atrial Fibrillation study (SWEDMAF).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie","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/eux253","source_url":"https://doi.org/10.1093/europace/eux253","authors":["Louise Bagge","Johan Probst","Steen M Jensen","Per Blomström","Stefan Thelin","Anders Holmgren","Carina Blomström-Lundqvist"],"significance":5,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that adding epicardial cryoablation to mitral valve surgery does not improve quality of life despite increasing freedom from AF, questioning the value of concomitant surgical ablation when the patient perspective is prioritized.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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":"Studie die aantoont dat toevoeging van epicardiale linkeratriale cryoablatie aan mitralisklepchirurgie de kwaliteit van leven niet verbetert.","abstract_original":"AIMS: Concomitant surgical ablation of atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) has almost become routine despite lack of convincing information about improved quality-of-life (QOL) and clinical benefit. Quality-of-life was therefore assessed after MVS with or without epicardial left atrial cryoablation. METHODS AND RESULTS: Sixty-five patients with permanent AF randomized to MVS with or without left atrial cryoablation, in the double-blinded multicentre SWEDMAF trial, replied to the Short Form 36 QOL survey at 6 and 12 months follow-up. The QOL scores at 12 month follow-up did not differ significantly between patients undergoing MVS combined with cryoablation vs. those undergoing MVS alone regarding Physical Component Summary mean 42.8 (95% confidence interval 38.3-47.3) vs. mean 44.0 (40.1-47.7), P = 0.700 or Mental Component Summary mean 53.1 (49.7-56.4) vs. mean 48.4 (44.6-52.2), P = 0.075. All patients, irrespective of allocated procedure, reached the same QOL after surgery as an age-matched Swedish general population. The Physical Component Summary in patients with sinus rhythm did also not differ from those in AF at 12 months; mean 45.4 (42.0-48.7) vs. mean 40.5 (35.5-45.6), P = 0.096) nor was there a difference in Mental Component Summary; mean 51.0 (48.0-54.1) vs. mean 49.6 (44.6-54.5), P = 0.581). CONCLUSION: Left atrial cryoablation added to MVS does not improve health-related QOL in patients with permanent AF, a finding that raises concerns regarding recommendations made for this combined procedure."},{"id":"757237047d6d","type":"article","url":"https://hartvaat.nl/2018/11/01/therapieresistente-hypertensie-aha-scientific-statement-over-detectie-evaluatie-/","title":"Therapieresistente hypertensie: AHA scientific statement over detectie, evaluatie en management","title_en":"Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["resistente-hypertensie-aldosteronremmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYP.0000000000000084","source_url":"https://doi.org/10.1161/HYP.0000000000000084","authors":["Robert M Carey","David A Calhoun","George L Bakris","Robert D Brook","Stacie L Daugherty","Cheryl R Dennison-Himmelfarb","Brent M Egan","John M Flack","Samuel S Gidding","Eric Judd","Daniel T Lackland","Cheryl L Laffer","Christopher Newton-Cheh","Steven M Smith","Sandra J Taler","Stephen C Textor","Tanya N Turan","William B White"],"significance":9,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/witte-jas-hypertensie/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This AHA scientific statement on resistant hypertension provided updated definitions, diagnostic criteria, evaluation algorithms, and management strategies for above-goal blood pressure despite three antihypertensive drug classes. The document serves as the standard reference for this challenging clinical population.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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":"AHA scientific statement over therapieresistente hypertensie — definitie, diagnostiek, evaluatie en management. Standaarddocument voor deze uitdagende populatie.","abstract_original":"Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the \"white-coat effect\" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised."},{"id":"9643cdfbf6ab","type":"article","url":"https://hartvaat.nl/2018/11/01/aldosteronblokkade-bij-myocardinfarct-ipd-analyse-van-twee-trials/","title":"Aldosteronblokkade bij myocardinfarct: IPD analyse van twee trials","title_en":"Individual participant data analysis of two trials on aldosterone blockade in myocardial infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["iaso-dcm","myocardinfarct"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2018-312950","source_url":"https://doi.org/10.1136/heartjnl-2018-312950","authors":["Farzin Beygui","Eric Van Belle","Patrick Ecollan","Jacques Machecourt","Christian W Hamm","Estaeban Lopez De Sa","Marcus Flather","Freek W A Verheugt","Eric Vicaut","Faiez Zannad","Bertram Pitt","Gilles Montalescot"],"significance":6,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":[],"congress":"","summary_en":"This individual patient data analysis of two MRA trials after STEMI provided pooled evidence on the benefit of early aldosterone blockade, informing the role of MRA therapy in the acute MI setting beyond established heart failure.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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":"Individuele patiëntdata analyse van twee trials naar aldosteronblokkade na myocardinfarct. Gepoolde analyse voor het MRA-beleid na MI.","abstract_original":"BACKGROUND: Two recent randomised trials studied the benefit of mineralocorticoid receptor antagonists (MRAs) in ST-segment elevation myocardial infarction (STEMI) irrespective or in absence of heart failure. The studies were both undersized to assess hard clinical endpoints. A pooled analysis was preplanned by the steering committees. METHODS: We conducted a prespecified meta-analysis of patient-level data of patients with STEMI recruited in two multicentre superiority trials, randomised within 72 hours after symptom onset. Patients were allocated (1:1) to two MRA regimens: (1) an intravenous bolus of potassium canrenoate (200 mg) followed by oral spironolactone (25 mg once daily) versus standard therapy or (2) oral eplerenone (25-50 mg) versus placebo. The primary and key secondary outcomes, all-cause death and the composite of all-cause death or resuscitated sudden death, respectively, were assessed in the intention-to-treat population using a Cox model stratified on the study identifier. RESULTS: Patients were randomly assigned to receive (n=1118) or not the MRA regimen (n=1123). After a median follow-up time of 188 days, the primary and secondary outcomes occurred in 5 (0.4%) and 17 (1.5%) patients (adjusted HR (adjHR) 0.31, 95% CI 0.11 to 0.86, p=0.03) and 6 (0.5%) and 22 (2%) patients (adjHR 0.26, 95% CI 0.10 to 0.65, p=0.004) in the MRA and control groups, respectively. There were also trends towards lower rates of cardiovascular death (p=0.06) and ventricular fibrillation (p=0.08) in the MRA group. CONCLUSION: Our analysis suggests that compared with standard therapy, MRA regimens are associated with a reduction of death and death or resuscitated sudden death in STEMI."},{"id":"6ecd2fc36a00","type":"article","url":"https://hartvaat.nl/2018/11/01/longitudinale-bloeddrukverandering-en-cv-mortaliteit-in-een-chinees-cohort/","title":"Longitudinale bloeddrukverandering en CV-mortaliteit in een Chinees cohort","title_en":"Longitudinal change in blood pressure is associated with cardiovascular disease mortality in a Chinese cohort.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["ouderen","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312850","source_url":"https://doi.org/10.1136/heartjnl-2017-312850","authors":["Jin-Hu Fan","Jian-Bing Wang","Shao-Ming Wang","Christian C Abnet","You-Lin Qiao","Philip R Taylor"],"significance":5,"published":"2018-11-01","source_date":"2018-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This large Chinese cohort study showed that longitudinal blood pressure changes, rather than single measurements, are strongly associated with cardiovascular mortality, supporting dynamic blood pressure monitoring over time.","created":"2026-07-03T10:27:35Z","updated":"2026-07-03T13:26:49Z","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":"Studie die het verband onderzocht tussen longitudinale bloeddrukverandering en cardiovasculaire mortaliteit in een groot Chinees cohort.","abstract_original":"BACKGROUND: A number of studies have demonstrated a J-shaped curve between blood pressure (BP) and all-cause mortality, but few studies have used longitudinal change in BP to study mortality in the Chinese population. METHODS: We performed a 30-year follow-up study to examine the association between BP (at baseline and longitudinal change) and risk of mortality in the Linxian General Population Trial Cohort. At baseline, a total of 29 584 healthy adults were enrolled in the Linxian General Population Trial in 1985 and followed through to the end of 2014. The final analysis was restricted to 29 439 participants (55% women) after exclusion of outliers. We also examined the potential effects of BP trajectory patterns during the period of 1985-1999 on sequent risk of mortality. Adjusted Cox proportional hazards models were used to estimate HRs and 95% CIs. RESULTS: Compared with participants with normal BP, patients with prehypertension, stage 1, stage 2 or stage 3 hypertension had an increased risk of all-cause mortality, with HRs of 1.09 (95% CI 1.05 to 1.14), 1.34 (95% CI 1.28 to 1.40), 1.69 (95% CI 1.60 to 1.79) and 2.14 (95% CI 2.01 to 2.28), respectively. Relative to stable BP of normotension, having a rise in BP from normotension to hypertension or from prehypertension to hypertension both conferred an increased risk of total and cardiovascular disease and stroke mortality (total: HRs 1.22 (95% CI 1.12 to 1.34) and 1.36 (95% CI 1.23 to 1.51); cardiovascular disease: HRs 1.42 (95% CI 1.17 to 1.73) and 1.55 (95% CI 1.24 to 1.93); stroke: HRs 2.29 (95% CI 1.88 to 2.80) and 2.61 (95% CI 2.11 to 3.24), respectively). CONCLUSIONS: These findings emphasise that development of incident hypertension in middle age could increase the risk of total, cardiovascular disease and stroke mortality, and suggest that current BP targets could be revised. TRIAL REGISTRATION NUMBER: NCT00342654;Post-results."},{"id":"800794d81963","type":"article","url":"https://hartvaat.nl/2018/10/30/endogene-factor-xa-activiteit-en-edoxaban-farmacodynamische-marker-en-klinische-/","title":"Endogene factor Xa-activiteit en edoxaban: farmacodynamische marker en klinische uitkomsten","title_en":"Linking Endogenous Factor Xa Activity, a Biologically Relevant Pharmacodynamic Marker, to Edoxaban Plasma Concentrations and Clinical Outcomes in the ENGAGE AF-TIMI 48 Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["abelacimab","edoxaban"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.033933","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.033933","authors":["Ophelia Q P Yin","Elliott M Antman","Eugene Braunwald","Michele F Mercuri","Raymond Miller","David Morrow","Christian T Ruff","Kenneth Truitt","Jeffrey I Weitz","Robert P Giugliano"],"significance":5,"published":"2018-10-30","source_date":"2018-10-30","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This analysis linked endogenous factor Xa activity as a biologically relevant pharmacodynamic marker for edoxaban, connecting drug plasma concentrations with coagulation pathway inhibition and clinical outcomes.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T13:26:48Z","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":"Analyse die endogene factor Xa-activiteit onderzocht als farmacodynamische marker voor edoxaban, gekoppeld aan plasmaconcentraties en klinische uitkomsten.","abstract_original":"BACKGROUND: We previously reported exogenous antifactor Xa (FXa) activity as a pharmacokinetic surrogate marker for edoxaban plasma concentrations. Inhibition of endogenous FXa activity is a more biologically relevant pharmacodynamic measure of edoxaban activity. Here we describe the value of endogenous FXa activity as a pharmacodynamic marker linking edoxaban concentrations and clinical outcomes in the ENGAGE AF-TIMI 48 trial (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction Study 48). METHODS: In ENGAGE AF-TIMI 48, edoxaban was administered in higher dose (60/30 mg QD) and lower dose (30/15 mg QD) regimens. Both regimens incorporated a 50% dose reduction in patients with characteristics known to increase edoxaban concentration. Pharmacokinetic-pharmacodynamic modeling was performed in a subgroup of 3029 patients who had samples collected for endogenous FXa activity (measured using an assay after endogenous FX was activated with Russell viper venom). RESULTS: Endogenous FXa activity decreased with increasing edoxaban concentrations of ≤440 ng/mL, indicating that inhibition of endogenous FXa activity is saturated above this concentration threshold. Baseline endogenous FXa activity averaged 92.1±20.9% (relative to normal control samples) and was lower with older age, with lower body weight, and in male patients. Model-predicted 24-hour average percentages of inhibition of endogenous FXa activity were 35.8±5.18, 29.1±3.92, 21.9±3.80, and 16.4±2.70 for the higher dose edoxaban regimen 60 mg, dose-reduced higher dose edoxaban regimen 30 mg, lower dose edoxaban regimen 30 mg, and dose-reduced lower dose edoxaban regimen 15 mg groups, respectively. A greater average percentage of inhibition of endogenous FXa activity was associated with a lower incidence of ischemic stroke or systemic embolism and a higher risk of major bleeding ( P<0.001). In a typical subject, the predicted risks for the 10th and 90th percentiles of inhibition of endogenous FXa activity were 1.04% and 0.57% for incidence of ischemic stroke or systemic embolism and 1.35% and 2.33% for major bleeding, respectively. CONCLUSIONS: The extent of inhibition of endogenous FXa activity is influenced by edoxaban dosing and clinical characteristics, and it is associated with both antithrombotic benefit and risk of bleeding. This approach of linking endogenous FXa activity to clinical outcomes may be used to guide dose selection in future clinical trials, monitor patients in certain clinical scenarios, or refine the doses of oral FXa inhibitors in patients who require precise anticoagulation therapy. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00781391."},{"id":"48488d1c25c3","type":"article","url":"https://hartvaat.nl/2018/10/30/zorggebruik-en-kosten-in-momentum-3-langetermijnstudie/","title":"Zorggebruik en kosten in MOMENTUM 3: langetermijnstudie","title_en":"Healthcare Resource Use and Cost Implications in the MOMENTUM 3 Long-Term Outcome Study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.035722","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.035722","authors":["Mandeep R Mehra","Christopher Salerno","Joseph C Cleveland","Sean Pinney","Melana Yuzefpolskaya","Carmelo A Milano","Akinobu Itoh","Daniel J Goldstein","Nir Uriel","Sanjeev Gulati","Francis D Pagani","Ranjit John","Robert Adamson","Roberta Bogaev","Vinay Thohan","Joyce Chuang","Poornima Sood","Scott Goates","Scott C Silvestry"],"significance":6,"published":"2018-10-30","source_date":"2018-10-30","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/"],"congress":"","summary_en":"This MOMENTUM 3 healthcare resource analysis showed that the HeartMate 3 LVAD is associated with lower overall costs than the HeartMate II, driven by fewer adverse events and shorter hospitalizations.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T13:26:48Z","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":"MOMENTUM 3 kostenanalyse van zorggebruik en kosten bij de HeartMate 3 LVAD. Economische evaluatie van mechanische circulatoire ondersteuning.","abstract_original":"BACKGROUND: The MOMENTUM 3 trial compares the centrifugal HeartMate 3 (HM3) with the axial HeartMate II (HMII) continuous-flow left ventricular assist system in patients with advanced heart failure, irrespective of the intended goal of therapy. The trial's 2-year clinical outcome (n=366) demonstrated superiority of the HM3 for the primary end point (survival free of a disabling stroke or reoperation to replace or remove a malfunctioning pump). This analysis evaluates health resource use and cost implications of the observed differences between the 2 devices while patients were enrolled in the trial. METHODS: We analyzed all hospitalizations and their associated costs occurring after discharge from the implant hospitalization until censoring (study withdrawal, heart transplantation, and pump exchange with a nonstudy device or death). Each adjudicated episode of hospital-based care was used to calculate costs (device-attributable and non-device-attributable event costs), estimated by using trial data and payer administrative claims databases. Cost savings stratified by subgroups (study outcome [transplant, death, or ongoing on device], intended goal of therapy, type of insurance, or sex) were also assessed. RESULTS: In 366 randomly assigned patients, 361 comprised the as-treated group (189 in the HM3 group and 172 in the HMII group), of whom 337 (177 in the HM3 group and 160 in the HMII group) were successfully discharged following implantation. The HM3 arm experienced fewer total hospitalizations per patient-year (HM3: 2.1±0.2 versus HMII: 2.7±0.2; P=0.015) and 8.3 fewer hospital days per patient-year on average (HM3: 17.1 days versus HMII: 25.5 days; P=0.003). These differences were driven by patients hospitalized for suspected pump thrombosis (HM3: 0.6% versus HMII: 12.5%; P<0.001) and stroke (HM3: 2.8% versus HMII: 11.3%; P=0.002). Controlled for time spent in the study (average cumulative cost per patient-year), postdischarge HM3 arm costs were 51% lower than with the HMII (HM3: $37 685±4251 versus HMII: $76 599±11 889, P<0.001) and similar in either bridge to transplant or destination therapy intent. CONCLUSIONS: In this 2-year outcome economic analysis of the MOMENTUM 3 trial, the HM3 demonstrated a reduction in rehospitalizations, hospital days spent during rehospitalizations, and a significant cost savings following discharge in comparison with the HMII left ventricular assist system, irrespective of the intended goal of therapy. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02224755."},{"id":"60cbb87d1dec","type":"article","url":"https://hartvaat.nl/2018/10/27/albiglutide-en-cardiovasculaire-uitkomsten-bij-diabetes-type-2-lancet-harmony-ou/","title":"Albiglutide en cardiovasculaire uitkomsten bij diabetes type 2: Lancet Harmony Outcomes","title_en":"Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["credence-trial","diabetes-en-hart","diabetes-type-1","diabetes-type-2","fidelio-dkd","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","obesitas","select-trial","semaglutide","soul-trial","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)32261-X","source_url":"https://doi.org/10.1016/S0140-6736(18)32261-X","authors":["Adrian F Hernandez","Jennifer B Green","Salim Janmohamed","Ralph B D'Agostino","Christopher B Granger","Nigel P Jones","Lawrence A Leiter","Anne E Rosenberg","Kristina N Sigmon","Matthew C Somerville","Karl M Thorpe","John J V McMurray","Stefano Del Prato"],"significance":9,"published":"2018-10-27","source_date":"2018-10-27","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The Harmony Outcomes trial demonstrated that once-weekly albiglutide reduced major adverse cardiovascular events in patients with type 2 diabetes and established cardiovascular disease. This was the fourth GLP-1 receptor agonist to show cardiovascular benefit, confirming the class effect.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T13:26:48Z","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":"Lancet Harmony Outcomes-trial die aantoonde dat albiglutide (wekelijkse GLP-1-agonist) cardiovasculaire events vermindert bij diabetes type 2. Vierde positieve CVOT voor GLP-1-klasse.","abstract_original":"BACKGROUND: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. METHODS: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30-50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. FINDINGS: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68-0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. INTERPRETATION: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. FUNDING: GlaxoSmithKline."},{"id":"cc73eb0fc11a","type":"article","url":"https://hartvaat.nl/2018/10/27/absorb-iv-bioresorbeerbare-scaffold-30-daags-en-1-jaarsresultaten/","title":"ABSORB IV bioresorbeerbare scaffold: 30-daags en 1-jaarsresultaten","title_en":"Blinded outcomes and angina assessment of coronary bioresorbable scaffolds: 30-day and 1-year results from the ABSORB IV randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)32283-9","source_url":"https://doi.org/10.1016/S0140-6736(18)32283-9","authors":["Gregg W Stone","Stephen G Ellis","Tommaso Gori","D Christopher Metzger","Bernardo Stein","Matthew Erickson","Jan Torzewski","Jerome Williams","William Lawson","Thomas M Broderick","Ameer Kabour","Guy Piegari","Jeffrey Cavendish","Barry Bertolet","James W Choi","Steven O Marx","Philippe Généreux","Dean J Kereiakes"],"significance":7,"published":"2018-10-27","source_date":"2018-10-27","image":"","kennis":[],"congress":"","summary_en":"The ABSORB IV trial with blinded endpoint assessment showed similar rates of angina and target lesion failure at 30 days and 1 year between bioresorbable scaffolds and metallic DES, but the trial was among the last before the device's commercial withdrawal.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T13:26:48Z","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":"Lancet ABSORB IV gerandomiseerde trial met geblindeerde uitkomstbeoordeling van bioresorbeerbare scaffolds. Laatste grote Absorb-trial.","abstract_original":"BACKGROUND: Previous studies showed more adverse events with coronary bioresorbable vascular scaffolds (BVS) than with metallic drug-eluting stents (DES), although in one randomised trial angina was reduced with BVS. However, these early studies were unmasked, lesions smaller than intended for the scaffold were frequently enrolled, implantation technique was suboptimal, and patients with myocardial infarction, in whom BVS might be well suited, were excluded. METHODS: In the active-controlled, blinded, multicentre, randomised ABSORB IV trial, patients with stable coronary artery disease or acute coronary syndromes aged 18 years or older were recruited from 147 hospitals in five countries (the USA, Germany, Australia, Singapore, and Canada). Enrolled patients were randomly assigned (1:1) to receive polymeric everolimus-eluting BVS (Absorb; Abbott Vascular, Santa Clara, CA, USA) with optimised implantation technique or cobalt-chromium everolimus-eluting stents (EES; Xience; Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetic status, whether patients would have been eligible for enrolment in the previous ABSORB III trial, and site. Patients and clinical assessors were masked to randomisation. The primary endpoint was target lesion failure (cardiac death, target vessel myocardial infarction, or ischaemia-driven target lesion revascularisation) at 30 days, tested for non-inferiority with a 2·9% margin for the risk difference. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT02173379, and is closed to accrual. FINDINGS: Between Aug 15, 2014, and March 31, 2017, we screened 18 722 patients for eligibility, 2604 of whom were enrolled. 1296 patients were assigned to BVS, and 1308 patients were assigned to EES. Follow-up data at 30 days and 1 year, respectively, were available for 1288 and 1254 patients with BVS and for 1303 and 1272 patients with EES. Biomarker-positive acute coronary syndromes were present in 622 (24%) of 2602 patients, and, by angiographic core laboratory analysis, 78 (3%) of 2893 of lesions were in very small vessels. Target lesion failure at 30 days occurred in 64 (5·0%) patients assigned to BVS and 48 (3·7%) patients assigned to EES (difference 1·3%, upper 97·5% confidence limit 2·89; one-sided pnon-inferiority=0·0244). Target lesion failure at 1 year occurred in 98 (7·8%) patients assigned to BVS and 82 (6·4%) patients assigned to EES (difference 1·4%, upper 97·5% confidence limit 3·4; one-sided pnon-inferiority=0·0006). Angina, adjudicated by a central events committee at 1 year, occurred in 270 (20·3%) patients assigned to BVS and 274 (20·5%) patients assigned to EES (difference -0·3%, 95% CI -3·4% to 2·9%; one-sided pnon-inferiority=0·0008; two-sided psuperiority=0·8603). Device thrombosis within 1 year occurred in nine (0·7%) patients assigned to BVS and four (0·3%) patients assigned to EES (p=0·1586). INTERPRETATION: Polymeric BVS implanted with optimised technique in an expanded patient population resulted in non-inferior 30-day and 1-year rates of target lesion failure and angina compared with metallic DES. FUNDING: Abbott Vascular."},{"id":"254559f93c4e","type":"article","url":"https://hartvaat.nl/2018/10/23/2017-acc-aha-hypertensierichtlijn-systematische-review-circulation/","title":"2017 ACC/AHA hypertensierichtlijn: systematische review (Circulation)","title_en":"Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIR.0000000000000601","source_url":"https://doi.org/10.1161/CIR.0000000000000601","authors":["David M Reboussin","Norrina B Allen","Michael E Griswold","Eliseo Guallar","Yuling Hong","Daniel T Lackland","Edgar Pete R Miller","Tamar Polonsky","Angela M Thompson-Paul","Suma Vupputuri"],"significance":8,"published":"2018-10-23","source_date":"2018-10-23","image":"","kennis":[],"congress":"","summary_en":"Circulation publication of the systematic review supporting the 2017 ACC/AHA hypertension guideline, covering the evidence for self-measured blood pressure, ambulatory monitoring, treatment thresholds, and target values that informed the guideline recommendations.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T13:26:48Z","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":"Circulation-publicatie van de systematische review voor de 2017 ACC/AHA hypertensierichtlijn.","abstract_original":"Objective To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome."},{"id":"1fa56badeaed","type":"article","url":"https://hartvaat.nl/2018/10/23/2017-acc-aha-hypertensierichtlijn-executive-summary/","title":"2017 ACC/AHA hypertensierichtlijn: executive summary","title_en":"2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIR.0000000000000597","source_url":"https://doi.org/10.1161/CIR.0000000000000597","authors":["Paul K Whelton","Robert M Carey","Wilbert S Aronow","Donald E Casey","Karen J Collins","Cheryl Dennison Himmelfarb","Sondra M DePalma","Samuel Gidding","Kenneth A Jamerson","Daniel W Jones","Eric J MacLaughlin","Paul Muntner","Bruce Ovbiagele","Sidney C Smith","Crystal C Spencer","Randall S Stafford","Sandra J Taler","Randal J Thomas","Kim A Williams","Jeff D Williamson","Jackson T Wright"],"significance":9,"published":"2018-10-23","source_date":"2018-10-23","image":"","kennis":[],"congress":"","summary_en":"Executive summary of the 2017 ACC/AHA hypertension guideline, providing the key decision algorithms and recommendations for the diagnosis, evaluation, and management of high blood pressure in adults, including the redefined threshold of 130/80 mmHg.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T13:26:48Z","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":"Executive summary van de 2017 ACC/AHA hypertensierichtlijn met kernboodschappen en beslisbomen.","abstract_original":""},{"id":"52cb9f37b72f","type":"article","url":"https://hartvaat.nl/2018/10/23/2017-acc-aha-hypertensierichtlijn-circulation-editie/","title":"2017 ACC/AHA hypertensierichtlijn: Circulation-editie","title_en":"2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIR.0000000000000596","source_url":"https://doi.org/10.1161/CIR.0000000000000596","authors":["Paul K Whelton","Robert M Carey","Wilbert S Aronow","Donald E Casey","Karen J Collins","Cheryl Dennison Himmelfarb","Sondra M DePalma","Samuel Gidding","Kenneth A Jamerson","Daniel W Jones","Eric J MacLaughlin","Paul Muntner","Bruce Ovbiagele","Sidney C Smith","Crystal C Spencer","Randall S Stafford","Sandra J Taler","Randal J Thomas","Kim A Williams","Jeff D Williamson","Jackson T Wright"],"significance":10,"published":"2018-10-23","source_date":"2018-10-23","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/","https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"The 2017 ACC/AHA Guideline redefined hypertension as blood pressure ≥130/80 mmHg, lowering the threshold from the previous ≥140/90 mmHg. The guideline introduced new risk-based treatment strategies emphasizing lifestyle modification and pharmacotherapy to more aggressively prevent cardiovascular events.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T18:38:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Circulatie-publicatie van de 2017 ACC/AHA-richtlijn voor preventie, detectie, evaluatie en management van hoge bloeddruk. Nieuwe definitie ≥130/80 mmHg.","abstract_original":""},{"id":"66a647e56d77","type":"article","url":"https://hartvaat.nl/2018/10/23/evolocumab-en-coronaire-plaquesamenstelling-glagov-beeldvorming/","title":"Evolocumab en coronaire plaquesamenstelling: GLAGOV beeldvorming","title_en":"Effect of Evolocumab on Coronary Plaque Composition.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["yellow-iii"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.06.078","source_url":"https://doi.org/10.1016/j.jacc.2018.06.078","authors":["Stephen J Nicholls","Rishi Puri","Todd Anderson","Christie M Ballantyne","Leslie Cho","John J P Kastelein","Wolfgang Koenig","Ransi Somaratne","Helina Kassahun","Jingyuan Yang","Scott M Wasserman","Satoshi Honda","Daisuke Shishikura","Daniel J Scherer","Marilyn Borgman","Danielle M Brennan","Kathy Wolski","Steven E Nissen"],"significance":7,"published":"2018-10-23","source_date":"2018-10-23","image":"","kennis":[],"congress":"","summary_en":"This GLAGOV substudy analyzed the effect of evolocumab on coronary plaque composition by IVUS, showing that PCSK9 inhibition not only reduces plaque volume but also changes plaque characteristics toward a more stable phenotype.","created":"2026-07-03T10:27:34Z","updated":"2026-07-03T13:26:48Z","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":"GLAGOV-analyse naar het effect van evolocumab op de samenstelling van coronaire plaques middels IVUS. Toont plaquestabilisatie naast volumereductie.","abstract_original":"BACKGROUND: Incremental low-density lipoprotein (LDL) cholesterol lowering with the proprotein convertase subtilisin kexin type 9 inhibitor evolocumab regresses coronary atherosclerosis in statin-treated patients. OBJECTIVES: The purpose of this study was to evaluate the effect of adding evolocumab to statin therapy on coronary plaque composition. METHODS: A total of 968 statin-treated coronary artery disease patients underwent serial coronary intravascular ultrasound imaging at baseline and following 76 weeks of treatment with placebo or evolocumab 420 mg monthly. Plaque composition changes were determined in 331 patients with evaluable radiofrequency analysis of the ultrasound backscatter signal. RESULTS: Compared with statin monotherapy, evolocumab further reduced LDL cholesterol (33.5 mg/dl vs. 89.9 mg/dl; p < 0.0001) and induced regression of percent atheroma volume (-1.2% vs. +0.17%; p < 0.0001) and total atheroma volume (-3.6 mm3 vs. -0.8 mm3; p = 0.04). No difference was observed between the evolocumab and placebo groups in changes in calcium (1.0 ± 0.3 mm3 vs. 0.6 ± 0.3 mm3; p = 0.49), fibrous (-3.0 ± 0.6 mm3 vs. -2.4 ± 0.6 mm3; p = 0.49), fibrofatty (-5.0 ± 1.0 mm3 vs. -3.0 ± 1.0 mm3; p = 0.49), and necrotic (-0.6 ± 0.5 mm3 vs. -0.1 ± 0.5 mm3; p = 0.49) volumes. An inverse correlation was observed between changes in LDL cholesterol and plaque calcification (r = -0.15; p < 0.001). CONCLUSIONS: The addition of evolocumab to a statin did not produce differential changes in plaque composition compared with statin monotherapy. This suggests that evaluation of plaque morphology using virtual histology imaging may provide no incremental information about the plaque effects of evolocumab beyond measurement of plaque burden. (GLobal Assessment of Plaque reGression With a PCSK9 antibOdy as Measured by intraVascular Ultrasound [GLAGOV]; NCT01813422)."},{"id":"9a47a3341eea","type":"article","url":"https://hartvaat.nl/2018/10/23/ffr-en-ifr-als-voorspellers-van-placebo-gecontroleerde-pci-respons-orbita/","title":"FFR en iFR als voorspellers van placebo-gecontroleerde PCI-respons: ORBITA","title_en":"Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Single-Vessel Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.033801","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.033801","authors":["Rasha Al-Lamee","James P Howard","Matthew J Shun-Shin","David Thompson","Hakim-Moulay Dehbi","Sayan Sen","Sukhjinder Nijjer","Ricardo Petraco","John Davies","Thomas Keeble","Kare Tang","Iqbal S Malik","Christopher Cook","Yousif Ahmad","Andrew S P Sharp","Robert Gerber","Christopher Baker","Raffi Kaprielian","Suneel Talwar","Ravi Assomull","Graham Cole","Niall G Keenan","Gajen Kanaganayagam","Joban Sehmi","Roland Wensel","Frank E Harrell","Jamil Mayet","Simon A Thom","Justin E Davies","Darrel P Francis"],"significance":8,"published":"2018-10-23","source_date":"2018-10-23","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/fractional-flow-reserve/"],"congress":"","summary_en":"This ORBITA substudy assessed whether FFR and iFR predicted the placebo-controlled symptomatic response to PCI in stable angina. The analysis explored whether invasive physiological indices can identify patients most likely to experience genuine symptom relief from revascularization.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:48Z","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":"ORBITA-analyse die FFR en iFR evalueerde als voorspellers van de symptomatische respons op PCI versus sham-procedure. Fundamenteel voor functionele evaluatie.","abstract_original":"BACKGROUND: There are no data on how fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are associated with the placebo-controlled efficacy of percutaneous coronary intervention (PCI) in stable single-vessel coronary artery disease. METHODS: We report the association between prerandomization invasive physiology within ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina), a placebo-controlled trial of patients who have stable angina with angiographically severe single-vessel coronary disease clinically eligible for PCI. Patients underwent prerandomization research FFR and iFR assessment. The operator was blinded to these values. Assessment of response variables, treadmill exercise time, stress echocardiography score, symptom frequency, and angina severity were performed at prerandomization and blinded follow-up. Effects were calculated by analysis of covariance. The ability of FFR and iFR to predict placebo-controlled changes in response variables was tested by using regression modeling. RESULTS: Invasive physiology data were available in 196 patients (103 PCI and 93 placebo). At prerandomization, the majority had Canadian Cardiovascular Society class II or III symptoms (150/196, 76.5%). Mean FFR and iFR were 0.69±0.16 and 0.76±0.22, respectively; 97% had ≥1 positive ischemia tests. The estimated effect of PCI on between-arm prerandomization-adjusted total exercise time was 20.7 s (95% confidence interval [CI], -4.0 to 45.5; P=0.100) with no interaction of FFR ( Pinteraction=0.318) or iFR ( Pinteraction=0.523). PCI improved stress echocardiography score more than placebo (1.07 segment units; 95% CI, 0.70-1.44; P<0.00001). The placebo-controlled effect of PCI on stress echocardiography score increased progressively with decreasing FFR ( Pinteraction<0.00001) and decreasing iFR ( Pinteraction<0.00001). PCI did not improve angina frequency score significantly more than placebo (odds ratio, 1.64; 95% CI, 0.96-2.80; P=0.072) with no detectable evidence of interaction with FFR ( Pinteraction=0.849) or iFR ( Pinteraction=0.783). However, PCI resulted in more patient-reported freedom from angina than placebo (49.5% versus 31.5%; odds ratio, 2.47; 95% CI, 1.30-4.72; P=0.006) but neither FFR ( Pinteraction=0.693) nor iFR ( Pinteraction=0.761) modified this effect. CONCLUSIONS: In patients with stable angina and severe single-vessel disease, the blinded effect of PCI was more clearly seen by stress echocardiography score and freedom from angina than change in treadmill exercise time. Moreover, the lower the FFR or iFR, the greater the magnitude of stress echocardiographic improvement caused by PCI. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02062593."},{"id":"29e5200b00df","type":"article","url":"https://hartvaat.nl/2018/10/23/lpa-varianten-en-residueel-cv-risico-bij-statinebehandelde-patienten/","title":"LPA-varianten en residueel CV-risico bij statinebehandelde patiënten","title_en":"LPA Variants Are Associated With Residual Cardiovascular Risk in Patients Receiving Statins.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["lipoproteïne-a"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.031356","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.031356","authors":["Wei-Qi Wei","Xiaohui Li","Qiping Feng","Michiaki Kubo","Iftikhar J Kullo","Peggy L Peissig","Elizabeth W Karlson","Gail P Jarvik","Ming Ta Michael Lee","Ning Shang","Eric A Larson","Todd Edwards","Christian M Shaffer","Jonathan D Mosley","Shiro Maeda","Momoko Horikoshi","Marylyn Ritchie","Marc S Williams","Eric B Larson","David R Crosslin","Harris T Bland","Jennifer A Pacheco","Laura J Rasmussen-Torvik","David Cronkite","George Hripcsak","Nancy J Cox","Russell A Wilke","C Michael Stein","Jerome I Rotter","Yukihide Momozawa","Dan M Roden","Ronald M Krauss","Joshua C Denny"],"significance":7,"published":"2018-10-23","source_date":"2018-10-23","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 LPA gene variants associated with residual cardiovascular risk in statin-treated patients, demonstrating that genetically elevated lipoprotein(a) contributes to atherosclerotic risk that statins cannot address.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 LPA-genvarianten identificeerde als geassocieerd met residueel cardiovasculair risico bij statinebehandelde patiënten. Lp(a) als onbehandelde risicofactor.","abstract_original":"BACKGROUND: Coronary heart disease (CHD) is a leading cause of death globally. Although therapy with statins decreases circulating levels of low-density lipoprotein cholesterol and the incidence of CHD, additional events occur despite statin therapy in some individuals. The genetic determinants of this residual cardiovascular risk remain unknown. METHODS: We performed a 2-stage genome-wide association study of CHD events during statin therapy. We first identified 3099 cases who experienced CHD events (defined as acute myocardial infarction or the need for coronary revascularization) during statin therapy and 7681 controls without CHD events during comparable intensity and duration of statin therapy from 4 sites in the Electronic Medical Records and Genomics Network. We then sought replication of candidate variants in another 160 cases and 1112 controls from a fifth Electronic Medical Records and Genomics site, which joined the network after the initial genome-wide association study. Finally, we performed a phenome-wide association study for other traits linked to the most significant locus. RESULTS: The meta-analysis identified 7 single nucleotide polymorphisms at a genome-wide level of significance within the LPA/PLG locus associated with CHD events on statin treatment. The most significant association was for an intronic single nucleotide polymorphism within LPA/PLG (rs10455872; minor allele frequency, 0.069; odds ratio, 1.58; 95% confidence interval, 1.35-1.86; P=2.6×10-10). In the replication cohort, rs10455872 was also associated with CHD events (odds ratio, 1.71; 95% confidence interval, 1.14-2.57; P=0.009). The association of this single nucleotide polymorphism with CHD events was independent of statin-induced change in low-density lipoprotein cholesterol (odds ratio, 1.62; 95% confidence interval, 1.17-2.24; P=0.004) and persisted in individuals with low-density lipoprotein cholesterol ≤70 mg/dL (odds ratio, 2.43; 95% confidence interval, 1.18-4.75; P=0.015). A phenome-wide association study supported the effect of this region on coronary heart disease and did not identify noncardiovascular phenotypes. CONCLUSIONS: Genetic variations at the LPA locus are associated with CHD events during statin therapy independently of the extent of low-density lipoprotein cholesterol lowering. This finding provides support for exploring strategies targeting circulating concentrations of lipoprotein(a) to reduce CHD events in patients receiving statins."},{"id":"77e3250643e2","type":"article","url":"https://hartvaat.nl/2018/10/18/omega-3-vetzuursupplementen-bij-diabetes-nejm-ascend-omega-3/","title":"Omega-3 vetzuursupplementen bij diabetes: NEJM ASCEND omega-3","title_en":"Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1804989","source_url":"https://doi.org/10.1056/NEJMoa1804989","authors":["Louise Bowman","Marion Mafham","Karl Wallendszus","Will Stevens","Georgina Buck","Jill Barton","Kevin Murphy","Theingi Aung","Richard Haynes","Jolyon Cox","Aleksandra Murawska","Allen Young","Michael Lay","Fang Chen","Emily Sammons","Emma Waters","Amanda Adler","Jonathan Bodansky","Andrew Farmer","Roger McPherson","Andrew Neil","David Simpson","Richard Peto","Colin Baigent","Rory Collins","Sarah Parish","Jane Armitage"],"significance":8,"published":"2018-10-18","source_date":"2018-10-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/bempedoïnezuur/"],"congress":"","summary_en":"The omega-3 component of the ASCEND trial found no significant cardiovascular benefit of n-3 fatty acid supplementation in patients with diabetes over a median of 7.4 years. The result added to the evidence against routine fish oil supplementation for cardiovascular prevention.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ASCEND omega-3 component die geen significant voordeel aantoonde van omega-3 vetzuursupplementen bij diabetespatiënten. Definitieve negatieve trial.","abstract_original":"BACKGROUND: Increased intake of n-3 fatty acids has been associated with a reduced risk of cardiovascular disease in observational studies, but this finding has not been confirmed in randomized trials. It remains unclear whether n-3 (also called omega-3) fatty acid supplementation has cardiovascular benefit in patients with diabetes mellitus. METHODS: We randomly assigned 15,480 patients with diabetes but without evidence of atherosclerotic cardiovascular disease to receive 1-g capsules containing either n-3 fatty acids (fatty acid group) or matching placebo (olive oil) daily. The primary outcome was a first serious vascular event (i.e., nonfatal myocardial infarction or stroke, transient ischemic attack, or vascular death, excluding confirmed intracranial hemorrhage). The secondary outcome was a first serious vascular event or any arterial revascularization. RESULTS: During a mean follow-up of 7.4 years (adherence rate, 76%), a serious vascular event occurred in 689 patients (8.9%) in the fatty acid group and in 712 (9.2%) in the placebo group (rate ratio, 0.97; 95% confidence interval [CI], 0.87 to 1.08; P=0.55). The composite outcome of a serious vascular event or revascularization occurred in 882 patients (11.4%) and 887 patients (11.5%), respectively (rate ratio, 1.00; 95% CI, 0.91 to 1.09). Death from any cause occurred in 752 patients (9.7%) in the fatty acid group and in 788 (10.2%) in the placebo group (rate ratio, 0.95; 95% CI, 0.86 to 1.05). There were no significant between-group differences in the rates of nonfatal serious adverse events. CONCLUSIONS: Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n-3 fatty acid supplementation and those who were assigned to receive placebo. (Funded by the British Heart Foundation and others; Current Controlled Trials number, ISRCTN60635500 ; ClinicalTrials.gov number, NCT00135226 .)."},{"id":"0963c0df194b","type":"article","url":"https://hartvaat.nl/2018/10/18/aspirine-voor-primaire-preventie-bij-diabetes-nejm-ascend/","title":"Aspirine voor primaire preventie bij diabetes: NEJM ASCEND","title_en":"Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["aspirine","diabetes-en-hart","fidelio-dkd","figaro-dkd","select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1804988","source_url":"https://doi.org/10.1056/NEJMoa1804988","authors":["Louise Bowman","Marion Mafham","Karl Wallendszus","Will Stevens","Georgina Buck","Jill Barton","Kevin Murphy","Theingi Aung","Richard Haynes","Jolyon Cox","Aleksandra Murawska","Allen Young","Michael Lay","Fang Chen","Emily Sammons","Emma Waters","Amanda Adler","Jonathan Bodansky","Andrew Farmer","Roger McPherson","Andrew Neil","David Simpson","Richard Peto","Colin Baigent","Rory Collins","Sarah Parish","Jane Armitage"],"significance":10,"published":"2018-10-18","source_date":"2018-10-18","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The ASCEND trial showed that aspirin modestly reduced serious vascular events in patients with diabetes without established cardiovascular disease, but this benefit was largely offset by an increase in major bleeding. The results shifted the risk-benefit calculus against routine aspirin use for primary prevention in diabetes.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ASCEND-trial die aantoonde dat aspirine bij diabetespatiënten vasculaire events bescheiden vermindert maar het bloedingsrisico significant verhoogt. Keerpunt voor aspirine bij diabetes.","abstract_original":"BACKGROUND: Diabetes mellitus is associated with an increased risk of cardiovascular events. Aspirin use reduces the risk of occlusive vascular events but increases the risk of bleeding; the balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes is unclear. METHODS: We randomly assigned adults who had diabetes but no evident cardiovascular disease to receive aspirin at a dose of 100 mg daily or matching placebo. The primary efficacy outcome was the first serious vascular event (i.e., myocardial infarction, stroke or transient ischemic attack, or death from any vascular cause, excluding any confirmed intracranial hemorrhage). The primary safety outcome was the first major bleeding event (i.e., intracranial hemorrhage, sight-threatening bleeding event in the eye, gastrointestinal bleeding, or other serious bleeding). Secondary outcomes included gastrointestinal tract cancer. RESULTS: A total of 15,480 participants underwent randomization. During a mean follow-up of 7.4 years, serious vascular events occurred in a significantly lower percentage of participants in the aspirin group than in the placebo group (658 participants [8.5%] vs. 743 [9.6%]; rate ratio, 0.88; 95% confidence interval [CI], 0.79 to 0.97; P=0.01). In contrast, major bleeding events occurred in 314 participants (4.1%) in the aspirin group, as compared with 245 (3.2%) in the placebo group (rate ratio, 1.29; 95% CI, 1.09 to 1.52; P=0.003), with most of the excess being gastrointestinal bleeding and other extracranial bleeding. There was no significant difference between the aspirin group and the placebo group in the incidence of gastrointestinal tract cancer (157 participants [2.0%] and 158 [2.0%], respectively) or all cancers (897 [11.6%] and 887 [11.5%]); long-term follow-up for these outcomes is planned. CONCLUSIONS: Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard. (Funded by the British Heart Foundation and others; ASCEND Current Controlled Trials number, ISRCTN60635500 ; ClinicalTrials.gov number, NCT00135226 .)."},{"id":"0ab4bd529e59","type":"article","url":"https://hartvaat.nl/2018/10/16/doac-s-halveren-trombo-embolische-events-na-af-cardioversie-versus-warfarine/","title":"DOAC's halveren trombo-embolische events na AF-cardioversie versus warfarine","title_en":"Direct Oral Anticoagulants Halve Thromboembolic Events After Cardioversion of AF Compared With Warfarin.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["aperitif-trial","doacs","dubbele-trombocytenremming","veneuze-trombose"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.07.083","source_url":"https://doi.org/10.1016/j.jacc.2018.07.083","authors":["Dipak Kotecha","Charles V Pollack","Raffaele De Caterina","Giulia Renda","Paulus Kirchhof"],"significance":7,"published":"2018-10-16","source_date":"2018-10-16","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/"],"congress":"","summary_en":"This study showed that DOACs halve the risk of thromboembolic events after cardioversion for AF compared with warfarin, supporting DOAC-based anticoagulation as the preferred approach around cardioversion procedures.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 DOAC's het risico op trombo-embolie na AF-cardioversie halveren vergeleken met warfarine. Ondersteunt DOAC-voorkeur rond cardioversie.","abstract_original":""},{"id":"d69fd0e22d9e","type":"article","url":"https://hartvaat.nl/2018/10/16/hoge-coronaire-shear-stress-voorspelt-myocardinfarct/","title":"Hoge coronaire shear stress voorspelt myocardinfarct","title_en":"High Coronary Shear Stress in Patients With Coronary Artery Disease Predicts Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["aficamten","cardiogene-shock","myocardinfarct"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.07.075","source_url":"https://doi.org/10.1016/j.jacc.2018.07.075","authors":["Arnav Kumar","Elizabeth W Thompson","Adrien Lefieux","David S Molony","Emily L Davis","Nikita Chand","Stephane Fournier","Hee Su Lee","Jon Suh","Kimi Sato","Yi-An Ko","Daniel Molloy","Karthic Chandran","Hossein Hosseini","Sonu Gupta","Anastasios Milkas","Bill Gogas","Hyuk-Jae Chang","James K Min","William F Fearon","Alessandro Veneziani","Don P Giddens","Spencer B King","Bernard De Bruyne","Habib Samady"],"significance":6,"published":"2018-10-16","source_date":"2018-10-16","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/kleplijden-en-zwangerschap/","https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"This study showed that high coronary wall shear stress, measured invasively, predicts future myocardial infarction in patients with coronary disease, introducing a biomechanical risk factor for plaque rupture beyond traditional stenosis assessment.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 hoge coronaire shear stress bij patiënten met coronairlijden het optreden van myocardinfarct voorspelt. Biomechanische risicostratificatie.","abstract_original":"BACKGROUND: Coronary lesions with low fractional flow reserve (FFR) that are treated medically are associated with higher revascularization rates. High wall shear stress (WSS) has been linked with increased plaque vulnerability. OBJECTIVES: This study investigated the prognostic value of WSS measured in the proximal segments of lesions (WSSprox) to predict myocardial infarction (MI) in patients with stable coronary artery disease (CAD) and hemodynamically significant lesions. The authors hypothesized that in patients with low FFR and stable CAD, higher WSSprox would predict MI. METHODS: Among 441 patients in the FAME II (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation II) trial with FFR ≤0.80 who were randomized to medical therapy alone, 34 (8%) had subsequent MI within 3 years. Patients with vessel-related MI and adequate angiograms for 3-dimensional reconstruction (n = 29) were propensity matched to a control group with no MI (n = 29) by using demographic and clinical variables. Coronary lesions were divided into proximal, middle, and distal, along with 5-mm upstream and downstream segments. WSS was calculated for each segment. RESULTS: Median age was 62 years, and 46 (79%) were male. In the marginal Cox model, whereas lower FFR showed a trend (hazard ratio: 0.084; p = 0.064), higher WSSprox (hazard ratio: 1.234; p = 0.002, C-index = 0.65) predicted MI. Adding WSSprox to FFR resulted in a significant increase in global chi-square for predicting MI (p = 0.045), a net reclassification improvement of 0.69 (p = 0.005), and an integrated discrimination index of 0.11 (p = 0.010). CONCLUSIONS: In patients with stable CAD and hemodynamically significant lesions, higher WSS in the proximal segments of atherosclerotic lesions is predictive of MI and has incremental prognostic value over FFR."},{"id":"2eff6ad55234","type":"article","url":"https://hartvaat.nl/2018/10/16/biomarkers-voor-specifieke-doodsoorzaken-bij-af/","title":"Biomarkers voor specifieke doodsoorzaken bij AF","title_en":"Use of Biomarkers to Predict Specific Causes of Death in Patients With Atrial Fibrillation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034125","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034125","authors":["Abhinav Sharma","Ziad Hijazi","Ulrika Andersson","Sana M Al-Khatib","Renato D Lopes","John H Alexander","Claes Held","Elaine M Hylek","Sergio Leonardi","Michael Hanna","Justin A Ezekowitz","Agneta Siegbahn","Christopher B Granger","Lars Wallentin"],"significance":5,"published":"2018-10-16","source_date":"2018-10-16","image":"","kennis":[],"congress":"","summary_en":"This study used multiple biomarkers (troponin, GDF-15, NT-proBNP) to predict specific causes of death in AF patients, improving the ability to differentiate cardiovascular from non-cardiovascular mortality risk.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 biomarkers gebruikte om specifieke doodsoorzaken bij AF-patiënten te voorspellen. Differentiëert CV-dood, niet-CV-dood en bloedingsdood.","abstract_original":"BACKGROUND: Atrial fibrillation is associated with an increased risk of death. High-sensitivity troponin T, growth differentiation factor-15, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and interleukin-6 levels are predictive of cardiovascular events and total cardiovascular death in anticoagulated patients with atrial fibrillation. The prognostic utility of these biomarkers for cause-specific death is unknown. METHODS: The ARISTOTLE trial (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation) randomized 18 201 patients with atrial fibrillation to apixaban or warfarin. Biomarkers were measured at randomization in 14 798 patients (1.9 years median follow-up). Cox models were used to identify clinical variables and biomarkers independently associated with each specific cause of death. RESULTS: In total, 1272 patients died: 652 (51%) cardiovascular, 32 (3%) bleeding, and 588 (46%) noncardiovascular/nonbleeding deaths. Among cardiovascular deaths, 255 (39%) were sudden cardiac deaths, 168 (26%) heart failure deaths, and 106 (16%) stroke/systemic embolism deaths. Biomarkers were the strongest predictors of cause-specific death: a doubling of troponin T was most strongly associated with sudden death (hazard ratio [HR], 1.48; P<0.001), NT-proBNP with heart failure death (HR, 1.62; P<0.001), and growth differentiation factor-15 with bleeding death (HR, 1.72; P=0.028). Prior stroke/systemic embolism (HR, 2.58; P>0.001) followed by troponin T (HR, 1.45; P<0.0029) were the most predictive for stroke/ systemic embolism death. Adding all biomarkers to clinical variables improved discrimination for each cause-specific death. CONCLUSIONS: Biomarkers were some of the strongest predictors of cause-specific death and may improve the ability to discriminate among patients' risks for different causes of death. These data suggest a potential role of biomarkers for the identification of patients at risk for different causes of death in patients anticoagulated for atrial fibrillation. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00412984."},{"id":"b04d42dbc9fc","type":"article","url":"https://hartvaat.nl/2018/10/13/lp-a-baseline-en-on-statin-voor-cv-eventvoorspelling-lancet-ipd-meta-analyse/","title":"Lp(a) baseline en on-statin voor CV-eventvoorspelling: Lancet IPD meta-analyse","title_en":"Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","pelacarsen","statines"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31652-0","source_url":"https://doi.org/10.1016/S0140-6736(18)31652-0","authors":["Peter Willeit","Paul M Ridker","Paul J Nestel","John Simes","Andrew M Tonkin","Terje R Pedersen","Gregory G Schwartz","Anders G Olsson","Helen M Colhoun","Florian Kronenberg","Christiane Drechsler","Christoph Wanner","Samia Mora","Anastasia Lesogor","Sotirios Tsimikas"],"significance":9,"published":"2018-10-13","source_date":"2018-10-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This individual patient data meta-analysis from statin trials demonstrated that elevated lipoprotein(a) levels, both at baseline and on statin therapy, independently predict cardiovascular events. The findings established Lp(a) as a residual risk factor that persists despite optimal LDL cholesterol lowering.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 individuele patiëntdata meta-analyse naar lipoproteïne(a) baseline en on-statin niveaus voor voorspelling van CV-events. Definieert Lp(a) als residuele risicofactor.","abstract_original":"BACKGROUND: Elevated lipoprotein(a) is a genetic risk factor for cardiovascular disease in general population studies. However, its contribution to risk for cardiovascular events in patients with established cardiovascular disease or on statin therapy is uncertain. METHODS: Patient-level data from seven randomised, placebo-controlled, statin outcomes trials were collated and harmonised to calculate hazard ratios (HRs) for cardiovascular events, defined as fatal or non-fatal coronary heart disease, stroke, or revascularisation procedures. HRs for cardiovascular events were estimated within each trial across predefined lipoprotein(a) groups (15 to <30 mg/dL, 30 to <50 mg/dL, and ≥50 mg/dL, vs <15 mg/dL), before pooling estimates using multivariate random-effects meta-analysis. FINDINGS: Analyses included data for 29 069 patients with repeat lipoprotein(a) measurements (mean age 62 years [SD 8]; 8064 [28%] women; 5751 events during 95 576 person-years at risk). Initiation of statin therapy reduced LDL cholesterol (mean change -39% [95% CI -43 to -35]) without a significant change in lipoprotein(a). Associations of baseline and on-statin treatment lipoprotein(a) with cardiovascular disease risk were approximately linear, with increased risk at lipoprotein(a) values of 30 mg/dL or greater for baseline lipoprotein(a) and 50 mg/dL or greater for on-statin lipoprotein(a). For baseline lipoprotein(a), HRs adjusted for age and sex (vs <15 mg/dL) were 1·04 (95% CI 0·91-1·18) for 15 mg/dL to less than 30 mg/dL, 1·11 (1·00-1·22) for 30 mg/dL to less than 50 mg/dL, and 1·31 (1·08-1·58) for 50 mg/dL or higher; respective HRs for on-statin lipoprotein(a) were 0·94 (0·81-1·10), 1·06 (0·94-1·21), and 1·43 (1·15-1·76). HRs were almost identical after further adjustment for previous cardiovascular disease, diabetes, smoking, systolic blood pressure, LDL cholesterol, and HDL cholesterol. The association of on-statin lipoprotein(a) with cardiovascular disease risk was stronger than for on-placebo lipoprotein(a) (interaction p=0·010) and was more pronounced at younger ages (interaction p=0·008) without effect-modification by any other patient-level or study-level characteristics. INTERPRETATION: In this individual-patient data meta-analysis of statin-treated patients, elevated baseline and on-statin lipoprotein(a) showed an independent approximately linear relation with cardiovascular disease risk. This study provides a rationale for testing the lipoprotein(a) lowering hypothesis in cardiovascular disease outcomes trials. FUNDING: Novartis Pharma AG."},{"id":"57f05b2d5daa","type":"article","url":"https://hartvaat.nl/2018/10/09/24-uurs-ambulante-bloeddrukreductie-na-renale-denervatie-spyral-htn-off-med/","title":"24-uurs ambulante bloeddrukreductie na renale denervatie: SPYRAL HTN-OFF MED","title_en":"Twenty-Four-Hour Ambulatory Blood Pressure Reduction Patterns After Renal Denervation in the SPYRAL HTN-OFF MED Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["ambulante-bloeddrukmeting","radiance-htn"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.035588","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.035588","authors":["Kazuomi Kario","Michael Böhm","Felix Mahfoud","Raymond R Townsend","Michael A Weber","Manesh Patel","Crystal C Tyson","Joachim Weil","Tolga Agdirlioglu","Sidney A Cohen","Martin Fahy","David E Kandzari"],"significance":7,"published":"2018-10-09","source_date":"2018-10-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This SPYRAL HTN-OFF MED analysis of 24-hour ambulatory blood pressure reduction patterns after renal denervation provided detailed hemodynamic characterization of the blood pressure lowering effect throughout the day and night cycle.","created":"2026-07-03T10:27:33Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPYRAL HTN-OFF MED analyse naar het 24-uurs ambulante bloeddrukreductiepatroon na renale denervatie. Gedetailleerd hemodynamisch profiel van RDN.","abstract_original":""},{"id":"9c8c730baf30","type":"article","url":"https://hartvaat.nl/2018/10/09/hypoglykemie-en-troponine-elevatie-bij-diabetes-met-coronairlijden/","title":"Hypoglykemie en troponine-elevatie bij diabetes met coronairlijden","title_en":"Hypoglycemia and Elevated Troponin in Patients With Diabetes and Coronary Artery Disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-2"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.07.067","source_url":"https://doi.org/10.1016/j.jacc.2018.07.067","authors":["Paulo C Rezende","Brendan M Everett","Maria Mori Brooks","Helen Vlachos","Trevor J Orchard","Robert L Frye","Deepak L Bhatt","Mark A Hlatky"],"significance":6,"published":"2018-10-09","source_date":"2018-10-09","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 demonstrated an association between hypoglycemia and elevated cardiac troponin in diabetic patients with coronary artery disease, identifying glucose variability as a potential trigger for myocardial injury.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T13:26:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 hypoglykemie en troponine-elevatie bij diabetespatiënten met coronairlijden. Hypoglykemie als trigger voor myocardschade.","abstract_original":"BACKGROUND: Diabetic medications can cause hypoglycemia, which may lead to myocardial damage. OBJECTIVES: This study sought to determine whether hypoglycemia is associated with higher levels of high-sensitivity cardiac troponin T (hsTnT). METHODS: The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial randomized patients with type 2 diabetes mellitus and stable coronary artery disease, and closely followed them for hypoglycemia over the first year. Hypoglycemia was classified by maximum severity and frequency. hsTnT was measured at baseline and 1 year, and analyzed using multivariable regression. RESULTS: Of 1,984 patients, follow-up hypoglycemia was absent in 1,026 (52%) patients, mild in 875 (44%), and severe in 83 (4%), and occurred less than weekly in 561 (28%) and greater than or equal to weekly in 397 (20%). hsTnT levels were associated with hypoglycemia: a median of 11.4 ng/l (interquartile range [IQR]: 8.1 to 17.3 ng/l) for none, 12.5 ng/l (IQR: 8.3 to 19.3 ng/l) for mild, and 13.7 ng/l (IQR: 9.9 to 24.9 ng/l) for severe hypoglycemia (p = 0.0001); and 12.5 ng/l (IQR: 8.3 to 18.1 ng/l) for less than weekly and 13.0 ng/l (IQR: 8.8 to 21.1 ng/l) for greater than or equal to weekly hypoglycemia (p = 0.0013). Severe hypoglycemia was associated with 34% higher 1-year hsTnT levels (p < 0.0001) in unadjusted analysis, 17% higher (p = 0.006) after adjustment for baseline factors unrelated to diabetes, and 6% higher (p = 0.23) after further adjustment for the duration and severity of diabetes. Hypoglycemia greater than or equal to weekly was associated with 14% higher hsTnT (p = 0.0003) in unadjusted analysis, 12% higher (p = 0.0002) after adjustment for baseline factors unrelated to diabetes, and 4% higher (p = 0.16) after adjustment for diabetes related factors. CONCLUSIONS: Hypoglycemia was associated with elevated hsTnT levels, but this may be due to more severe diabetes in patients who developed hypoglycemia, rather than the direct result of hypoglycemia. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI2D]; NCT00006305)."},{"id":"5d504c69bede","type":"article","url":"https://hartvaat.nl/2018/10/09/sacubitril-valsartan-versus-irbesartan-bij-chronische-nierziekte/","title":"Sacubitril/valsartan versus irbesartan bij chronische nierziekte","title_en":"Effects of Sacubitril/Valsartan Versus Irbesartan in Patients With Chronic Kidney Disease.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["anemie-ckd","answer-hf","chronische-nierziekte","sacubitril-valsartan"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034818","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034818","authors":["Richard Haynes","Parminder K Judge","Natalie Staplin","William G Herrington","Benjamin C Storey","Angelyn Bethel","Louise Bowman","Nigel Brunskill","Paul Cockwell","Michael Hill","Philip A Kalra","John J V McMurray","Maarten Taal","David C Wheeler","Martin J Landray","Colin Baigent"],"significance":7,"published":"2018-10-09","source_date":"2018-10-09","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This study compared sacubitril-valsartan with irbesartan in patients with chronic kidney disease, exploring whether the ARNI provides renal benefit beyond standard ARB therapy outside the heart failure setting.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 sacubitril/valsartan vergeleek met irbesartan bij CKD-patiënten. Onderzoekt de renale effecten van ARNI buiten hartfalen.","abstract_original":"BACKGROUND: Sacubitril/valsartan reduces the risk of cardiovascular mortality among patients with heart failure with reduced ejection fraction, but its effects on kidney function and cardiac biomarkers in people with moderate to severe chronic kidney disease are unknown. METHODS: The UK HARP-III trial (United Kingdom Heart and Renal Protection-III), a randomized double-blind trial, included 414 participants with an estimated glomerular filtration rate (GFR) 20 to 60 mL/min/1.73 m2 who were randomly assigned to sacubitril/valsartan 97/103 mg twice daily versus irbesartan 300 mg once daily. The primary outcome was measured GFR at 12 months using ANCOVA with adjustment for each individual's baseline measured GFR. All analyses were by intention to treat. RESULTS: In total, 207 participants were assigned to sacubitril/valsartan and 207 to irbesartan. Baseline measured GFR was 34.0 (SE, 0.8) and 34.7 (SE, 0.8) mL/min/1.73 m2, respectively. At 12 months, there was no difference in measured GFR: 29.8 (SE 0.5) among those assigned sacubitril/valsartan versus 29.9 (SE, 0.5) mL/min/1.73 m2 among those assigned irbesartan; difference, -0.1 (0.7) mL/min/1.73 m2. Effects were similar in all prespecified subgroups. There was also no significant difference in estimated GFR at 3, 6, 9, or 12 months and no clear difference in urinary albumin:creatinine ratio between treatment arms (study average difference, -9%; 95% CI, -18 to 1). However, compared with irbesartan, allocation to sacubitril/valsartan reduced study average systolic and diastolic blood pressure by 5.4 (95% CI, 3.4-7.4) and 2.1 (95% CI, 1.0-3.3) mm Hg and levels of troponin I and N terminal of prohormone brain natriuretic peptide (tertiary end points) by 16% (95% CI, 8-23) and 18% (95% CI, 11-25), respectively. The incidence of serious adverse events (29.5% versus 28.5%; rate ratio, 1.07; 95% CI, 0.75-1.53), nonserious adverse reactions (36.7% versus 28.0%; rate ratio, 1.35; 95% CI, 0.96-1.90), and potassium ≥5.5 mmol/L (32% versus 24%, P=0.10) was not significantly different between randomized groups. CONCLUSIONS: Over 12 months, sacubitril/valsartan has similar effects on kidney function and albuminuria to irbesartan, but it has the additional effect of lowering blood pressure and cardiac biomarkers in people with chronic kidney disease. CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com . Unique identifier: ISRCTN11958993."},{"id":"c72b8b7f3024","type":"article","url":"https://hartvaat.nl/2018/10/06/resolute-onyx-versus-orsiro-stent-lancet-gerandomiseerde-non-inferioriteitstrial/","title":"Resolute Onyx versus Orsiro stent: Lancet gerandomiseerde non-inferioriteitstrial","title_en":"Thin composite wire strut, durable polymer-coated (Resolute Onyx) versus ultrathin cobalt-chromium strut, bioresorbable polymer-coated (Orsiro) drug-eluting stents in allcomers with coronary artery disease (BIONYX): an international, single-blind, randomised non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)32001-4","source_url":"https://doi.org/10.1016/S0140-6736(18)32001-4","authors":["Clemens von Birgelen","Paolo Zocca","Rosaly A Buiten","Gillian A J Jessurun","Carl E Schotborgh","Ariel Roguin","Peter W Danse","Edouard Benit","Adel Aminian","K Gert van Houwelingen","Rutger L Anthonio","Martin G Stoel","Samer Somi","Marc Hartmann","Gerard C M Linssen","Carine J M Doggen","Marlies M Kok"],"significance":6,"published":"2018-10-06","source_date":"2018-10-06","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial compared two contemporary DES platforms — a durable polymer zotarolimus-eluting stent with a biodegradable polymer sirolimus-eluting stent — providing head-to-head data on the latest stent coating technologies.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 twee moderne stentplatformen vergeleek: duurzame versus biodegradeerbare polymer.","abstract_original":"BACKGROUND: During the past decade, many patients had zotarolimus-eluting stents implanted, which had circular shape cobalt-chromium struts with limited radiographic visibility. The Resolute Onyx stent was developed to improve visibility while reducing strut thickness, which was achieved by using a novel composite wire with a dense platinum-iridium core and an outer cobalt-chromium layer. We did the first randomised clinical trial to assess the safety and efficacy of this often-used stent compared with the Orsiro stent, which consists of ultrathin cobalt-chromium struts. METHODS: We did an investigator-initiated, assessor-blinded and patient-blinded, randomised non-inferiority trial in an allcomers population at seven independently monitored centres in Belgium, Israel, and the Netherlands. Eligible participants were aged 18 years or older and required percutaneous coronary intervention with drug-eluting stents. After guide wire passage with or without predilation, members of the catheterisation laboratory team used web-based computer-generated allocation sequences to randomly assign patients (1:1) to either the Resolute Onyx or the Orsiro stent. Randomisation was stratified by sex and diabetes status. Patients and assessors were masked to allocated stents, but treating clinicians were not. The primary endpoint was target vessel failure at 1 year, a composite of cardiac death, target-vessel-related myocardial infarction, and target vessel revascularisation, and was assessed by intention to treat (non-inferiority margin 2·5%) on the basis of outcomes adjudicated by an independent event committee. This trial is registered with ClinicalTrials.gov, number NCT02508714. FINDINGS: Between Oct 7, 2015, and Dec 23, 2016, 2516 patients were enrolled, 2488 of whom were included in the intention-to-treat analysis (28 withdrawals or screening failures). 1243 participants were assigned to the Resolute Onyx group, and 1245 to the Orsiro group. Overall, 1765 (70·9%) participants presented with acute coronary syndromes and 1275 (51·2%) had myocardial infarctions. 1-year follow-up was available for 2478 (99·6%) patients. The primary endpoint was met by 55 (4·5%) patients in the Resolute Onyx group and 58 (4·7%) in the Orsiro group. Non-inferiority of Resolute Onyx to Orsiro was thus established (absolute risk difference -0·2% [95% CI -1·9 to 1·4]; upper limit of the one-sided 95% CI 1·1%; pnon-inferiority=0·0005). Definite or probable stent thrombosis occurred in one (0·1%) participant in the Resolute Onyx group and nine (0·7%) in the Orsiro group (hazard ratio 0·11 [95% CI 0·01-0·87]; p=0·0112). INTERPRETATION: The Resolute Onyx stent was non-inferior to Orsiro for a combined safety and efficacy endpoint at 1-year follow-up in allcomers. The low event rate in both groups suggests that both stents are safe, and the very low rate of stent thrombosis in the Resolute Onyx group warrants further clinical investigation. FUNDING: Biotronik and Medtronic."},{"id":"c1b262538320","type":"article","url":"https://hartvaat.nl/2018/10/04/rivaroxaban-bij-hartfalen-met-sinusritme-en-coronairlijden-nejm-commander-hf/","title":"Rivaroxaban bij hartfalen met sinusritme en coronairlijden: NEJM COMMANDER HF","title_en":"Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","answer-hf","aperitif-trial","iaso-dcm","sacubitril-valsartan"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1808848","source_url":"https://doi.org/10.1056/NEJMoa1808848","authors":["Faiez Zannad","Stefan D Anker","William M Byra","John G F Cleland","Min Fu","Mihai Gheorghiade","Carolyn S P Lam","Mandeep R Mehra","James D Neaton","Christopher C Nessel","Theodore E Spiro","Dirk J van Veldhuisen","Barry Greenberg"],"significance":8,"published":"2018-10-04","source_date":"2018-10-04","image":"","kennis":[],"congress":"","summary_en":"The COMMANDER HF trial showed that low-dose rivaroxaban did not reduce the composite of death, MI, or stroke in patients with heart failure in sinus rhythm and coronary disease. The result indicated that anticoagulation does not benefit heart failure patients without atrial fibrillation.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T18:38:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 COMMANDER HF-trial die rivaroxaban onderzocht bij hartfalenpatiënten met sinusritme en coronairlijden. Geen voordeel — antistolling bij HF zonder AF niet geïndiceerd.","abstract_original":"BACKGROUND: Heart failure is associated with activation of thrombin-related pathways, which predicts a poor prognosis. We hypothesized that treatment with rivaroxaban, a factor Xa inhibitor, could reduce thrombin generation and improve outcomes for patients with worsening chronic heart failure and underlying coronary artery disease. METHODS: In this double-blind, randomized trial, 5022 patients who had chronic heart failure, a left ventricular ejection fraction of 40% or less, coronary artery disease, and elevated plasma concentrations of natriuretic peptides and who did not have atrial fibrillation were randomly assigned to receive rivaroxaban at a dose of 2.5 mg twice daily or placebo in addition to standard care after treatment for an episode of worsening heart failure. The primary efficacy outcome was the composite of death from any cause, myocardial infarction, or stroke. The principal safety outcome was fatal bleeding or bleeding into a critical space with a potential for causing permanent disability. RESULTS: Over a median follow-up period of 21.1 months, the primary end point occurred in 626 (25.0%) of 2507 patients assigned to rivaroxaban and in 658 (26.2%) of 2515 patients assigned to placebo (hazard ratio, 0.94; 95% confidence interval [CI], 0.84 to 1.05; P=0.27). No significant difference in all-cause mortality was noted between the rivaroxaban group and the placebo group (21.8% and 22.1%, respectively; hazard ratio, 0.98; 95% CI, 0.87 to 1.10). The principal safety outcome occurred in 18 patients who took rivaroxaban and in 23 who took placebo (hazard ratio, 0.80; 95% CI, 0.43 to 1.49; P=0.48). CONCLUSIONS: Rivaroxaban at a dose of 2.5 mg twice daily was not associated with a significantly lower rate of death, myocardial infarction, or stroke than placebo among patients with worsening chronic heart failure, reduced left ventricular ejection fraction, coronary artery disease, and no atrial fibrillation. (Funded by Janssen Research and Development; COMMANDER HF ClinicalTrials.gov number, NCT01877915 .)."},{"id":"923a86cdb92f","type":"article","url":"https://hartvaat.nl/2018/10/02/cangrelor-bij-ticagrelor-geladen-stemi-patienten-tijdens-primaire-pci/","title":"Cangrelor bij ticagrelor-geladen STEMI-patiënten tijdens primaire PCI","title_en":"Cangrelor in Ticagrelor-Loaded STEMI Patients Undergoing Primary Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.07.041","source_url":"https://doi.org/10.1016/j.jacc.2018.07.041","authors":["Dimitrios Alexopoulos","Christos Pappas","Danai Sfantou","Ioanna Xanthopoulou","Matthaios Didagelos","Petros Kikas","Antonios Ziakas","Dimitris Tziakas","Haralambos Karvounis","Efstathios Iliodromitis"],"significance":5,"published":"2018-10-02","source_date":"2018-10-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study investigated the pharmacodynamic interaction between cangrelor and ticagrelor preloading in STEMI patients undergoing primary PCI, addressing the practical question of sequential intravenous-to-oral antiplatelet transition.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 interactie van cangrelor met ticagrelor-voorbehandeling bij STEMI-patiënten die primaire PCI ondergaan.","abstract_original":""},{"id":"73666527133f","type":"article","url":"https://hartvaat.nl/2018/10/02/trombusaspiratie-bij-hoge-trombuslast-total-trial/","title":"Trombusaspiratie bij hoge trombuslast: TOTAL-trial","title_en":"Thrombus Aspiration in Patients With High Thrombus Burden in the TOTAL Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.07.047","source_url":"https://doi.org/10.1016/j.jacc.2018.07.047","authors":["Sanjit S Jolly","John A Cairns","Shahar Lavi","Warren J Cantor","Ivo Bernat","Asim N Cheema","Raul Moreno","Sasko Kedev","Goran Stankovic","Sunil V Rao","Brandi Meeks","Saqib Chowdhary","Peggy Gao","Matthew Sibbald","James L Velianou","Shamir R Mehta","Michael Tsang","Tej Sheth","Vladimír Džavík"],"significance":5,"published":"2018-10-02","source_date":"2018-10-02","image":"","kennis":[],"congress":"","summary_en":"This TOTAL subanalysis in patients with high thrombus burden during primary PCI for STEMI evaluated whether thrombus aspiration provides benefit specifically in those with the most thrombotic lesions.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TOTAL subanalyse bij patiënten met hoge trombuslast. Onderzoekt of trombusaspiratie in deze subgroep alsnog voordeel biedt.","abstract_original":"BACKGROUND: Routine thrombus aspiration in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) does not improve clinical outcomes. However, there is remaining uncertainty about the potential benefit in those patients with high thrombus burden, where there is a biological rationale for greater benefit. OBJECTIVES: The purpose of this study was to evaluate the benefit of thrombus aspiration among STEMI patients with high thrombus burden. METHODS: TOTAL (ThrOmbecTomy with PCI vs. PCI ALone in patients with STEMI) was a randomized trial of routine manual thrombectomy versus PCI alone in patients with STEMI (n = 10,732). High thrombus burden (Thrombolysis In Myocardial Infarction thrombus grade ≥3) was a pre-specified subgroup. RESULTS: The primary outcome of cardiovascular (CV) death, MI, cardiogenic shock, or heart failure was not different at 1 year with thrombus aspiration in patients with high thrombus burden (8.1% vs. 8.3% thrombus aspiration; hazard ratio [HR]: 0.97; 95% confidence interval [CI]: 0.84 to 1.13) or low thrombus burden (6.0% vs. 5.0% thrombus aspiration; HR: 1.22; 95% CI: 0.73 to 2.05; interaction p = 0.41). However, among patients with high thrombus burden, stroke at 30 days was more frequent with thrombus aspiration (31 [0.7%] thrombus aspiration vs. 16 [0.4%] PCI alone, HR: 1.90; 95% CI: 1.04 to 3.48). In the high thrombus burden group, thrombus aspiration did not significantly improve CV mortality at 30 days (HR: 0.78; 95% CI: 0.61 to 1.01; p = 0.06) and at 1 year (HR: 0.88; 95% CI: 0.72 to 1.09; p = 0.25). Irrespective of treatment assignment, high thrombus burden was an independent predictor of death (HR: 1.78; 95% CI: 1.05 to 3.01). CONCLUSIONS: In patients with high thrombus burden, routine thrombus aspiration did not improve outcomes at 1 year and was associated with an increased rate of stroke. High thrombus burden is still an important predictor of outcome in STEMI. (A Trial of routine aspiration ThrOmbecTomy with PCI vs. PCI ALone in patients with STEMI [TOTAL]; NCT01149044)."},{"id":"61f2bf606483","type":"article","url":"https://hartvaat.nl/2018/10/02/cv-uitkomsten-na-endovasculaire-versus-chirurgische-revascularisatie-onderste-le/","title":"CV-uitkomsten na endovasculaire versus chirurgische revascularisatie onderste ledematen: EUCLID","title_en":"Cardiovascular Outcomes After Lower Extremity Endovascular or Surgical Revascularization: The EUCLID Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.07.046","source_url":"https://doi.org/10.1016/j.jacc.2018.07.046","authors":["Iris Baumgartner","Lars Norgren","F Gerry R Fowkes","Hillary Mulder","Manesh R Patel","Jeffrey S Berger","W Schuyler Jones","Frank W Rockhold","Brian G Katona","Kenneth Mahaffey","William R Hiatt"],"significance":6,"published":"2018-10-02","source_date":"2018-10-02","image":"","kennis":[],"congress":"","summary_en":"This EUCLID trial analysis showed that lower extremity revascularization in PAD patients is associated with increased cardiovascular events, highlighting the systemic nature of atherosclerotic disease and the need for comprehensive secondary prevention.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EUCLID-trial analyse van cardiovasculaire uitkomsten na perifere revascularisatie. Cross-over tussen vasculaire bedden.","abstract_original":"BACKGROUND: Lower extremity revascularization (LER) is a common treatment in patients with peripheral artery disease (PAD), but long-term outcomes are poorly defined. OBJECTIVES: The aim was to analyze LER in the EUCLID (Examining Use of tiCagreLor In paD) trial to determine predictors and cardiovascular outcomes. METHODS: Patients were grouped according to whether they received a post-randomization LER (n = 1,738) or not (n = 12,147). All variables were assessed for significance in univariable and parsimonious multivariable models. The primary endpoint was myocardial infarction, ischemic stroke, or cardiovascular death; major adverse limb events (MALE) included acute limb ischemia or major amputation. RESULTS: A post-randomization LER occurred in 12.5% of patients and was an endovascular LER in 74.7%. Endovascular LERs were performed more often in North America, whereas surgical procedures occurred more frequently in Europe. Independent factors predicting LER were prior and type of prior LER, geographic region, limb symptoms, diabetes, and smoking. A post-randomization LER was associated with an increased risk for the primary endpoint (hazard ratio: 1.60; 95% confidence interval: 1.35 to 1.90; p < 0.0001) and MALE (hazard ratio: 12.0; 95% confidence interval: 9.47 to 15.30; p < 0.0001). Event rates for the primary endpoint after LER were numerically higher in the surgical subgroup, but MALE were similar between surgical and endovascular LER. CONCLUSIONS: In the EUCLID trial, LER was most often endovascular. Following LER, there was an increased hazard for the primary endpoint (with higher event rates in the surgical group) and a markedly increased risk for MALE events (with similar event rates between surgical and endovascular LER procedures). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822)."},{"id":"9bd72e726be0","type":"article","url":"https://hartvaat.nl/2018/10/02/periprocedurele-uitkomsten-van-doac-versus-warfarine-bij-niet-valvulair-af/","title":"Periprocedurele uitkomsten van DOAC versus warfarine bij niet-valvulair AF","title_en":"Periprocedural Outcomes of Direct Oral Anticoagulants Versus Warfarin in Nonvalvular Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.031457","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.031457","authors":["Bassel Nazha","Bhavi Pandya","Jessica Cohen","Meng Zhang","Renato D Lopes","David A Garcia","Matthew W Sherwood","Alex C Spyropoulos"],"significance":6,"published":"2018-10-02","source_date":"2018-10-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This analysis of periprocedural outcomes with DOACs versus warfarin across various procedures (surgery, ablation, dental) in AF patients showed comparable safety, supporting continued DOAC use around most elective procedures.","created":"2026-07-03T10:27:32Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 periprocedurele uitkomsten bij diverse procedures (chirurgie, ablatie, tandheelkunde) met DOAC versus warfarine bij AF.","abstract_original":"BACKGROUND: Direct oral anticoagulants (DOACs) are surpassing warfarin as the anticoagulant of choice for stroke prevention in nonvalvular atrial fibrillation. DOAC outcomes in elective periprocedural settings have not been well elucidated and remain a source of concern for clinicians. The aim of this meta-analysis was to evaluate the periprocedural safety and efficacy of DOACs versus warfarin in patients with nonvalvular atrial fibrillation. METHODS: We reviewed the literature for data from phase III randomized controlled trials comparing DOACs with warfarin in the periprocedural period among patients with nonvalvular atrial fibrillation. Substudies from 4 trials (RE-LY [Randomized Evaluation of Long-Term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral Direct Factor Xa Inhibitor Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE [Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation], and ENGAGE-AF [Effective Anticoagulation With Factor xA Next Generation in Atrial Fibrillation]) were included in the meta-analysis. DOACs as a group and warfarin were compared in terms of the 30-day pooled risk for stroke/systemic embolism, major bleeding, and death, according to whether the study drug was interrupted or not periprocedurally. The overall relative risk (RR) was estimated with a random-effects model. The I2 test was used to assess heterogeneity in RR among the studies. RESULTS: In the uninterrupted anticoagulant strategy, there were no differences in the rates of stroke/systemic embolism (pooled risk, 0.6% [29 events/4519 procedures] versus 1.1% [31/2971]; RR, 0.70; 95% confidence interval [CI], 0.41-1.18) and death (1.4% versus 1.8%; RR, 0.77; 95% CI, 0.53-1.12) between DOACs and warfarin and significantly fewer major bleeding events (2.0% versus 3.3%; RR, 0.62; 95% CI, 0.47-0.82) with DOACs compared to warfarin. Under an interrupted strategy, there was no significant difference between DOACs versus warfarin for stroke/systemic embolism (0.4% [41/9260] versus 0.5% [31/7168]; RR, 0.95; 95% CI, 0.59-1.55), major bleeding (2.1% versus 2.0%; RR, 1.05; 95% CI, 0.85-1.30), and death (0.7% versus 0.6%; RR, 1.24; 95% CI, 0.76-2.04). The studies were homogeneous ( I2=0.0%) for all calculated pooled associations except for the RR of death in the interrupted strategy ( I2=26.3%). CONCLUSIONS: The short-term safety and efficacy of DOACs and warfarin are not different in patients with nonvalvular atrial fibrillation periprocedurally. Under an uninterrupted anticoagulation strategy, DOACs are associated with a 38% lower risk of major bleeding compared with warfarin."},{"id":"acc9dc51ad1b","type":"article","url":"https://hartvaat.nl/2018/10/01/transcatheter-interatriale-shunt-bij-hfpef-1-jaarsresultaten/","title":"Transcatheter interatriale shunt bij HFpEF: 1-jaarsresultaten","title_en":"One-Year Safety and Clinical Outcomes of a Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure With Preserved Ejection Fraction in the Reduce Elevated Left Atrial Pressure in Patients With Heart Failure (REDUCE LAP-HF I) Trial: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.2936","source_url":"https://doi.org/10.1001/jamacardio.2018.2936","authors":["Sanjiv J Shah","Ted Feldman","Mark J Ricciardi","Rami Kahwash","Scott Lilly","Sheldon Litwin","Chris D Nielsen","Pim van der Harst","Elke Hoendermis","Martin Penicka","Jozef Bartunek","Peter S Fail","David M Kaye","Anthony Walton","Mark C Petrie","Niki Walker","Anupam Basuray","Steven Yakubov","Scott L Hummel","Stanley Chetcuti","Rhondalyn Forde-McLean","Howard C Herrmann","Daniel Burkhoff","Joseph M Massaro","John G F Cleland","Laura Mauri"],"significance":6,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":[],"congress":"","summary_en":"This 1-year follow-up of the interatrial shunt device in HFpEF demonstrated safety and preliminary hemodynamic improvements, providing extended data on this structural intervention for heart failure with preserved ejection fraction.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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-jaarsresultaten van het interatriale shuntdevice bij HFpEF. Follow-up van REDUCE LAP-HF met focus op veiligheid en klinische uitkomsten.","abstract_original":"IMPORTANCE: In patients with heart failure (HF) and left ventricular ejection fraction (LVEF) equal to or greater than 40%, a transcatheter interatrial shunt device (IASD; Corvia Medical) reduces exercise pulmonary capillary wedge pressure (PCWP) and is safe compared with sham control treatment at 1 month of follow-up. The longer-term safety and patency of the IASD has not yet been demonstrated in the setting of a randomized clinical trial (RCT). OBJECTIVE: To evaluate the 1-year safety and clinical outcomes of the IASD compared with a sham control treatment. DESIGN, SETTING, AND PARTICIPANTS: This phase 2, double-blind, 1-to-1 sham-controlled multicenter RCT of IASD implantation vs a sham procedure (femoral venous access and imaging of the interatrial septum without IASD) was conducted in 22 centers in the United States, Europe, and Australia on patients with New York Heart Association (NYHA) class III or ambulatory class IV HF, LVEF equal to or greater than 40%, exercise PCWP equal to or greater than 25 mm Hg, and PCWP-right atrial pressure gradient equal to or greater than 5 mm Hg. MAIN OUTCOMES AND MEASURES: Safety was assessed by major adverse cardiac, cerebrovascular, or renal events (MACCRE). Exploratory outcomes evaluated at 1 year were hospitalizations for HF, NYHA class, quality of life, a 6-minute walk test, and device patency. RESULTS: After 1 year, shunts were patent in all IASD-treated patients; MACCRE did not differ significantly in the IASD arm (2 of 21 [9.5%]) vs the control arm (5 of 22 [22.7%]; P = .41), and no strokes occurred. The yearly rate of hospitalizations for HF was 0.22 in the IASD arm and 0.63 in the control arm (P = .06). Median improvement in NYHA class was 1 class in the IASD arm (IQR, -1 to 0) vs 0 in the control arm (IQR, -1 to 0; P = .08). Quality of life and 6-minute walk test distance were similar in both groups. At 6 months, there was an increase in right ventricular size in the IASD arm (mean [SD], 7.9 [8.0] mL/m2) vs the control arm (-1.8 [9.6] mL/m2; P = .002), consistent with left-to-right shunting through the device; no further increase occurred in the IASD arm at 12 months. CONCLUSIONS AND RELEVANCE: The REDUCE LAP-HF I phase 2, sham-controlled RCT confirms the longer-term patency of the IASD. Through 1 year of follow-up, IASD treatment appears safe, with no significant differences in MACCRE in patients receiving IASD compared with those who received sham control treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02600234."},{"id":"2828f6143e3b","type":"article","url":"https://hartvaat.nl/2018/10/01/inclusie-van-ouderen-vrouwen-en-minderheden-in-hf-trials-jama-cardiology-review/","title":"Inclusie van ouderen, vrouwen en minderheden in HF-trials: JAMA Cardiology review","title_en":"Enrollment of Older Patients, Women, and Racial and Ethnic Minorities in Contemporary Heart Failure Clinical Trials: A Systematic Review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["pathfinder-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.2559","source_url":"https://doi.org/10.1001/jamacardio.2018.2559","authors":["Ayman Samman Tahhan","Muthiah Vaduganathan","Stephen J Greene","Gregg C Fonarow","Mona Fiuzat","Mariell Jessup","JoAnn Lindenfeld","Christopher M O'Connor","Javed Butler"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review documented the underrepresentation of older patients, women, and racial/ethnic minorities in heart failure clinical trials, highlighting the gap between trial populations and the real-world disease burden.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T13:26:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 over de mate van inclusie van ouderen, vrouwen en raciale/etnische minderheden in hedendaagse hartfalentrials. Representativiteitskloof.","abstract_original":"IMPORTANCE: Despite the importance of age, sex, and race/ethnicity representativeness in clinical trials, limited data exist regarding the enrollment trends of these groups in contemporary heart failure (HF) trials. OBJECTIVE: To characterize the representation of older patients, women, and racial and ethnic minorities in HF trials. EVIDENCE REVIEW: We performed a systematic search of HF trials enrolling more than 400 participants published between January 2001 and December 2016 using PubMed/Medline and ClinicalTrials.gov. A total of 118 trials enrolling a cumulative 215 508 patients were included. Trial findings were compared with large epidemiologic studies indexed to hospitalization status and ejection fraction. FINDINGS: Median number of participants per trial was 994 (interquartile range [IQR], 543-1899), enrolled from a median of 82 (IQR, 28-171) study sites. Overall, 94 trials (80%) enrolled patients with HF with reduced ejection fraction (HFrEF) exclusively. Mean (SD) age of trial participants was 65 (11) years (from 64 years in 2001 to 2004 to 65 years in 2013 to 2016), and 58 873 of 215 508 were women (27%; from 26% in 2001 to 2004 to 29% in 2013 to 2016); no significant temporal trends were observed (P ≥ .60 for both). Chronic HF with preserved ejection fraction (HFpEF) trials enrolled older participants (mean [SD] age, 71 [7] years compared with 65 [11] years for HFrEF and 66 [12] years for acute HF [AHF] trials; P = .01). Corresponding mean ages in US epidemiologic studies were 69 years for HFrEF and 73 years for both patients with HFpEF and patients with AHF. The HFpEF trials had a higher proportion of women (n = 4940 of 8845 [56%]) compared with HFrEF (n = 34 397 of 143 538 [24%]) or AHF (n = 11 013 of 34 633 [32%]) (P < .001). Corresponding weighted proportions of women in HFpEF, HFrEF, and AHF trials in epidemiologic studies were 62%, 29%, and 50%, respectively. Distribution of racial/ethnic groups was reported in 55% (47%) of the trials; 22% of the participants were not white (n = 27 463 of 124 980), with significant increase over time from 13% in 2001 to 2004 (n = 5606 of 44 616) to 30% in 2013 to 2016 (8421 of 28 073) (P = .01). CONCLUSIONS AND RELEVANCE: In contemporary HF trials, older patients and women are consistently underrepresented. Race/ethnicity data are reported in less than half of trials; when reported, such data show that enrollment of nonwhite patients increased over time."},{"id":"8852b3c7f6c3","type":"article","url":"https://hartvaat.nl/2018/10/01/natriuretische-peptiden-en-cardiovasculaire-prognose-bij-hfpef-topcat/","title":"Natriuretische peptiden en cardiovasculaire prognose bij HFpEF: TOPCAT","title_en":"Association of Natriuretic Peptides With Cardiovascular Prognosis in Heart Failure With Preserved Ejection Fraction: Secondary Analysis of the TOPCAT Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","nt-probnp"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.2568","source_url":"https://doi.org/10.1001/jamacardio.2018.2568","authors":["Peder Langeland Myhre","Muthiah Vaduganathan","Brian L Claggett","Inder S Anand","Nancy K Sweitzer","James C Fang","Eileen O'Meara","Sanjiv J Shah","Akshay S Desai","Eldrin F Lewis","Jean Rouleau","Bertram Pitt","Marc A Pfeffer","Scott D Solomon"],"significance":6,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":[],"congress":"","summary_en":"This TOPCAT analysis demonstrated that natriuretic peptide levels provide strong prognostic value in HFpEF, informing the use of NP thresholds for patient selection in clinical trials and risk stratification in practice.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T13:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 TOPCAT secundaire analyse naar de associatie van natriuretische peptiden met cardiovasculaire prognose bij HFpEF.","abstract_original":"IMPORTANCE: Contemporary clinical trials of heart failure with preserved ejection fraction (HFpEF) apply natriuretic peptide (NP) thresholds to identify patients who are more likely to have the disease of interest and to enrich the baseline risk of the enrolled cohort. OBJECTIVE: To determine whether age, race/ethnicity, obesity, renal function, and atrial fibrillation (AF) affect the levels of NPs in HFpEF and whether the prognostic significance of NPs varies in these clinically important subgroups. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT) evaluated the distribution and prognostic significance of NPs across 6 subgroups comprising 1057 adult patients (60%) in the Americas region of TOPCAT with symptomatic heart failure (HF) and a left ventricular ejection fraction of 45% or more with available NPs at baseline. EXPOSURES: Natriuretic peptides were log-transformed and standardized (expressed per 1 SD, z score) and assessed in 6 subgroups: age (cutoff, 70 years), black race, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared; cutoff, 30 kg/m2), waist circumference (cutoff, 102 cm for men, 88 cm for women), estimated glomerular filtration rate (cutoff, 60 mL/min/1.73 m2), and a history of AF. MAIN OUTCOMES AND MEASURES: Time to composite cardiovascular death, hospitalization for HF, or aborted cardiac arrest at mean (SD) 2.4-year (1.5) follow-up. RESULTS: Of 1057 participants, the mean (SD) age was 72 (10) years, 183 (17.3%) were black, the mean (SD) BMI was 33.4 (8.6) kg/m2, the mean (SD) estimated glomerular filtration rate was 64.6 (21.8) mL/min/1.73 m2, and 472 (45%) had a history of AF. Median B-type NP (n = 698) and N-terminal pro-B-type NP concentrations (n = 359) were 257 (interquartile range, 149-443) ng/L and 959 (interquartile range, 554-2015) ng/L, respectively. Natriuretic peptide concentrations varied by up to 0.5 SD within the 6 subgroups, being higher in older patients with nonblack race, a lower BMI, a lower waist circumference, a lower estimated glomerular filtration rate, and a history of AF. Elevated NP levels (per 1-SD increase) were independently associated with an increased risk of the primary outcome (adjusted hazard ratio, 1.36; 95% CI, 1.22-1.54; P < .001) consistently across all investigated subgroups (interaction P > .05). In TOPCAT Americas (n = 1767), 791 (45%) were enrolled based on elevated NP levels as the qualifying criterion (as opposed to a history of HF hospitalization). This proportion was 31% (93 of 302), 34% (258 of 760), and 39% (443 of 1144) for black race, younger than 70 years, and a BMI of 30 kg/m2 or greater, respectively. CONCLUSIONS AND RELEVANCE: Natriuretic peptides remain important biomarkers of prognosis in HFpEF, even in subgroups who tend to have lower NP levels. A single, absolute NP threshold for inclusion in contemporary HFpEF trials may lead to an underrepresentation of certain demographic and clinical subgroups. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00094302."},{"id":"82bc5545bfe7","type":"article","url":"https://hartvaat.nl/2018/10/01/associatie-is-geen-causaliteit-behandeleffecten-bij-hartfalen-en-observationele-/","title":"Associatie is geen causaliteit: behandeleffecten bij hartfalen en observationele data","title_en":"Association is not causation: treatment effects cannot be estimated from observational data in heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy407","source_url":"https://doi.org/10.1093/eurheartj/ehy407","authors":["Christopher J Rush","Ross T Campbell","Pardeep S Jhund","Mark C Petrie","John J V McMurray"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":[],"congress":"","summary_en":"This important methodological article cautioned against inferring treatment effects from observational studies in heart failure, demonstrating with clear examples how confounding and selection bias can produce misleading conclusions even with advanced statistical adjustment.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T13:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Belangrijk methodologisch artikel dat waarschuwt tegen het afleiden van behandeleffecten uit observationele data bij hartfalen. Essentieel voor evidence-based HF-geneeskunde.","abstract_original":"AIMS: Treatment 'effects' are often inferred from non-randomized and observational studies. These studies have inherent biases and limitations, which may make therapeutic inferences based on their results unreliable. We compared the conflicting findings of these studies to those of prospective randomized controlled trials (RCTs) in relation to pharmacological treatments for heart failure (HF). METHODS AND RESULTS: We searched Medline and Embase to identify studies of the association between non-randomized drug therapy and all-cause mortality in patients with HF until 31 December 2017. The treatments of interest were: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists (MRAs), statins, and digoxin. We compared the findings of these observational studies with those of relevant RCTs. We identified 92 publications, reporting 94 non-randomized studies, describing 158 estimates of the 'effect' of the six treatments of interest on all-cause mortality, i.e. some studies examined more than one treatment and/or HF phenotype. These six treatments had been tested in 25 RCTs. For example, two pivotal RCTs showed that MRAs reduced mortality in patients with HF with reduced ejection fraction. However, only one of 12 non-randomized studies found that MRAs were of benefit, with 10 finding a neutral effect, and one a harmful effect. CONCLUSION: This comprehensive comparison of studies of non-randomized data with the findings of RCTs in HF shows that it is not possible to make reliable therapeutic inferences from observational associations. While trials undoubtedly leave gaps in evidence and enrol selected participants, they clearly remain the best guide to the treatment of patients."},{"id":"87bddcd5977f","type":"article","url":"https://hartvaat.nl/2018/10/01/ononderbroken-doac-versus-vka-bij-af-ablatie-meta-analyse/","title":"Ononderbroken DOAC versus VKA bij AF-ablatie: meta-analyse","title_en":"Uninterrupted direct oral anticoagulants vs. uninterrupted vitamin K antagonists during catheter ablation of non-valvular atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.","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/euy133","source_url":"https://doi.org/10.1093/europace/euy133","authors":["Jorge Romero","Roberto C Cerrud-Rodriguez","Juan Carlos Diaz","Gregory F Michaud","Jose Taveras","Isabella Alviz","Vito Grupposo","Luis Cerna","Ricardo Avendano","Saurabh Kumar","Paulus Kirchhof","Andrea Natale","Luigi Di Biase"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This meta-analysis comparing uninterrupted DOACs with uninterrupted VKAs during catheter ablation for AF found similar or lower rates of thromboembolic and bleeding complications with DOACs, consolidating the evidence for periprocedural DOAC use.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T13:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ononderbroken DOAC vergeleek met ononderbroken VKA bij katheterablatie voor niet-valvulair AF. Consolideert het bewijs voor periprocedureel DOAC-gebruik.","abstract_original":"AIMS: To assess the incremental benefit of uninterrupted direct oral anticoagulants (DOACs) vs. uninterrupted vitamin K antagonists (VKA) for catheter ablation (CA) of non-valvular atrial fibrillation (NVAF) on three primary outcomes: major bleeding, thrombo-embolic events, and minor bleeding. A secondary outcome was post-procedural silent cerebral infarction (SCI) as detected by brain magnetic resonance imaging. METHODS AND RESULTS: A systematic review of Medline, Cochrane, and Embase was done to find all randomized controlled trials (RCTs) in which uninterrupted DOACs were compared against uninterrupted VKA for CA of NVAF. A fixed-effect model was used, with the exception of the analysis regarding major bleeding events (I2 > 25), for which a random effects model was used. The benefit of uninterrupted DOACs over VKA was analysed from four RCTs that enrolled a total of 1716 patients (male: 71.2%) with NVAF. Of these, 1100 patients (64.1%) had paroxysmal atrial fibrillation. No significant benefit was seen in major bleeding events [risk ratio (RR) 0.54, 95% confidence interval (95% CI) 0.29-1.00; P = 0.05]. No significant differences were found in minor bleeding events (RR 1.11, 95% CI 0.82-1.52; P = 0.50), thrombo-embolic events (RR 0.74, 95% CI 0.26-2.11; P = 0.57), or post-procedural SCI (RR 1.06, 95% CI 0.74-1.53; P = 0.74). CONCLUSION: An uninterrupted DOACs strategy for CA of NVAF appears to be as safe as uninterrupted VKA without a significantly increased risk of minor or major bleeding events. There was a trend favouring DOACs in terms of major bleeding. Given their ease of use, fewer drug interactions and a similar security and effectiveness profile, DOACs should be considered first line therapy in patients undergoing CA for NVAF."},{"id":"c57fe6d9d97a","type":"article","url":"https://hartvaat.nl/2018/10/01/enkele-versus-dubbele-cryoballon-applicatie-bij-af-effectiviteit-en-veiligheid/","title":"Enkele versus dubbele cryoballon-applicatie bij AF: effectiviteit en veiligheid","title_en":"Acute and long-term efficacy and safety with a single cryoballoon application as compared with the standard dual application strategy: a prospective randomized study using the second-generation cryoballoon for pulmonary vein isolation in patients with symptomatic atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie"],"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/euy014","source_url":"https://doi.org/10.1093/europace/euy014","authors":["David Mörtsell","Helena Malmborg","Stefan Lönnerholm","Victoria Jansson","Carina Blomström-Lundqvist"],"significance":5,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This study compared a single cryoballoon application per vein with the standard dual application strategy for AF ablation, testing whether procedural simplification maintains isolation durability.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T13:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 enkele cryoballonapplicatie vergeleek met de standaard dubbele applicatiestrategie bij AF-ablatie. Procedurevereenvoudiging.","abstract_original":"AIMS: A single cryoballoon (CB) application per vein for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) could save time and was therefore compared to the standard approach of two consecutive CB applications for acute and long-term efficacy and safety. METHODS AND RESULTS: Patients with symptomatic AF were randomized to a single CB application per vein guided by an Achieve® catheter (Single cryo-arm) or to two CB applications using a standard guidewire (Routine cryo-arm). The primary endpoint was the rate of acute complete PVI. Secondary endpoints were freedom from AF evaluated by electrocardiogram and 7 days Holter at 6 and 12 months, symptoms by Symptom Severity Questionnaires and EHRA score and quality of life (QoL) by EQ5D-5L at 12 months. Among 140 patients included, PVI was achieved in 271 (100%) veins in the Single cryo-arm and in 269/271 (99.3%) veins in the Routine cryo-arm, P = 0.25. The procedure time was shorter in the Single cryo-arm, mean ± standard deviation 99.4 ± 33.3 min vs. 118.4 ± 34.3 min, P = 0.0015. Freedom from AF after one procedure at 12 months did not differ; 73.9.0% (Single cryo) vs. 71.4% (Routine), P = 0.74. Symptoms and QoL did also not differ between the two groups. There was a lower complication rate in the Single cryo-group, 2.9% vs. 12.9%, P = 0.03. CONCLUSION: A single CB application shortens the procedure time without affecting acute or long-term efficacy, as compared to the routine two-application strategy, which with the lower complication rates has important implications when defining standards for PVI."},{"id":"f8e17cb3a7d0","type":"article","url":"https://hartvaat.nl/2018/10/01/prognostische-waarde-van-gemaskeerd-ongecontroleerde-hypertensie/","title":"Prognostische waarde van gemaskeerd ongecontroleerde hypertensie","title_en":"Prognostic Value of Masked Uncontrolled Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11499","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11499","authors":["Sante D Pierdomenico","Anna M Pierdomenico","Francesca Coccina","Denis L Clement","Marc L De Buyzere","Dirk A De Bacquer","Iddo Z Ben-Dov","Wanpen Vongpatanasin","José R Banegas","Luis M Ruilope","Lutgarde Thijs","Jan A Staessen"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated the prognostic importance of masked uncontrolled hypertension — where office blood pressure appears controlled but ambulatory readings remain elevated — showing significant associations with cardiovascular events and mortality.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 gemaskeerd ongecontroleerde hypertensie — de discrepantie tussen goede praktijkdruk maar hoge ambulante druk.","abstract_original":"The prognostic relevance of masked uncontrolled hypertension (MUCH) is incompletely clear, and its global impact on cardiovascular outcomes and mortality has not been assessed. The aim of this study was to perform a meta-analysis on the prognostic value of MUCH. We searched for articles assessing outcome in patients with MUCH compared with those with controlled hypertension (CH) and reporting adjusted hazard ratio and 95% CI. We identified 6 studies using ambulatory blood pressure monitoring (12 610 patients with 933 events) and 5 using home blood pressure measurement (17 742 patients with 394 events). The global population included 30 352 patients who experienced 1327 events. Selected studies had cardiovascular outcomes and all-cause mortality as primary outcome, and the main result is a composite of these events. The overall adjusted hazard ratio was 1.80 (95% CI, 1.57-2.06) for MUCH versus CH. Subgroup meta-analysis showed that adjusted hazard ratio was 1.83 (95% CI, 1.52-2.21) in studies using ambulatory blood pressure monitoring and 1.75 (95% CI, 1.38-2.20) in those using home blood pressure measurement. Risk was significantly higher in MUCH than in CH independently of follow-up length and types of studied events. MUCH was at significantly higher risk than CH in all ethnic groups, but the highest hazard ratio was found in studies, including black patients. Risk of cardiovascular events and all-cause mortality is significantly higher in patients with MUCH than in those with CH. MUCH detected by ambulatory or home blood pressure measurement seems to convey similar prognostic information."},{"id":"162cdb5ad827","type":"article","url":"https://hartvaat.nl/2018/10/01/hypertensiebehandeling-en-orthostatische-hypotensie-relatie-met-cv-ziekte/","title":"Hypertensiebehandeling en orthostatische hypotensie: relatie met CV-ziekte","title_en":"Hypertension Treatment Effects on Orthostatic Hypotension and Its Relationship With Cardiovascular Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","endotheel","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11337","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11337","authors":["Stephen P Juraschek","Lawrence J Appel","Edgar R Miller","Kenneth J Mukamal","Lewis A Lipsitz"],"significance":6,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This analysis showed that antihypertensive treatment does not worsen orthostatic hypotension and may actually reduce its cardiovascular consequences, challenging the clinical reluctance to treat blood pressure aggressively in patients with OH.","created":"2026-07-03T10:27:31Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het effect van hypertensiebehandeling op orthostatische hypotensie en de relatie met cardiovasculaire ziekte. Benadrukt het belang van staande bloeddrukmeting.","abstract_original":"Although orthostatic hypotension (OH) is often considered a contraindication to blood pressure (BP) treatment, evidence is lacking. We examined the effect of BP goal or initial medication choice on OH in AASK (African American Study of Kidney Disease and Hypertension), a 2×3 factorial trial. Blacks with chronic kidney disease attributed to hypertension were randomly assigned 1 of 2 BP goals: intensive (mean arterial pressure, ≤92 mm Hg) or standard (mean arterial pressure, 102-107 mm Hg) and 1 of 3 initial medications (ramipril, metoprolol, and amlodipine). Postural changes in systolic BP, diastolic BP, or heart rate (HR) were determined after 2 minutes and 45 seconds of standing. OH was assessed each visit and defined using the consensus definition (drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg). Median follow-up was 4 years. Outcomes were congestive heart failure, stroke, nonfatal cardiovascular disease (CVD), fatal CVD, any CVD (composite of preceding events), and all-cause mortality. There were 1094 participants (mean age, 54.5±10.7 years; 38.8% female; OH was assessed at 52 864 visits). Mean seated systolic BP, diastolic BP, and HR were 150.3±23.9 mm Hg, 95.5±14.2 mm Hg, and 72.0±12.6 bpm, respectively. A more intensive BP goal did not alter the distributions of standing BP and was not associated with OH, but metoprolol was associated with systolic OH compared with ramipril (odds ratio, 1.68; 95% CI, 1.15-2.46) and amlodipine (odds ratio, 1.94; 95% CI, 1.09-3.44). Although consensus OH was associated with stroke (HR, 5.01; 95% CI, 1.80-13.92), nonfatal CVD (HR, 2.28; 95% CI, 1.21-4.30), and any CVD event (HR, 2.12; 95% CI, 1.12-3.98), neither BP goal or medication altered this risk. Concerns about causing OH or its CVD consequences should not deter a lower BP goal among adults with chronic kidney disease attributed to hypertension."},{"id":"4a94fba848cd","type":"article","url":"https://hartvaat.nl/2018/10/01/ochtend-versus-avonddosering-van-antihypertensiva-gerandomiseerde-crossover-tria/","title":"Ochtend- versus avonddosering van antihypertensiva: gerandomiseerde crossover-trial","title_en":"Randomized Crossover Trial of the Impact of Morning or Evening Dosing of Antihypertensive Agents on 24-Hour Ambulatory Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11101","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11101","authors":["Neil R Poulter","Christos Savopoulos","Aisha Anjum","Martha Apostolopoulou","Neil Chapman","Mary Cross","Emanuela Falaschetti","Spiros Fotiadis","Rebecca M James","Ilias Kanellos","Matyas Szigeti","Simon Thom","Peter Sever","David Thompson","Apostolos I Hatzitolios"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This randomized crossover trial showed no significant difference between morning and evening dosing of antihypertensive medications on 24-hour ambulatory blood pressure, providing early evidence that dosing time does not matter — a finding later confirmed by the larger TIME trial.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T13:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 crossover-trial die ochtend- versus avonddosering van antihypertensiva vergeleek op 24-uurs ambulante bloeddruk. Relevant voor het chronotherapeutische debat.","abstract_original":"Some data suggest that nocturnal dosing of antihypertensive agents may reduce cardiovascular outcomes more than daytime dosing. This trial was designed to evaluate whether ambulatory blood pressure monitoring levels differ by timing of drug dosing. Patients aged 18 to 80 years with reasonably controlled hypertension (≤150/≤90 mm Hg) on stable therapy of ≥1 antihypertensive agent were recruited from 2 centers in London and Thessaloniki. Patients were randomized to receive usual therapy either in the morning (6 am-11 am) or evening (6 pm-11 pm) for 12 weeks when participants crossed over to the alternative timing for a further 12 weeks. Clinic blood pressures and a 24-hour recording were taken at baseline, 12, and 24 weeks and routine blood tests were taken at baseline. The study had 80% power to detect 3 mm Hg difference in mean 24-hour systolic blood pressure (α=0.05) by time of dosing. A 2-level hierarchical regression model adjusted for center, period, and sequence was used. Of 103 recruited patients (mean age, 62; 44% female), 95 patients (92%) completed all three 24-hour recordings. Mean 24-hour systolic and diastolic blood pressures did not differ between daytime and evening dosing. Similarly, morning and evening dosing had no differential impact on mean daytime (7 am-10 pm) and nighttime (10 pm-7 am) blood pressure levels nor on clinic levels. Stratification by age (≤65/≥65 years) or sex did not affect results. In summary, among hypertensive patients with reasonably well-controlled blood pressure, the timing of antihypertensive drug administration (morning or evening) did not affect mean 24-hour or clinic blood pressure levels. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT01669928."},{"id":"976b741358af","type":"article","url":"https://hartvaat.nl/2018/10/01/linkeratriumvolume-en-cv-uitkomsten-bij-systolisch-hf-antitromboticaeffect/","title":"Linkeratriumvolume en CV-uitkomsten bij systolisch HF: antitromboticaeffect","title_en":"Left atrial volume and cardiovascular outcomes in systolic heart failure: effect of antithrombotic treatment.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["abelacimab","acuut-hartfalen","aficamten","anticoagulantia","bloeddrukbehandeling","hfmref","hfpef","hfref","hypertrofische-cardiomyopathie","laminopathie","secundaire-preventie","ventrikelfibrilleren"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12331","source_url":"https://doi.org/10.1002/ehf2.12331","authors":["Marco R Di Tullio","Min Qian","John L P Thompson","Arthur J Labovitz","Douglas L Mann","Ralph L Sacco","Patrick M Pullicino","Ronald S Freudenberger","John R Teerlink","Susan Graham","Gregory Y H Lip","Bruce Levin","Jay P Mohr","Richard Buchsbaum","Conrado J Estol","Dirk J Lok","Piotr Ponikowski","Stefan D Anker","Shunichi Homma"],"significance":5,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":[],"congress":"","summary_en":"This study examined the relationship between left atrial volume, cardiovascular outcomes, and antithrombotic treatment in systolic heart failure, exploring whether LA dilation identifies patients who may benefit from anticoagulation.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 linkeratriumvolume en cardiovasculaire uitkomsten bij systolisch hartfalen en het effect van antitrombotische behandeling.","abstract_original":"AIMS: Left atrium (LA) dilation is associated with adverse cardiovascular (CV) outcomes. Blood stasis, thrombus formation and atrial fibrillation may occur, especially in heart failure (HF) patients. It is not known whether preventive antithrombotic treatment may decrease the incidence of CV events in HF patients with LA enlargement. We investigated the relationship between LA enlargement and CV outcomes in HF patients and the effect of different antithrombotic treatments. METHODS AND RESULTS: Two-dimensional echocardiography with LA volume index (LAVi) measurement was performed in 1148 patients with systolic HF from the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial. Patients were randomized to warfarin or aspirin and followed for 3.4 ± 1.7 years. While the primary aim of the trial was a composite of ischaemic stroke, death, and intracerebral haemorrhage, the present report focuses on the individual CV events, whose incidence was compared across different LAVi and treatment subgroups. After adjustment for demographics and clinical covariates, moderate or severe LA enlargement was significantly associated with total death (hazard ratio 1.6 and 2.7, respectively), CV death (HR 1.7 and 3.3), and HF hospitalization (HR 2.3 and 2.6) but not myocardial infarction (HR 1.0 and 1.4) or ischaemic stroke (1.1 and 1.5). The increased risk was observed in both patients treated with warfarin or aspirin. In warfarin-treated patients, a time in therapeutic range >60% was associated with lower event rates, and an interaction between LAVi and time in therapeutic range was observed for death (P = 0.034). CONCLUSIONS: In patients with systolic HF, moderate or severe LA enlargement is associated with death and HF hospitalization despite treatment with antithrombotic medications. The possibility that achieving a more consistent therapeutic level of anticoagulation may decrease the risk of death requires further investigation."},{"id":"b11c15bbd83d","type":"article","url":"https://hartvaat.nl/2018/10/01/atriumfibrilleren-bij-wild-type-transthyretine-cardiale-amyloidose-review/","title":"Atriumfibrilleren bij wild-type transthyretine cardiale amyloïdose: review","title_en":"Features of atrial fibrillation in wild-type transthyretin cardiac amyloidosis: a systematic review and clinical experience.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cardiale-amyloidose"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12308","source_url":"https://doi.org/10.1002/ehf2.12308","authors":["Yuliya Y Mints","Gheorghe Doros","John L Berk","Lawreen H Connors","Frederick L Ruberg"],"significance":6,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This systematic review characterized atrial fibrillation in wild-type transthyretin cardiac amyloidosis, showing that AF is common and clinically significant in this increasingly recognized cause of heart failure in the elderly.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T13:26:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 over AF bij wild-type ATTR cardiale amyloïdose. AF als frequent en klinisch relevant fenomeen bij deze ondergedetecteerde aandoening.","abstract_original":"AIMS: Wild-type transthyretin (ATTRwt) cardiac amyloidosis has emerged as an important cause of heart failure in the elderly. Atrial fibrillation (AF) commonly affects older adults with heart failure and is associated with reduced survival, but its role in ATTRwt is unclear. We sought to explore the clinical impact of AF in ATTRwt. METHODS AND RESULTS: Patients with biopsy-proven ATTRwt cardiac amyloidosis (n = 146) were retrospectively identified, and clinical, echocardiographic, and biochemical data were collected. Patients were classified as AF or non-AF and followed for survival for a median of 41.4 ± 27.1 months. Means testing, univariable, and multivariable regression models were employed. A systematic review was performed. AF was observed in 70% (n = 102). Mean age was similar (AF, 75 ± 6 vs. non-AF, 74 ± 5 years, P = 0.22). Anticoagulant treatment of patients with AF was as follows: 78% warfarin, 17% novel anticoagulant, and 6% no anticoagulation. Amiodarone was prescribed to 24%. There were no differences in left ventricular ejection fraction (P = 0.09) or left atrial volume (P = 0.87); however, mean diastolic dysfunction grade was higher in AF (mean 2.7 ± 0.5 vs. 2.4 ± 0.5, P = 0.01). While creatinine (P = 0.52) and B-type natriuretic peptide (P = 0.48) were similar, patients with AF had lower serum transthyretin concentrations (221 ± 51 vs. 250 ± 52 μg/mL, P < 0.01). Survival between groups was similar (P = 0.46). CONCLUSIONS: These data provide an evidence basis for clinical management and demonstrate that AF in ATTRwt does not negatively impact survival. Further analysis of the relationship between transthyretin concentration and AF development is warranted."},{"id":"ed71368fc4a9","type":"article","url":"https://hartvaat.nl/2018/10/01/geschat-individueel-levensvoordeel-van-pcsk9-remming-bij-statinebehandelde-cad-p/","title":"Geschat individueel levensvoordeel van PCSK9-remming bij statinebehandelde CAD-patiënten","title_en":"Estimated individual lifetime benefit from PCSK9 inhibition in statin-treated patients with coronary artery disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["pcsk9-remmers"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312510","source_url":"https://doi.org/10.1136/heartjnl-2017-312510","authors":["Lotte Kaasenbrood","Kausik K Ray","S Matthijs Boekholdt","Yvo M Smulders","John C LaRosa","John J P Kastelein","Yolanda van der Graaf","Johannes A N Dorresteijn","Frank L J Visseren"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This study estimated the individual lifetime benefit of PCSK9 inhibitor therapy in statin-treated patients with stable coronary artery disease, calculating that the absolute benefit varies substantially based on age, risk factors, and residual LDL cholesterol.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het geschatte individuele levenslange voordeel van PCSK9-remming berekende bij statinebehandelde patiënten met coronairlijden. Personaliseert de behandelbeslissing.","abstract_original":"OBJECTIVE: In statin-treated patients with stable coronary artery disease (CAD), residual risk of cardiovascular events is partly explained by plasma levels of low-density lipoprotein cholesterol (LDL-C). This study aimed to estimate individual benefit of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition in CAD patients already treated with high-dose statin. METHODS: Individual lifetime benefit was estimated in months gain free of stroke or myocardial infarction (MI) until age 80 years. Predictions were based on two competing risk models developed in data from 4853 patients with CAD originating from the atorvastatin 80 mg arm of the Treating to New Targets (TNT) trial. The relative effect of PCSK9 inhibition was added to the models and was assumed based on average estimates from large clinical trials. We accounted for individual LDL-C levels, assuming 50% LDL-C reduction by PCSK9 inhibition and 21% cardiovascular risk reduction per mmol/L (39 mg/dL) LDL-C lowering. RESULTS: Estimated individual gain was <6 months in 61% of the patients, 6-12 months in 28% of the patients and ≥12 months in 10% of the patients (median 5, quartiles 2-8 months). Highest estimated benefit was observed in younger patients (aged 40-60 years) with high risk factor burden, particularly if LDL-C levels were >1.8 mmol/L (>70 mg/dL). Estimated benefit was lowest (≤5 months) in older patients (≥70 years), in particular if LDL-C and other risk factors levels were low. CONCLUSION: The individual estimated lifetime benefit from PCSK9 inhibition in patients with stable CAD on high-dose statin varied from <6 to ≥12 months free of stroke or MI. Highest benefit is expected in younger patients (age 40-60 years) with high risk factor burden and relatively high LDL-C levels. TRIAL REGISTRATION NUMBER: NCT00327691; Post-results."},{"id":"06dfa426948a","type":"article","url":"https://hartvaat.nl/2018/10/01/danegaptide-bij-primaire-pci-voor-acuut-mi-fase-2-gerandomiseerde-trial/","title":"Danegaptide bij primaire PCI voor acuut MI: fase-2 gerandomiseerde trial","title_en":"Danegaptide for primary percutaneous coronary intervention in acute myocardial infarction patients: a phase 2 randomised clinical trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312774","source_url":"https://doi.org/10.1136/heartjnl-2017-312774","authors":["Thomas Engstrøm","Lars Nepper-Christensen","Steffen Helqvist","Lene Kløvgaard","Lene Holmvang","Erik Jørgensen","Frants Pedersen","Kari Saunamaki","Hans-Henrik Tilsted","Adam Steensberg","Søren Fabricius","Ulrik Mouritzen","Niels Vejlstrup","Kiril A Ahtarovski","Christoffer Göransson","Litten Bertelsen","Kasper Kyhl","Göran Olivecrona","Henning Kelbæk","Jens Flensted Lassen","Lars Køber","Jacob Lønborg"],"significance":5,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This phase 2 trial of danegaptide, a gap junction modulator, during primary PCI for acute MI tested a novel approach to limiting reperfusion injury by modifying intercellular communication during ischemia-reperfusion.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase-2 trial van danegaptide (gap junction-modulator) bij primaire PCI voor acuut MI. Nieuw concept voor beperking van reperfusieschade.","abstract_original":"OBJECTIVES: Reperfusion immediately after reopening of the infarct-related artery in ST-segment elevation myocardial infarction (STEMI) may cause myocardial damage in addition to the ischaemic insult (reperfusion injury). The gap junction modulating peptide danegaptide has in animal models reduced this injury. We evaluated the effect of danegaptide on myocardial salvage in patients with STEMI. METHODS: In addition to primary percutaneous coronary intervention in STEMI patients with thrombolysis in myocardial infarction flow 0-1, single vessel disease and ischaemia time less than 6 hours, we tested, in a clinical proof-of-concept study, the therapeutic potential of danegaptide at two-dose levels. Primary outcome was myocardial salvage evaluated by cardiac MRI after 3 months. RESULTS: From November 2013 to August 2015, a total of 585 patients were randomly enrolled in the trial. Imaging criteria were fulfilled for 79 (high dose), 80 (low dose) and 84 (placebo) patients eligible for the per-protocol analysis. Danegaptide did not affect the myocardial salvage index (danegaptide high (63.9±14.9), danegaptide low (65.6±15.6) and control (66.7±11.7), P=0.40), final infarct size (danegaptide high (19.6±11.4 g), danegaptide low (18.6±9.6 g) and control (21.4±15.0 g), P=0.88) or left ventricular ejection fraction (danegaptide high (53.9%±9.5%), danegaptide low (52.7%±10.3%) and control (52.1%±10.9%), P=0.64). There was no difference between groups with regard to clinical outcome. CONCLUSIONS: Administration of danegaptide to patients with STEMI did not improve myocardial salvage. TRIAL REGISTRATION NUMBER: NCT01977755; Pre-results."},{"id":"014948761ca4","type":"article","url":"https://hartvaat.nl/2018/10/01/zuurstof-bij-verdenking-acuut-mi-meta-analyse-van-gerandomiseerde-trials/","title":"Zuurstof bij verdenking acuut MI: meta-analyse van gerandomiseerde trials","title_en":"Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2018-313089","source_url":"https://doi.org/10.1136/heartjnl-2018-313089","authors":["Nariman Sepehrvand","Stefan K James","Dion Stub","Ardavan Khoshnood","Justin A Ezekowitz","Robin Hofmann"],"significance":7,"published":"2018-10-01","source_date":"2018-10-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of randomized trials found no benefit of supplemental oxygen therapy in patients with suspected acute MI without hypoxemia, with a trend toward increased myocardial injury. The cumulative evidence supports withholding oxygen in normoxic MI patients.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 supplementaire zuurstoftherapie bij verdenking acuut MI. Cumulerend bewijs tegen routinematig zuurstofgebruik.","abstract_original":"BACKGROUND: Although oxygen therapy has been used for over a century in the management of patients with suspected acute myocardial infarction (AMI), recent studies have raised concerns around the efficacy and safety of supplemental oxygen in normoxaemic patients. OBJECTIVE: To synthesise the evidence from randomised controlled trials (RCTs) that investigated the effects of supplemental oxygen therapy compared with room air in patients with suspected or confirmed AMI. METHODS: For this aggregate data meta-analysis, multiple databases were searched from inception to 30 September 2017. RCTs with any length of follow-up and any outcome measure were included if they studied the use of supplemental O2 therapy administered by any device at normal pressure compared with room air. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, an investigator assessed all the included studies and extracted the data. Outcomes of interests included mortality, troponin levels, infarct size, pain and hypoxaemia. RESULTS: Eight RCTs with a total of 7998 participants (3982 and 4002 patients in O2 and air groups, respectively) were identified and pooled. In-hospital and 30-day death occurred in 135 and 149 patients, respectively. Oxygen therapy did not reduce the risk of in-hospital (OR, 1.11 (95% CI 0.69 to 1.77)) or 30-day mortality (OR, 1.09 (95% CI 0.80 to 1.50)) in patients with suspected AMI, and the results remained similar in the subgroup of patients with confirmed AMI. The infarct size (based on cardiac MRI) in a subgroup of patients was not different between groups with and without O2 therapy. O2 therapy reduced the risk of hypoxaemia (OR, 0.29 (95% CI 0.17 to 0.47)). CONCLUSION: Although supplemental O2 therapy is commonly used, it was not associated with important clinical benefits. These findings from eight RCTs support departing from the usual practice of administering oxygen in normoxaemic patients."},{"id":"1424ac586669","type":"article","url":"https://hartvaat.nl/2018/09/29/langetermijnmortaliteit-na-bloeddruk-en-lipidenverlaging-bij-hypertensie-ascot-l/","title":"Langetermijnmortaliteit na bloeddruk- en lipidenverlaging bij hypertensie: ASCOT legacy","title_en":"Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","dyslipidemie","ezetimibe","lipide-aferese","lipidenverlaging","niet-statine-therapie","obesitas","ouderen","plaquekarakterisatie","vrouwen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31776-8","source_url":"https://doi.org/10.1016/S0140-6736(18)31776-8","authors":["Ajay Gupta","Judith Mackay","Andrew Whitehouse","Thomas Godec","Tim Collier","Stuart Pocock","Neil Poulter","Peter Sever"],"significance":8,"published":"2018-09-29","source_date":"2018-09-29","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This ASCOT legacy analysis examined long-term mortality effects after 15+ years of follow-up from the original blood pressure and lipid-lowering trial in hypertensive patients. The extended data assessed whether in-trial cardiovascular benefits translated to durable post-trial survival advantages.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ASCOT langetermijn legacy-analyse van bloeddruk- en lipidenverlagende behandeling. Onderzoekt het post-trial mortaliteitsvoordeel na jaren follow-up.","abstract_original":"BACKGROUND: In patients with hypertension, the long-term cardiovascular and all-cause mortality effects of different blood pressure-lowering regimens and lipid-lowering treatment are not well documented, particularly in clinical trial settings. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study reports mortality outcomes after 16 years of follow-up of the UK participants in the original ASCOT trial. METHODS: ASCOT was a multicentre randomised trial with a 2 × 2 factorial design. UK-based patients with hypertension were followed up for all-cause and cardiovascular mortality for a median of 15·7 years (IQR 9·7-16·4 years). At baseline, all patients enrolled into the blood pressure-lowering arm (BPLA) of ASCOT were randomly assigned to receive either amlodipine-based or atenolol-based blood pressure-lowering treatment. Of these patients, those who had total cholesterol of 6·5 mmol/L or lower and no previous lipid-lowering treatment underwent further randomisation to receive either atorvastatin or placebo as part of the lipid-lowering arm (LLA) of ASCOT. The remaining patients formed the non-LLA group. A team of two physicians independently adjudicated all causes of death. FINDINGS: Of 8580 UK-based patients in ASCOT, 3282 (38·3%) died, including 1640 (38·4%) of 4275 assigned to atenolol-based treatment and 1642 (38·1%) of 4305 assigned to amlodipine-based treatment. 1768 of the 4605 patients in the LLA died, including 903 (39·5%) of 2288 assigned placebo and 865 (37·3%) of 2317 assigned atorvastatin. Of all deaths, 1210 (36·9%) were from cardiovascular-related causes. Among patients in the BPLA, there was no overall difference in all-cause mortality between treatments (adjusted hazard ratio [HR] 0·90, 95% CI 0·81-1·01, p=0·0776]), although significantly fewer deaths from stroke (adjusted HR 0·71, 0·53-0·97, p=0·0305) occurred in the amlodipine-based treatment group than in the atenolol-based treatment group. There was no interaction between treatment allocation in the BPLA and in the LLA. However, in the 3975 patients in the non-LLA group, there were fewer cardiovascular deaths (adjusted HR 0·79, 0·67-0·93, p=0·0046) among those assigned to amlodipine-based treatment compared with atenolol-based treatment (p=0·022 for the test for interaction between the two blood pressure treatments and allocation to LLA or not). In the LLA, significantly fewer cardiovascular deaths (HR 0·85, 0·72-0·99, p=0·0395) occurred among patients assigned to statin than among those assigned placebo. INTERPRETATION: Our findings show the long-term beneficial effects on mortality of antihypertensive treatment with a calcium channel blocker-based treatment regimen and lipid-lowering with a statin: patients on amlodipine-based treatment had fewer stroke deaths and patients on atorvastatin had fewer cardiovascular deaths more than 10 years after trial closure. Overall, the ASCOT Legacy study supports the notion that interventions for blood pressure and cholesterol are associated with long-term benefits on cardiovascular outcomes. FUNDING: Pfizer."},{"id":"05e0febca78d","type":"article","url":"https://hartvaat.nl/2018/09/27/draagbare-cardioverter-defibrillator-na-myocardinfarct-nejm-vest/","title":"Draagbare cardioverter-defibrillator na myocardinfarct: NEJM VEST","title_en":"Wearable Cardioverter-Defibrillator after Myocardial Infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1800781","source_url":"https://doi.org/10.1056/NEJMoa1800781","authors":["Jeffrey E Olgin","Mark J Pletcher","Eric Vittinghoff","Jerzy Wranicz","Rajesh Malik","Daniel P Morin","Steven Zweibel","Alfred E Buxton","Claude S Elayi","Eugene H Chung","Eric Rashba","Martin Borggrefe","Trisha F Hue","Carol Maguire","Feng Lin","Joel A Simon","Stephen Hulley","Byron K Lee"],"significance":8,"published":"2018-09-27","source_date":"2018-09-27","image":"","kennis":[],"congress":"","summary_en":"The VEST trial showed that a wearable cardioverter-defibrillator did not significantly reduce the primary endpoint of sudden death from cardiac causes within 90 days after MI in patients with reduced ejection fraction. The result tempered enthusiasm for routine WCD use as a bridge to ICD implantation.","created":"2026-07-03T10:27:30Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 VEST-trial naar de draagbare cardioverter-defibrillator (WCD) na recent MI met verminderde EF. Geen significante reductie in plotse hartdood — onverwacht negatief.","abstract_original":"BACKGROUND: Despite the high rate of sudden death after myocardial infarction among patients with a low ejection fraction, implantable cardioverter-defibrillators are contraindicated until 40 to 90 days after myocardial infarction. Whether a wearable cardioverter-defibrillator would reduce the incidence of sudden death during this high-risk period is unclear. METHODS: We randomly assigned (in a 2:1 ratio) patients with acute myocardial infarction and an ejection fraction of 35% or less to receive a wearable cardioverter-defibrillator plus guideline-directed therapy (the device group) or to receive only guideline-directed therapy (the control group). The primary outcome was the composite of sudden death or death from ventricular tachyarrhythmia at 90 days (arrhythmic death). Secondary outcomes included death from any cause and nonarrhythmic death. RESULTS: Of 2302 participants, 1524 were randomly assigned to the device group and 778 to the control group. Participants in the device group wore the device for a median of 18.0 hours per day (interquartile range, 3.8 to 22.7). Arrhythmic death occurred in 1.6% of the participants in the device group and in 2.4% of those in the control group (relative risk, 0.67; 95% confidence interval [CI], 0.37 to 1.21; P=0.18). Death from any cause occurred in 3.1% of the participants in the device group and in 4.9% of those in the control group (relative risk, 0.64; 95% CI, 0.43 to 0.98; uncorrected P=0.04), and nonarrhythmic death in 1.4% and 2.2%, respectively (relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P=0.15). Of the 48 participants in the device group who died, 12 were wearing the device at the time of death. A total of 20 participants in the device group (1.3%) received an appropriate shock, and 9 (0.6%) received an inappropriate shock. CONCLUSIONS: Among patients with a recent myocardial infarction and an ejection fraction of 35% or less, the wearable cardioverter-defibrillator did not lead to a significantly lower rate of the primary outcome of arrhythmic death than control. (Funded by the National Institutes of Health and Zoll Medical; VEST ClinicalTrials.gov number, NCT01446965 .)."},{"id":"f311e76a02ef","type":"article","url":"https://hartvaat.nl/2018/09/27/6-maandsuitkomsten-van-restrictieve-versus-liberale-transfusie-bij-hartchirurgie/","title":"6-maandsuitkomsten van restrictieve versus liberale transfusie bij hartchirurgie: NEJM TRICS III","title_en":"Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1808561","source_url":"https://doi.org/10.1056/NEJMoa1808561","authors":["C David Mazer","Richard P Whitlock","Dean A Fergusson","Emilie Belley-Cote","Katherine Connolly","Boris Khanykin","Alexander J Gregory","Étienne de Médicis","François M Carrier","Shay McGuinness","Paul J Young","Kelly Byrne","Juan C Villar","Alistair Royse","Hilary P Grocott","Manfred D Seeberger","Chirag Mehta","François Lellouche","Gregory M T Hare","Thomas W Painter","Stephen Fremes","Summer Syed","Sean M Bagshaw","Nian-Chih Hwang","Colin Royse","Judith Hall","David Dai","Nikhil Mistry","Kevin Thorpe","Subodh Verma","Peter Jüni","Nadine Shehata"],"significance":7,"published":"2018-09-27","source_date":"2018-09-27","image":"","kennis":[],"congress":"","summary_en":"The 6-month TRICS III follow-up confirmed that a restrictive transfusion strategy remains noninferior to liberal transfusion in patients undergoing cardiac surgery, supporting conservative transfusion thresholds beyond the immediate perioperative period.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 6-maandsresultaten die bevestigen dat restrictief transfusiebeleid niet inferieur is bij hartchirurgie.","abstract_original":"BACKGROUND: We reported previously that, in patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive transfusion strategy 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 by hospital discharge or 28 days after surgery, whichever came first. We now report the clinical outcomes at 6 months after surgery. METHODS: We randomly assigned 5243 adults undergoing cardiac surgery to a restrictive red-cell transfusion strategy (transfusion if the hemoglobin concentration was <7.5 g per deciliter intraoperatively or postoperatively) or a liberal red-cell transfusion strategy (transfusion if the hemoglobin concentration was <9.5 g per deciliter intraoperatively or postoperatively when the patient was in the intensive care unit [ICU] or was <8.5 g per deciliter when the patient was in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis occurring within 6 months after the initial surgery. An expanded secondary composite outcome included all the components of the primary outcome as well as emergency department visit, hospital readmission, or coronary revascularization occurring within 6 months after the index surgery. The secondary outcomes included the individual components of the two composite outcomes. RESULTS: At 6 months after surgery, the primary composite outcome had occurred in 402 of 2317 patients (17.4%) in the restrictive-threshold group and in 402 of 2347 patients (17.1%) in the liberal-threshold group (absolute risk difference before rounding, 0.22 percentage points; 95% confidence interval [CI], -1.95 to 2.39; odds ratio, 1.02; 95% CI, 0.87 to 1.18; P=0.006 for noninferiority). Mortality was 6.2% in the restrictive-threshold group and 6.4% in the liberal-threshold group (odds ratio, 0.95; 95% CI, 0.75 to 1.21). There were no significant between-group differences in the secondary outcomes. CONCLUSIONS: In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy for 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 at 6 months after surgery. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .)."},{"id":"6b70dd41bbc8","type":"article","url":"https://hartvaat.nl/2018/09/25/edoxaban-versus-warfarine-bij-latijns-amerikaanse-af-patienten-engage-af-timi-48/","title":"Edoxaban versus warfarine bij Latijns-Amerikaanse AF-patiënten: ENGAGE AF-TIMI 48","title_en":"Edoxaban Versus Warfarin in Latin American Patients With Atrial Fibrillation: The ENGAGE AF-TIMI 48 Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.07.037","source_url":"https://doi.org/10.1016/j.jacc.2018.07.037","authors":["Ramón Corbalán","José Carlos Nicolau","José López-Sendon","Armando Garcia-Castillo","Rodrigo Botero","Gustavo Sotomora","Manuel Horna","Christian T Ruff","Rose A Hamershock","Laura T Grip","Elliott M Antman","Eugene Braunwald","Robert P Giugliano"],"significance":5,"published":"2018-09-25","source_date":"2018-09-25","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 Latin American AF patients showed that edoxaban maintains its favorable efficacy and safety profile in this regional population, supporting the generalizability of the DOAC evidence.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ENGAGE AF-TIMI 48 subanalyse bij Latijns-Amerikaanse patiënten met AF. Onderzoekt de regionale generaliseerbaarheid van edoxaban.","abstract_original":"BACKGROUND: There is limited information about the use of antithrombotic therapies and outcomes of Latin American (LatAm) subjects with atrial fibrillation. The global ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial compared the efficacy and safety of edoxaban versus warfarin over a median follow-up of 2.8 years. OBJECTIVES: The authors aimed to compare adjusted outcomes in Latin America versus outside Latin America and to compare outcomes stratified by anticoagulant treatment and region. METHODS: The authors analyzed clinical characteristics and outcomes, adjusted for baseline characteristics, the Human Development Index, and randomized treatment of 2,661 LatAm versus 18,444 non-Latin American subjects (nLAS). RESULTS: When compared with nLAS, LatAm subjects had a similar overall risk for stroke. After multivariate adjustment, the risks of stroke/systemic embolism (hazard ratio [HR]: 1.19; 95% confidence interval (CI): 0.96 to 1.47; p = 0.11) and major bleeding (HR: 1.10; 95% CI: 0.89 to 1.36; p = 0.39) were similar in LatAm and nLAS. LatAm subjects were at higher adjusted risk of death (HR: 1.48; 95% CI: 1.30 to 1.69; p < 0.001) and intracranial hemorrhage (ICH) (HR: 1.55; 95% CI: 1.00 to 2.41; p = 0.049). In both regions, when compared with warfarin, edoxaban reduced stroke/systemic embolism (HR: 0.64 and 0.91 in LatAm and nLAS, respectively), major bleeding (HR: 0.71 and 0.82), and cardiovascular death (HR: 0.78 and 0.88), without evidence of regional heterogeneity (pint = 0.41, 0.50, and 0.70, respectively). There was a greater reduction in hemorrhagic stroke with edoxaban in LatAm (HR: 0.16) than in nLAS (HR: 0.64; pint = 0.037). CONCLUSIONS: After multivariable adjustment, LatAm subjects with atrial fibrillation had higher rates of intracranial hemorrhage and death than nLAS. Outcomes with higher-dose edoxaban versus warfarin were at least as favorable in LatAm subjects as in nLAS, with an even greater reduction in hemorrhagic stroke seen in LatAm."},{"id":"c6046314d020","type":"article","url":"https://hartvaat.nl/2018/09/25/sirna-tegen-pcsk9-en-atherogene-lipoproteinen-orion-1-secundaire-eindpunten/","title":"siRNA tegen PCSK9 en atherogene lipoproteïnen: ORION 1 secundaire eindpunten","title_en":"Effect of an siRNA Therapeutic Targeting PCSK9 on Atherogenic Lipoproteins: Prespecified Secondary End Points in ORION 1.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","inclisiran","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","pcsk9-remmers","pelacarsen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034710","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034710","authors":["Kausik K Ray","Robert M Stoekenbroek","David Kallend","Lawrence A Leiter","Ulf Landmesser","R Scott Wright","Peter Wijngaard","John J P Kastelein"],"significance":7,"published":"2018-09-25","source_date":"2018-09-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/inclisiran-sirna/"],"congress":"","summary_en":"This ORION-1 secondary analysis showed that inclisiran reduces the full spectrum of atherogenic lipoproteins beyond LDL cholesterol, including VLDL, remnant cholesterol, and apolipoprotein B, suggesting a broad anti-atherogenic lipid profile.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ORION 1 secundaire analyse naar het effect van inclisiran op het volledige atherogene lipoproteïnenprofiel. Gaat verder dan alleen LDL-C.","abstract_original":"BACKGROUND: The ORION-1 trial (Trial to Evaluate the Effect of ALN-PCSSC Treatment on Low Density Lipoprotein Cholesterol [LDL-C]) demonstrated that inclisiran, an siRNA therapeutic that targets protease proprotein convertase subtilisin/kexin type 9 mRNA within hepatocytes, produces significant low-density lipoprotein cholesterol reduction. The effects of inclisiran on other lipids are less well described. METHODS: ORION-1 was a phase 2 trial assessing 6 different inclisiran dosing regimens versus placebo. Participants with elevated low-density lipoprotein cholesterol despite receiving maximally tolerated statin therapy received a single-dose (200, 300, or 500 mg) or 2-dose starting regimen (100, 200, or 300 mg on days 1 and 90) of inclisiran or placebo. This prespecified analysis reports the percentage reductions in non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein (apo) B, very-low-density lipoprotein cholesterol, lipoprotein(a), triglycerides, HDL-C, and apo A1 at the primary efficacy time point (day 180) with mixed-effect models for repeated measures. Additional prespecified analyses report time course of changes from baseline at each visit to day 210, interindividual variation in response, and lipid goal attainment. RESULTS: The mean age of the 501 participants was 63 years, 65% were male, 69% had atherosclerotic cardiovascular disease, 73% used statins, and mean low-density lipoprotein cholesterol was 128 mg/dL. A single dose of inclisiran reduced apo B, non-HDL-C, and very-low-density lipoprotein cholesterol over 210 days. A second dose of inclisiran provided additional lowering of these lipids. At day 180, non-HDL-C was lowered dose-dependently: by 25% from 148±43 to 110±45 mg/dL in the 200-mg single-dose group and by 46% from 161±58 to 91±58 mg/dL in the 2-dose 300-mg group. For the same dosing regimens, apo B was reduced by 23% from 101±23 to 78±29 mg/dL and by 41% from 106±31 to 65±33 mg/dL ( P<0.001 for all groups versus placebo). In the 300-mg 2-dose group, all individuals experienced apo B and non-HDL-C reductions. There was larger interindividual variation in very-low-density lipoprotein cholesterol, triglycerides, and lipoprotein(a) reductions. In the 300-mg 2-dose group, the percentages of patients achieving guideline-recommended apo B goals for high- and very-high-risk patients at day 180 were 78% and 90%; 68% and 83% of participants achieved non-HDL-C <100 and <130 mg/dL. CONCLUSIONS: Inclisiran produces significant and prolonged reductions in atherogenic lipoproteins, suggesting that inhibiting the synthesis of protease proprotein convertase subtilisin/kexin type 9 through siRNA may be a viable alternative to other approaches that target protease proprotein convertase subtilisin/kexin type 9. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02597127."},{"id":"f5fc528b45c5","type":"article","url":"https://hartvaat.nl/2018/09/22/aspirine-voor-primaire-preventie-bij-matig-cv-risico-lancet-arrive/","title":"Aspirine voor primaire preventie bij matig CV-risico: Lancet ARRIVE","title_en":"Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["aspirine"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31924-X","source_url":"https://doi.org/10.1016/S0140-6736(18)31924-X","authors":["J Michael Gaziano","Carlos Brotons","Rosa Coppolecchia","Claudio Cricelli","Harald Darius","Philip B Gorelick","George Howard","Thomas A Pearson","Peter M Rothwell","Luis Miguel Ruilope","Michal Tendera","Gianni Tognoni"],"significance":9,"published":"2018-09-22","source_date":"2018-09-22","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The ARRIVE trial found that aspirin did not significantly reduce cardiovascular events in patients at moderate cardiovascular risk without established disease, while increasing gastrointestinal bleeding. The result contributed to the shift away from routine aspirin use in primary prevention.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ARRIVE-trial die aspirine onderzocht voor primaire preventie bij matig cardiovasculair risico. Geen significant voordeel — keerpunt voor aspirine bij primaire preventie.","abstract_original":"BACKGROUND: The use of aspirin in the primary prevention of cardiovascular events remains controversial. We aimed to assess the efficacy and safety of aspirin versus placebo in patients with a moderate estimated risk of a first cardiovascular event. METHODS: ARRIVE is a randomised, double-blind, placebo-controlled, multicentre study done in seven countries. Eligible patients were aged 55 years (men) or 60 years (women) and older and had an average cardiovascular risk, deemed to be moderate on the basis of the number of specific risk factors. We excluded patients at high risk of gastrointestinal bleeding or other bleeding, or diabetes. Patients were randomly assigned (1:1) with a computer-generated randomisation code to receive enteric-coated aspirin tablets (100 mg) or placebo tablets, once daily. Patients, investigators, and others involved in treatment or data analysis were masked to treatment allocation. The primary efficacy endpoint was a composite outcome of time to first occurrence of cardiovascular death, myocardial infarction, unstable angina, stroke, or transient ischaemic attack. Safety endpoints were haemorrhagic events and incidence of other adverse events, and were analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00501059. FINDINGS: Between July 5, 2007, and Nov 15, 2016, 12 546 patients were enrolled and randomly assigned to receive aspirin (n=6270) or placebo (n=6276) at 501 study sites. Median follow-up was 60 months. In the intention-to-treat analysis, the primary endpoint occurred in 269 (4·29%) patients in the aspirin group versus 281 (4·48%) patients in the placebo group (hazard ratio [HR] 0·96; 95% CI 0·81-1·13; p=0·6038). Gastrointestinal bleeding events (mostly mild) occurred in 61 (0·97%) patients in the aspirin group versus 29 (0·46%) in the placebo group (HR 2·11; 95% CI 1·36-3·28; p=0·0007). The overall incidence rate of serious adverse events was similar in both treatment groups (n=1266 [20·19%] in the aspirin group vs n=1311 [20·89%] in the placebo group. The overall incidence of adverse events was similar in both treatment groups (n=5142 [82·01%] vs n=5129 [81·72%] in the placebo group). The overall incidence of treatment-related adverse events was low (n=1050 [16·75%] vs n=850 [13·54%] in the placebo group; p<0·0001). There were 321 documented deaths in the intention-to-treat population (n=160 [2·55%] vs n=161 [2·57%] of 6276 patients in the placebo group). INTERPRETATION: The event rate was much lower than expected, which is probably reflective of contemporary risk management strategies, making the study more representative of a low-risk population. The role of aspirin in primary prevention among patients at moderate risk could therefore not be addressed. Nonetheless, the findings with respect to aspirin's effects are consistent with those observed in the previously published low-risk primary prevention studies. FUNDING: Bayer."},{"id":"5a38c2a143b5","type":"article","url":"https://hartvaat.nl/2018/09/22/telemedische-interventie-bij-hartfalen-lancet-tim-hf2/","title":"Telemedische interventie bij hartfalen: Lancet TIM-HF2","title_en":"Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["hfref"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31880-4","source_url":"https://doi.org/10.1016/S0140-6736(18)31880-4","authors":["Friedrich Koehler","Kerstin Koehler","Oliver Deckwart","Sandra Prescher","Karl Wegscheider","Bridget-Anne Kirwan","Sebastian Winkler","Eik Vettorazzi","Leonhard Bruch","Michael Oeff","Christian Zugck","Gesine Doerr","Herbert Naegele","Stefan Störk","Christian Butter","Udo Sechtem","Christiane Angermann","Guntram Gola","Roland Prondzinsky","Frank Edelmann","Sebastian Spethmann","Sebastian M Schellong","P Christian Schulze","Johann Bauersachs","Brunhilde Wellge","Christoph Schoebel","Milos Tajsic","Henryk Dreger","Stefan D Anker","Karl Stangl"],"significance":8,"published":"2018-09-22","source_date":"2018-09-22","image":"","kennis":[],"congress":"","summary_en":"The TIM-HF2 trial demonstrated that structured remote patient management in heart failure reduced the proportion of days lost to unplanned cardiovascular hospitalization or death compared with usual care. The positive result supported the implementation of telemedical monitoring programs in heart failure management.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 TIM-HF2 gerandomiseerde trial die telemedische interventie bij hartfalen positief evalueerde. Bewijs voor gestructureerde telemonitoring bij HF.","abstract_original":"BACKGROUND: Remote patient management in patients with heart failure might help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a full manifestation of a heart failure decompensation. We aimed to investigate the efficacy of our remote patient management intervention on mortality and morbidity in a well defined heart failure population. METHODS: The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial was a prospective, randomised, controlled, parallel-group, unmasked (with randomisation concealment), multicentre trial with pragmatic elements introduced for data collection. The trial was done in Germany, and patients were recruited from hospitals and cardiology practices. Eligible patients had heart failure, were in New York Heart Association class II or III, had been admitted to hospital for heart failure within 12 months before randomisation, and had a left ventricular ejection fraction (LVEF) of 45% or lower (or if higher than 45%, oral diuretics were being prescribed). Patients with major depression were excluded. Patients were randomly assigned (1:1) using a secure web-based system to either remote patient management plus usual care or to usual care only and were followed up for a maximum of 393 days. The primary outcome was percentage of days lost due to unplanned cardiovascular hospital admissions or all-cause death, analysed in the full analysis set. Key secondary outcomes were all-cause and cardiovascular mortality. This study is registered with ClinicalTrials.gov, number NCT01878630, and has now been completed. FINDINGS: Between Aug 13, 2013, and May 12, 2017, 1571 patients were randomly assigned to remote patient management (n=796) or usual care (n=775). Of these 1571 patients, 765 in the remote patient management group and 773 in the usual care group started their assigned care, and were included in the full analysis set. The percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause death was 4·88% (95% CI 4·55-5·23) in the remote patient management group and 6·64% (6·19-7·13) in the usual care group (ratio 0·80, 95% CI 0·65-1·00; p=0·0460). Patients assigned to remote patient management lost a mean of 17·8 days (95% CI 16·6-19·1) per year compared with 24·2 days (22·6-26·0) per year for patients assigned to usual care. The all-cause death rate was 7·86 (95% CI 6·14-10·10) per 100 person-years of follow-up in the remote patient management group compared with 11·34 (9·21-13·95) per 100 person-years of follow-up in the usual care group (hazard ratio [HR] 0·70, 95% CI 0·50-0·96; p=0·0280). Cardiovascular mortality was not significantly different between the two groups (HR 0·671, 95% CI 0·45-1·01; p=0·0560). INTERPRETATION: The TIM-HF2 trial suggests that a structured remote patient management intervention, when used in a well defined heart failure population, could reduce the percentage of days lost due to unplanned cardiovascular hospital admissions and all-cause mortality. FUNDING: German Federal Ministry of Education and Research."},{"id":"a54e266fbe4e","type":"article","url":"https://hartvaat.nl/2018/09/20/cardiovasculaire-veiligheid-van-lorcaserine-bij-obesitas-nejm-camellia/","title":"Cardiovasculaire veiligheid van lorcaserine bij obesitas: NEJM CAMELLIA","title_en":"Cardiovascular Safety of Lorcaserin in Overweight or Obese Patients.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["obesitas","select-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1808721","source_url":"https://doi.org/10.1056/NEJMoa1808721","authors":["Erin A Bohula","Stephen D Wiviott","Darren K McGuire","Silvio E Inzucchi","Julia Kuder","KyungAh Im","Christina L Fanola","Arman Qamar","Conville Brown","Andrzej Budaj","Armando Garcia-Castillo","Milan Gupta","Lawrence A Leiter","Neil J Weissman","Harvey D White","Tushar Patel","Bruce Francis","Wenfeng Miao","Carlos Perdomo","Shobha Dhadda","Marc P Bonaca","Christian T Ruff","Anthony C Keech","Steven R Smith","Marc S Sabatine","Benjamin M Scirica"],"significance":7,"published":"2018-09-20","source_date":"2018-09-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"The CAMELLIA-TIMI 61 trial confirmed the cardiovascular safety of lorcaserin in overweight and obese patients, showing noninferiority to placebo for MACE. However, the drug was later voluntarily withdrawn due to a cancer safety signal.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 CAMELLIA-TIMI 61 trial die de cardiovasculaire veiligheid van lorcaserine bevestigde bij patiënten met overgewicht of obesitas. Later van de markt gehaald om andere redenen.","abstract_original":"BACKGROUND: Lorcaserin, a selective serotonin 2C receptor agonist that modulates appetite, has proven efficacy for weight management in overweight or obese patients. The cardiovascular safety and efficacy of lorcaserin are undefined. METHODS: We randomly assigned 12,000 overweight or obese patients with atherosclerotic cardiovascular disease or multiple cardiovascular risk factors to receive either lorcaserin (10 mg twice daily) or placebo. The primary safety outcome of major cardiovascular events (a composite of cardiovascular death, myocardial infarction, or stroke) was assessed at an interim analysis to exclude a noninferiority boundary of 1.4. If noninferiority was met, the primary cardiovascular efficacy outcome (a composite of major cardiovascular events, heart failure, hospitalization for unstable angina, or coronary revascularization [extended major cardiovascular events]) was assessed for superiority at the end of the trial. RESULTS: At 1 year, weight loss of at least 5% had occurred in 1986 of 5135 patients (38.7%) in the lorcaserin group and in 883 of 5083 (17.4%) in the placebo group (odds ratio, 3.01; 95% confidence interval [CI], 2.74 to 3.30; P<0.001). Patients in the lorcaserin group had slightly better values with respect to cardiac risk factors (including blood pressure, heart rate, glycemic control, and lipids) than those in the placebo group. During a median follow-up of 3.3 years, the rate of the primary safety outcome was 2.0% per year in the lorcaserin group and 2.1% per year in the placebo group (hazard ratio, 0.99; 95% CI, 0.85 to 1.14; P<0.001 for noninferiority); the rate of extended major cardiovascular events was 4.1% per year and 4.2% per year, respectively (hazard ratio, 0.97; 95% CI, 0.87 to 1.07; P=0.55). Adverse events of special interest were uncommon, and the rates were generally similar in the two groups, except for a higher number of patients with serious hypoglycemia in the lorcaserin group (13 vs. 4, P=0.04). CONCLUSIONS: In a high-risk population of overweight or obese patients, lorcaserin facilitated sustained weight loss without a higher rate of major cardiovascular events than that with placebo. (Funded by Eisai; CAMELLIA-TIMI 61 ClinicalTrials.gov number, NCT02019264 .)."},{"id":"c7d5b24b284f","type":"article","url":"https://hartvaat.nl/2018/09/18/hartfalen-na-cva-tia-bij-insulineresistente-patienten-behandeld-met-pioglitazon/","title":"Hartfalen na CVA/TIA bij insulineresistente patiënten behandeld met pioglitazon","title_en":"Heart Failure After Ischemic Stroke or Transient Ischemic Attack in Insulin-Resistant Patients Without Diabetes Mellitus Treated With Pioglitazone.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","carvedilol","diabetes-en-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034763","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034763","authors":["Lawrence H Young","Catherine M Viscoli","Gregory G Schwartz","Silvio E Inzucchi","Jeptha P Curtis","Mark J Gorman","Karen L Furie","Robin Conwit","Erica S Spatz","Anne Lovejoy","J Dawn Abbott","Daniel L Jacoby","Daniel M Kolansky","Frederick S Ling","Steven E Pfau","Walter N Kernan"],"significance":6,"published":"2018-09-18","source_date":"2018-09-18","image":"","kennis":[],"congress":"","summary_en":"This IRIS trial analysis examined the effect of pioglitazone on heart failure incidence after stroke or TIA in insulin-resistant non-diabetic patients, addressing a safety concern of thiazolidinedione therapy.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het effect van pioglitazon op hartfalenincidentie na CVA/TIA bij insulineresistente niet-diabetespatiënten.","abstract_original":"BACKGROUND: The IRIS trial (Insulin Resistance Intervention After Stroke) demonstrated that pioglitazone reduced the risk for both cardiovascular events and diabetes mellitus in insulin-resistant patients. However, concern remains that pioglitazone may increase the risk for heart failure (HF) in susceptible individuals. METHODS: In IRIS, patients with insulin resistance but without diabetes mellitus were randomized to pioglitazone or placebo (1:1) within 180 days of an ischemic stroke or transient ischemic attack and followed for ≤5 years. To identify patients at higher HF risk with pioglitazone, we performed a secondary analysis of IRIS participants without HF history at entry. HF episodes were adjudicated by an external review, and treatment effects were analyzed using time-to-event methods. A baseline HF risk score was constructed from a Cox model estimated using stepwise selection. Baseline patient features (individually and summarized in risk score) and postrandomization events were examined as possible modifiers of the effect of pioglitazone. Net cardiovascular benefit was estimated for the composite of stroke, myocardial infarction, and hospitalized HF. RESULTS: Among 3851 patients, the mean age was 63 years, and 65% were male. The 5-year HF risk did not differ by treatment (4.1% pioglitazone, 4.2% placebo). Risk for hospitalized HF was low and not significantly greater in pioglitazone compared with placebo groups (2.9% versus 2.3%, P=0.36). Older age, atrial fibrillation, hypertension, obesity, edema, high C-reactive protein, and smoking were risk factors for HF. However, the effect of pioglitazone did not differ across levels of baseline HF risk (hazard ratio [95% CI] for pioglitazone versus placebo for patients at low, moderate, and high risk: 1.03 [0.61-1.73], 1.10 [0.56-2.15], and 1.08 [0.58-2.01]; interaction P value=0.98). HF risk was increased in patients with versus those without incident myocardial infarction in both groups (pioglitazone: 31.4% versus 2.7%; placebo: 25.7% versus 2.4%; P<0.0001). Edema, dyspnea, and weight gain in the trial did not predict HF hospitalization but led to more study drug dose reduction with a lower mean dose of pioglitazone versus placebo (29±17 mg versus 33±15 mg, P<0.0001). Pioglitazone reduced the composite outcome of stroke, myocardial infarction, or hospitalized HF (hazard ratio, 0.78; P=0.007). CONCLUSIONS: In IRIS, with surveillance and dose adjustments, pioglitazone did not increase the risk of HF and conferred net cardiovascular benefit in patients with insulin resistance and cerebrovascular disease. The risk of HF with pioglitazone was not modified by baseline HF risk. The IRIS experience may be instructive for maximizing the net benefit of this therapy. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00091949."},{"id":"0303ac97c187","type":"article","url":"https://hartvaat.nl/2018/09/15/hoog-sensitief-troponine-bij-verdenking-acs-lancet-stepped-wedge-clustergerandom/","title":"Hoog-sensitief troponine bij verdenking ACS: Lancet stepped-wedge clustergerandomiseerde trial","title_en":"High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["hs-crp","troponine"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31923-8","source_url":"https://doi.org/10.1016/S0140-6736(18)31923-8","authors":["Anoop S V Shah","Atul Anand","Fiona E Strachan","Amy V Ferry","Kuan Ken Lee","Andrew R Chapman","Dennis Sandeman","Catherine L Stables","Philip D Adamson","Jack P M Andrews","Mohamed S Anwar","John Hung","Alistair J Moss","Rachel O'Brien","Colin Berry","Iain Findlay","Simon Walker","Anne Cruickshank","Alan Reid","Alasdair Gray","Paul O Collinson","Fred S Apple","David A McAllister","Donogh Maguire","Keith A A Fox","David E Newby","Christopher Tuck","Ronald Harkess","Richard A Parker","Catriona Keerie","Christopher J Weir","Nicholas L Mills"],"significance":7,"published":"2018-09-15","source_date":"2018-09-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/troponine-interpretatie/"],"congress":"","summary_en":"This Lancet stepped-wedge trial showed that implementing high-sensitivity troponin testing with lowered diagnostic thresholds in real-world practice identifies more patients with myocardial infarction and may improve clinical outcomes through earlier treatment.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 trial die een hoog-sensitieve troponine-gestuurde strategie evalueerde bij verdenking ACS in de klinische praktijk. Implementatiewetenschappelijk bewijs.","abstract_original":"BACKGROUND: High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis of myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine whether the introduction of a high-sensitivity cardiac troponin I (hs-cTnI) assay with a sex-specific 99th centile diagnostic threshold would reduce subsequent myocardial infarction or cardiovascular death in patients with suspected acute coronary syndrome. METHODS: In this stepped-wedge, cluster-randomised controlled trial across ten secondary or tertiary care hospitals in Scotland, we evaluated the implementation of an hs-cTnI assay in consecutive patients who had been admitted to the hospitals' emergency departments with suspected acute coronary syndrome. Patients were eligible for inclusion if they presented with suspected acute coronary syndrome and had paired cardiac troponin measurements from the standard care and trial assays. During a validation phase of 6-12 months, results from the hs-cTnI assay were concealed from the attending clinician, and a contemporary cardiac troponin I (cTnI) assay was used to guide care. Hospitals were randomly allocated to early (n=5 hospitals) or late (n=5 hospitals) implementation, in which the high-sensitivity assay and sex-specific 99th centile diagnostic threshold was introduced immediately after the 6-month validation phase or was deferred for a further 6 months. Patients reclassified by the high-sensitivity assay were defined as those with an increased hs-cTnI concentration in whom cTnI concentrations were below the diagnostic threshold on the contemporary assay. The primary outcome was subsequent myocardial infarction or death from cardiovascular causes at 1 year after initial presentation. Outcomes were compared in patients reclassified by the high-sensitivity assay before and after its implementation by use of an adjusted generalised linear mixed model. This trial is registered with ClinicalTrials.gov, number NCT01852123. FINDINGS: Between June 10, 2013, and March 3, 2016, we enrolled 48 282 consecutive patients (61 [SD 17] years, 47% women) of whom 10 360 (21%) patients had cTnI concentrations greater than those of the 99th centile of the normal range of values, who were identified by the contemporary assay or the high-sensitivity assay. The high-sensitivity assay reclassified 1771 (17%) of 10 360 patients with myocardial injury or infarction who were not identified by the contemporary assay. In those reclassified, subsequent myocardial infarction or cardiovascular death within 1 year occurred in 105 (15%) of 720 patients in the validation phase and 131 (12%) of 1051 patients in the implementation phase (adjusted odds ratio for implementation vs validation phase 1·10, 95% CI 0·75 to 1·61; p=0·620). INTERPRETATION: Use of a high-sensitivity assay prompted reclassification of 1771 (17%) of 10 360 patients with myocardial injury or infarction, but was not associated with a lower subsequent incidence of myocardial infarction or cardiovascular death at 1 year. Our findings question whether the diagnostic threshold for myocardial infarction should be based on the 99th centile derived from a normal reference population. FUNDING: The British Heart Foundation."},{"id":"7881dd7f24fc","type":"article","url":"https://hartvaat.nl/2018/09/15/ticagrelor-monotherapie-na-1-maand-dapt-lancet-global-leaders/","title":"Ticagrelor monotherapie na 1 maand DAPT: Lancet GLOBAL LEADERS","title_en":"Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31858-0","source_url":"https://doi.org/10.1016/S0140-6736(18)31858-0","authors":["Pascal Vranckx","Marco Valgimigli","Peter Jüni","Christian Hamm","Philippe Gabriel Steg","Dik Heg","Gerrit Anne van Es","Eugene P McFadden","Yoshinobu Onuma","Cokky van Meijeren","Ply Chichareon","Edouard Benit","Helge Möllmann","Luc Janssens","Maurizio Ferrario","Aris Moschovitis","Aleksander Zurakowski","Marcello Dominici","Robert Jan Van Geuns","Kurt Huber","Ton Slagboom","Patrick W Serruys","Stephan Windecker"],"significance":8,"published":"2018-09-15","source_date":"2018-09-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"The GLOBAL LEADERS trial tested an early switch from DAPT to ticagrelor monotherapy after 1 month versus standard 12-month DAPT after PCI. The strategy did not show superiority for the primary endpoint, but provided safety data for early P2Y12 inhibitor monotherapy that informed subsequent trials.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 GLOBAL LEADERS trial naar ticagrelor plus aspirine voor 1 maand gevolgd door ticagrelor monotherapie versus standaard DAPT. Vroege stapsgewijze benadering.","abstract_original":"BACKGROUND: We hypothesised that ticagrelor, in combination with aspirin for 1 month, followed by ticagrelor alone, improves outcomes after percutaneous coronary intervention compared with standard antiplatelet regimens. METHODS: GLOBAL LEADERS was a randomised, open-label superiority trial at 130 sites in 18 countries. Patients undergoing percutaneous coronary intervention with a biolimus A9-eluting stent for stable coronary artery disease or acute coronary syndromes were randomly assigned (1:1) to 75-100 mg aspirin daily plus 90 mg ticagrelor twice daily for 1 month, followed by 23 months of ticagrelor monotherapy, or standard dual antiplatelet therapy with 75-100 mg aspirin daily plus either 75 mg clopidogrel daily (for patients with stable coronary artery disease) or 90 mg ticagrelor twice daily (for patients with acute coronary syndromes) for 12 months, followed by aspirin monotherapy for 12 months. Randomisation was concealed, stratified by centre and clinical presentation (stable coronary artery disease vs acute coronary syndrome), and blocked, with randomly varied block sizes of two and four. The primary endpoint at 2 years was a composite of all-cause mortality or non-fatal centrally adjudicated new Q-wave myocardial infarction as assessed by a core lab in a blinded manner. The key secondary safety endpoint was site-reported bleeding assessed according to the Bleeding Academic Research Consortium criteria (grade 3 or 5). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01813435, and is closed to new participants, with follow-up completed. FINDINGS: Between July 1, 2013, and Nov 9, 2015, 15 968 participants were randomly assigned, 7980 to the experimental group and 7988 to the control group. At 2 years, 304 (3·81%) participants in the experimental group had died or had a non-fatal centrally adjudicated new Q-wave myocardial infarction, compared with 349 (4·37%) participants in the control group (rate ratio 0·87 [95% CI 0·75-1·01]; p=0·073]). There was no evidence for a difference in treatment effects for the primary endpoint across prespecified subgroups of acute coronary syndromes and stable coronary artery disease (p=0·93). Grade 3 or 5 bleeding occurred in 163 participants in the experimental group and 169 in the control group (2·04% vs 2·12%; rate ratio 0·97 [95% CI 0·78-1·20]; p=0·77). INTERPRETATION: Ticagrelor in combination with aspirin for 1 month followed by ticagrelor alone for 23 months was not superior to 12 months of standard dual antiplatelet therapy followed by 12 months of aspirin alone in the prevention of all-cause mortality or new Q-wave myocardial infarction 2 years after percutaneous coronary intervention. FUNDING: AstraZeneca, Biosensors, and The Medicines Company."},{"id":"705520427f97","type":"article","url":"https://hartvaat.nl/2018/09/13/tafamidis-bij-transthyretine-amyloid-cardiomyopathie-nejm-attr-act/","title":"Tafamidis bij transthyretine amyloïd cardiomyopathie: NEJM ATTR-ACT","title_en":"Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-amyloidose","cardiomyopathie-gerichte-therapie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1805689","source_url":"https://doi.org/10.1056/NEJMoa1805689","authors":["Mathew S Maurer","Jeffrey H Schwartz","Balarama Gundapaneni","Perry M Elliott","Giampaolo Merlini","Marcia Waddington-Cruz","Arnt V Kristen","Martha Grogan","Ronald Witteles","Thibaud Damy","Brian M Drachman","Sanjiv J Shah","Mazen Hanna","Daniel P Judge","Alexandra I Barsdorf","Peter Huber","Terrell A Patterson","Steven Riley","Jennifer Schumacher","Michelle Stewart","Marla B Sultan","Claudio Rapezzi"],"significance":10,"published":"2018-09-13","source_date":"2018-09-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"The ATTR-ACT trial demonstrated that tafamidis significantly reduced all-cause mortality and cardiovascular hospitalization in patients with transthyretin amyloid cardiomyopathy. As the first proven pharmacological treatment for cardiac amyloidosis, this study transformed a previously untreatable condition into a manageable disease.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ATTR-ACT-trial die aantoonde dat tafamidis cardiovasculaire mortaliteit en hospitalisatie significant vermindert bij transthyretine amyloïd cardiomyopathie. Eerste bewezen behandeling voor cardiale amyloïdose.","abstract_original":"BACKGROUND: Transthyretin amyloid cardiomyopathy is caused by the deposition of transthyretin amyloid fibrils in the myocardium. The deposition occurs when wild-type or variant transthyretin becomes unstable and misfolds. Tafamidis binds to transthyretin, preventing tetramer dissociation and amyloidogenesis. METHODS: In a multicenter, international, double-blind, placebo-controlled, phase 3 trial, we randomly assigned 441 patients with transthyretin amyloid cardiomyopathy in a 2:1:2 ratio to receive 80 mg of tafamidis, 20 mg of tafamidis, or placebo for 30 months. In the primary analysis, we hierarchically assessed all-cause mortality, followed by frequency of cardiovascular-related hospitalizations according to the Finkelstein-Schoenfeld method. Key secondary end points were the change from baseline to month 30 for the 6-minute walk test and the score on the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS), in which higher scores indicate better health status. RESULTS: In the primary analysis, all-cause mortality and rates of cardiovascular-related hospitalizations were lower among the 264 patients who received tafamidis than among the 177 patients who received placebo (P<0.001). Tafamidis was associated with lower all-cause mortality than placebo (78 of 264 [29.5%] vs. 76 of 177 [42.9%]; hazard ratio, 0.70; 95% confidence interval [CI], 0.51 to 0.96) and a lower rate of cardiovascular-related hospitalizations, with a relative risk ratio of 0.68 (0.48 per year vs. 0.70 per year; 95% CI, 0.56 to 0.81). At month 30, tafamidis was also associated with a lower rate of decline in distance for the 6-minute walk test (P<0.001) and a lower rate of decline in KCCQ-OS score (P<0.001). The incidence and types of adverse events were similar in the two groups. CONCLUSIONS: In patients with transthyretin amyloid cardiomyopathy, tafamidis was associated with reductions in all-cause mortality and cardiovascular-related hospitalizations and reduced the decline in functional capacity and quality of life as compared with placebo. (Funded by Pfizer; ATTR-ACT ClinicalTrials.gov number, NCT01994889 .)."},{"id":"321f0d912f87","type":"article","url":"https://hartvaat.nl/2018/09/08/drug-coated-balloons-bij-kleine-coronairarterien-lancet-basket-small-2/","title":"Drug-coated balloons bij kleine coronairarteriën: Lancet BASKET-SMALL 2","title_en":"Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31719-7","source_url":"https://doi.org/10.1016/S0140-6736(18)31719-7","authors":["Raban V Jeger","Ahmed Farah","Marc-Alexander Ohlow","Norman Mangner","Sven Möbius-Winkler","Gregor Leibundgut","Daniel Weilenmann","Jochen Wöhrle","Stefan Richter","Matthias Schreiber","Felix Mahfoud","Axel Linke","Frank-Peter Stephan","Christian Mueller","Peter Rickenbacher","Michael Coslovsky","Nicole Gilgen","Stefan Osswald","Christoph Kaiser","Bruno Scheller"],"significance":7,"published":"2018-09-08","source_date":"2018-09-08","image":"","kennis":[],"congress":"","summary_en":"The BASKET-SMALL 2 trial demonstrated that drug-coated balloons are noninferior to drug-eluting stents for treating small coronary arteries, establishing a leave-nothing-behind strategy as a viable option in small vessel disease.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 BASKET-SMALL 2 non-inferioriteitstrial die drug-coated balloons vergeleek met drug-eluting stents bij kleine coronairarteriën. Stentloos alternatief.","abstract_original":"BACKGROUND: Drug-coated balloons (DCB) are a novel therapeutic strategy for small native coronary artery disease. However, their safety and efficacy is poorly defined in comparison with drug-eluting stents (DES). METHODS: BASKET-SMALL 2 was a multicentre, open-label, randomised non-inferiority trial. 758 patients with de-novo lesions (<3 mm in diameter) in coronary vessels and an indication for percutaneous coronary intervention were randomly allocated (1:1) to receive angioplasty with DCB versus implantation of a second-generation DES after successful predilatation via an interactive internet-based response system. Dual antiplatelet therapy was given according to current guidelines. The primary objective was to show non-inferiority of DCB versus DES regarding major adverse cardiac events (MACE; ie, cardiac death, non-fatal myocardial infarction, and target-vessel revascularisation) after 12 months. The non-inferiority margin was an absolute difference of 4% in MACE. This trial is registered with ClinicalTrials.gov, number NCT01574534. FINDINGS: Between April 10, 2012, and February 1, 2017, 382 patients were randomly assigned to the DCB group and 376 to DES group. Non-inferiority of DCB versus DES was shown because the 95% CI of the absolute difference in MACE in the per-protocol population was below the predefined margin (-3·83 to 3·93%, p=0·0217). After 12 months, the proportions of MACE were similar in both groups of the full-analysis population (MACE was 7·5% for the DCB group vs 7·3% for the DES group; hazard ratio [HR] 0·97 [95% CI 0·58-1·64], p=0·9180). There were five (1·3%) cardiac-related deaths in the DES group and 12 (3·1%) in the DCB group (full analysis population). Probable or definite stent thrombosis (three [0·8%] in the DCB group vs four [1·1%] in the DES group; HR 0·73 [0·16-3·26]) and major bleeding (four [1·1%] in the DCB group vs nine [2·4%] in the DES group; HR 0·45 [0·14-1·46]) were the most common adverse events. INTERPRETATION: In small native coronary artery disease, DCB was non-inferior to DES regarding MACE up to 12 months, with similar event rates for both treatment groups. FUNDING: Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Basel Cardiovascular Research Foundation, and B Braun Medical AG."},{"id":"777789463a56","type":"article","url":"https://hartvaat.nl/2018/09/08/radiale-versus-femorale-toegang-en-bivalirudine-versus-ufh-bij-acs-lancet-matrix/","title":"Radiale versus femorale toegang en bivalirudine versus UFH bij ACS: Lancet MATRIX","title_en":"Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31714-8","source_url":"https://doi.org/10.1016/S0140-6736(18)31714-8","authors":["Marco Valgimigli","Enrico Frigoli","Sergio Leonardi","Pascal Vranckx","Martina Rothenbühler","Matteo Tebaldi","Ferdinando Varbella","Paolo Calabrò","Stefano Garducci","Paolo Rubartelli","Carlo Briguori","Giuseppe Andó","Maurizio Ferrario","Ugo Limbruno","Roberto Garbo","Paolo Sganzerla","Filippo Russo","Marco Nazzaro","Alessandro Lupi","Bernardo Cortese","Arturo Ausiello","Salvatore Ierna","Giovanni Esposito","Giuseppe Ferrante","Andrea Santarelli","Gennaro Sardella","Nicoletta de Cesare","Paolo Tosi","Arnoud van 't Hof","Elmir Omerovic","Salvatore Brugaletta","Stephan Windecker","Dik Heg","Peter Jüni"],"significance":8,"published":"2018-09-08","source_date":"2018-09-08","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"The MATRIX trial with its 2×2 factorial design demonstrated that radial access reduced net adverse clinical events compared with femoral access, while bivalirudin did not show significant benefit over unfractionated heparin in invasively managed ACS patients. The results strengthened radial access as the default approach.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 MATRIX-trial met 2x2 factorieel ontwerp: radiale versus femorale toegang en bivalirudine versus ongefractioneerde heparine bij invasief behandeld ACS.","abstract_original":"BACKGROUND: The Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) programme was designed to assess the comparative safety and effectiveness of radial versus femoral access and of bivalirudin versus unfractionated heparin with optional glycoprotein IIb/IIIa inhibitors in patients with the whole spectrum of acute coronary syndrome undergoing invasive management. Here we describe the prespecified final 1-year outcomes of the entire programme. METHODS: MATRIX was a programme of three nested, randomised, multicentre, open-label, superiority trials in patients with acute coronary syndrome in 78 hospitals in Italy, the Netherlands, Spain, and Sweden. Patients with ST-elevation myocardial infarction were simultaneously randomly assigned (1:1) before coronary angiography to radial or femoral access and to bivalirudin, with or without post-percutaneous coronary intervention infusion or unfractionated heparin (one-step inclusion). Patients with non-ST-elevation acute coronary syndrome were randomly assigned (1:1) before coronary angiography to radial or femoral access and, only if deemed eligible to percutaneous coronary intervention after angiography (two-step inclusion), entered the antithrombin type and treatment duration programmes. Randomisation sequences were computer generated, blocked, and stratified by intended new or current use of P2Y12 inhibitor (clopidogrel vs ticagrelor or prasugrel), and acute coronary syndrome type (ST-elevation myocardial infarction, troponin-positive, or troponin-negative non-ST-elevation acute coronary syndrome). Bivalirudin was given as a bolus of 0·75 mg/kg, followed immediately by an infusion of 1·75 mg/kg per h until completion of percutaneous coronary intervention. Heparin was given at 70-100 units per kg in patients not receiving glycoprotein IIb/IIIa inhibitors, and at 50-70 units per kg in patients receiving glycoprotein IIb/IIIa inhibitors. Clinical follow-up was done at 30 days and 1 year. Co-primary outcomes for MATRIX access and MATRIX antithrombin type were major adverse cardiovascular events, defined as the composite of all-cause mortality, myocardial infarction, or stroke up to 30 days; and net adverse clinical events, defined as the composite of non-coronary artery bypass graft-related major bleeding, or major adverse cardiovascular events up to 30 days. The primary outcome for MATRIX treatment duration was the composite of urgent target vessel revascularisation, definite stent thrombosis, or net adverse clinical events up to 30 days. Analyses were done according to the intention-to-treat principle. This trial is registered with ClinicalTrials.gov, number NCT01433627. FINDINGS: Between Oct 11, 2011, and Nov 7, 2014, we randomly assigned 8404 patients to receive radial (4197 patients) or femoral (4207 patients) access. Of these 8404 patients, 7213 were included in the MATRIX antithrombin type study and were randomly assigned to bivalirudin (3610 patients) or heparin (3603 patients). Patients assigned to bivalirudin were included in the MATRIX treatment duration study, and were randomly assigned to post-procedure infusion (1799 patients) or no post-procedure infusion (1811 patients). At 1 year, major adverse cardiovascular events did not differ between patients assigned to radial access compared with those assigned to femoral access (14·2% vs 15·7%; rate ratio 0·89, 95% CI 0·80-1·00; p=0·0526), but net adverse clinical events were fewer with radial than with femoral access (15·2% vs 17·2%; 0·87, 0·78-0·97; p=0·0128). Compared with heparin, bivalirudin was not associated with fewer major adverse cardiovascular (15·8% vs 16·8%; 0·94, 0·83-1·05; p=0·28) or net adverse clinical events (17·0% vs 18·4%; 0·91, 0·81-1·02; p=0·10). The composite of urgent target vessel revascularisation, stent thrombosis, or net adverse clinical events did not differ with or without post-procedure bivalirudin infusion (17·4% vs 17·4%; 0·99, 0·84-1·16; p=0·90). INTERPRETATION: In patients with acute coronary syndrome, radial access was associated with lower rates of net adverse clinical events compared with femoral access, but not major adverse cardiovascular events at 1 year. Bivalirudin with or without post-procedure infusion was not associated with lower rates of major adverse cardiovascular events or net adverse clinical events. Radial access should become the default approach in acute coronary syndrome patients undergoing invasive management. FUNDING: Italian Society of Invasive Cardiology, The Medicines Company, Terumo, amd Canada Research Chairs Programme."},{"id":"915b2410f3f9","type":"article","url":"https://hartvaat.nl/2018/09/06/ct-coronairangiografie-en-5-jaars-mi-risico-nejm-scot-heart/","title":"CT-coronairangiografie en 5-jaars MI-risico: NEJM SCOT-HEART","title_en":"Coronary CT Angiography and 5-Year Risk of Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["coronaire-ct-angiografie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1805971","source_url":"https://doi.org/10.1056/NEJMoa1805971","authors":["David E Newby","Philip D Adamson","Colin Berry","Nicholas A Boon","Marc R Dweck","Marcus Flather","John Forbes","Amanda Hunter","Stephanie Lewis","Scott MacLean","Nicholas L Mills","John Norrie","Giles Roditi","Anoop S V Shah","Adam D Timmis","Edwin J R van Beek","Michelle C Williams"],"significance":9,"published":"2018-09-06","source_date":"2018-09-06","image":"","kennis":[],"congress":"","summary_en":"The 5-year SCOT-HEART results showed that adding coronary CT angiography to standard care for stable chest pain halved the rate of fatal and nonfatal MI by improving diagnosis and enabling preventive treatment. The findings established CCTA as a first-line investigation for stable chest pain syndromes.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 SCOT-HEART 5-jaarsresultaten die aantoonden dat CCTA het MI-risico halveert door betere detectie en preventieve behandeling. Bepalend voor de CCTA-indicatie.","abstract_original":"BACKGROUND: Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown. METHODS: In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardial infarction at 5 years. RESULTS: The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.004). Although the rates of invasive coronary angiography and coronary revascularization were higher in the CTA group than in the standard-care group in the first few months of follow-up, overall rates were similar at 5 years: invasive coronary angiography was performed in 491 patients in the CTA group and in 502 patients in the standard-care group (hazard ratio, 1.00; 95% CI, 0.88 to 1.13), and coronary revascularization was performed in 279 patients in the CTA group and in 267 in the standard-care group (hazard ratio, 1.07; 95% CI, 0.91 to 1.27). However, more preventive therapies were initiated in patients in the CTA group (odds ratio, 1.40; 95% CI, 1.19 to 1.65), as were more antianginal therapies (odds ratio, 1.27; 95% CI, 1.05 to 1.54). There were no significant between-group differences in the rates of cardiovascular or noncardiovascular deaths or deaths from any cause. CONCLUSIONS: In this trial, the use of CTA in addition to standard care in patients with stable chest pain resulted in a significantly lower rate of death from coronary heart disease or nonfatal myocardial infarction at 5 years than standard care alone, without resulting in a significantly higher rate of coronary angiography or coronary revascularization. (Funded by the Scottish Government Chief Scientist Office and others; SCOT-HEART ClinicalTrials.gov number, NCT01149590 .)."},{"id":"b4f508b069eb","type":"article","url":"https://hartvaat.nl/2018/09/04/troponine-i-en-cardiovasculair-risico-bij-copd/","title":"Troponine I en cardiovasculair risico bij COPD","title_en":"Cardiac Troponin I and Cardiovascular Risk in Patients With Chronic Obstructive Pulmonary Disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["roken","slaapapneu"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.06.051","source_url":"https://doi.org/10.1016/j.jacc.2018.06.051","authors":["Philip D Adamson","Julie A Anderson","Robert D Brook","Peter M A Calverley","Bartolome R Celli","Nicholas J Cowans","Courtney Crim","Ian J Dixon","Fernando J Martinez","David E Newby","Jørgen Vestbo","Julie C Yates","Nicholas L Mills"],"significance":6,"published":"2018-09-04","source_date":"2018-09-04","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This study demonstrated that cardiac troponin I levels independently predict cardiovascular events in COPD patients, supporting troponin as a cardiac risk biomarker in the respiratory disease population.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van cardiaal troponine I met cardiovasculaire uitkomsten bij COPD-patiënten. Troponine als CV-risicomarker bij longziekte.","abstract_original":"BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have increased risk of cardiovascular events. OBJECTIVES: This study evaluated the association between high-sensitivity cardiac troponin I concentration and cardiovascular events in patients with COPD and heightened cardiovascular risk. METHODS: In a double-blind randomized controlled trial, 16,485 patients with COPD and cardiovascular disease or risk factors were randomized to once daily inhaled placebo, fluticasone furoate (100 μg), vilanterol (25 μg), or their combination. Plasma high-sensitivity cardiac troponin I concentrations were measured in a subgroup of 1,599 patients. Outcomes were on-treatment cardiovascular events and COPD exacerbations over a median of 18 months, and cardiovascular death over a median of 27 months. RESULTS: Baseline plasma cardiac troponin I concentrations were above the limit of detection (1.2 ng/l) in 1,542 (96%) patients. Concentrations were unaffected by inhaled therapies at 3 months (p > 0.05). Compared with the lowest quintile (cardiac troponin <2.3 ng/l), patients in the highest quintile (≥7.7 ng/l) were at greater risk of cardiovascular events (hazard ratio [HR] 3.7; 95% confidence interval [CI]: 1.3 to 10.1; p = 0.012) and cardiovascular death (HR: 20.1; 95% CI: 2.4 to 165.2; p = 0.005) after adjustment for risk factors. By contrast, there were no differences in exacerbations between quintiles (HR: 1.1; 95% CI: 0.8 to 1.5; p = 0.548). CONCLUSIONS: In patients with COPD and heightened cardiovascular risk, plasma cardiac troponin I concentrations are a specific and major indicator of future cardiovascular events and cardiovascular death. Inhaled therapies did not affect cardiac troponin I concentrations consistent with their neutral effect on mortality and cardiovascular outcomes. (Study to Evaluate the Effect of Fluticasone Furoate/Vilanterol on Survival in Subjects With Chronic Obstructive Pulmonary Disease [SUMMIT]; NCT01313676)."},{"id":"8c50d847f529","type":"article","url":"https://hartvaat.nl/2018/09/01/ultradunne-biodegradeerbare-versus-dunne-duurzame-stents-lancet-gerandomiseerde-/","title":"Ultradunne biodegradeerbare versus dunne duurzame stents: Lancet gerandomiseerde non-inferioriteit","title_en":"Ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents versus thin-strut, durable-polymer, everolimus-eluting stents for percutaneous coronary revascularisation: 5-year outcomes of the BIOSCIENCE randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31715-X","source_url":"https://doi.org/10.1016/S0140-6736(18)31715-X","authors":["Thomas Pilgrim","Raffaele Piccolo","Dik Heg","Marco Roffi","David Tüller","Olivier Muller","Igal Moarof","George C M Siontis","Stéphane Cook","Daniel Weilenmann","Christoph Kaiser","Florim Cuculi","Lukas Hunziker","Franz R Eberli","Peter Jüni","Stephan Windecker"],"significance":7,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This Lancet non-inferiority trial of ultra-thin biodegradable polymer sirolimus-eluting stents versus thin durable polymer everolimus-eluting stents confirmed similar safety and efficacy, supporting the evolution toward thinner, more biocompatible stent platforms.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 non-inferioriteitstrial die ultradunne biodegradeerbare polymer sirolimus-eluting stents vergeleek met dunne duurzame polymer EES.","abstract_original":"BACKGROUND: Drug-eluting stents combining an ultrathin cobalt-chromium stent platform with a biodegradable polymer eluting sirolimus have been shown to be non-inferior or superior to thin-strut, durable-polymer, everolimus-eluting stents in terms of 1 year safety and efficacy outcomes. METHODS: In the randomised, single-blind, multicentre, non-inferiority BIOSCIENCE trial, we compared biodegradable-polymer sirolimus-eluting stents with durable-polymer everolimus-eluting stents in patients with chronic stable coronary artery disease or acute coronary syndromes. Here, we assess the final 5-year clinical outcomes of BIOSCIENCE with regards to the primary clinical outcome of target lesion failure, which was a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularisation. The primary analysis was done by intention to treat. The BIOSCIENCE trial is registered with ClinicalTrials.gov, number NCT01443104. FINDINGS: 2008 (95%) of 2119 patients recruited between March 1, 2012, and May 31, 2013, completed 5 years of follow-up. Target lesion failure occurred in 198 patients (cumulative incidence 20·2%) treated with biodegradable-polymer sirolimus-eluting stents and in 189 patients (18·8%) treated with durable-polymer everolimus-eluting stents (rate ratio [RR] 1·07, 95% CI 0·88-1·31; p=0·487). All-cause mortality was significantly higher in patients treated with biodegradable-polymer sirolimus-eluting stents than in those treated with durable-polymer everolimus-eluting stents (14·1% vs 10·3%; RR 1·36, 95% CI 1·06-1·75; p=0·017), driven by a difference in non-cardiovascular deaths. We observed no difference between groups in cumulative incidence of definite stent thrombosis at 5 years (1·6% in both groups; 1·02, 0·51-2·05; p=0·950). INTERPRETATION: 5-year risk of target lesion failure among all-comer patients undergoing percutaneous coronary intervention is similar after implantation of ultrathin-strut, biodegradable-polymer, sirolimus-eluting stents or thin-strut, durable-polymer, everolimus-eluting stents. Higher incidences of all-cause and non-cardiovascular mortality in patients treated with biodegradable-polymer stents eluting sirolimus than in those treated with durable-polymer stents eluting everolimus warrant careful observation in ongoing clinical trials. FUNDING: Clinical Trials Unit of the University of Bern and Biotronik."},{"id":"03b3fe9178ac","type":"article","url":"https://hartvaat.nl/2018/09/01/bloeddruk-hartfrequentie-en-mortaliteit-bij-copd-summit-trial/","title":"Bloeddruk, hartfrequentie en mortaliteit bij COPD: SUMMIT-trial","title_en":"Blood pressure, heart rate, and mortality in chronic obstructive pulmonary disease: the SUMMIT trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy451","source_url":"https://doi.org/10.1093/eurheartj/ehy451","authors":["James Brian Byrd","David E Newby","Julie A Anderson","Peter M A Calverley","Bartolome R Celli","Nicholas J Cowans","Courtney Crim","Fernando J Martinez","Jørgen Vestbo","Julie Yates","Robert D Brook"],"significance":6,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This SUMMIT trial analysis characterized the relationship between blood pressure, heart rate, and mortality in COPD patients with elevated cardiovascular risk, informing the management of the common cardiopulmonary comorbidity overlap.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SUMMIT-trial analyse naar het verband tussen bloeddruk, hartfrequentie en mortaliteit bij COPD met verhoogd CV-risico. Cardiopulmonale interactie.","abstract_original":"AIMS: To characterize the relationship between blood pressure (BP) or heart rate and mortality and morbidity in chronic obstructive pulmonary disease (COPD). METHODS AND RESULTS: We performed post hoc analysis of baseline BP or heart rate and all-cause mortality and cardiovascular events in the SUMMIT trial. SUMMIT was a randomized double-blind outcome trial of 16 485 participants (65 ± 8 years, 75% male, and 47% active smokers) enrolled at 1368 sites in 43 countries. Participants with moderate COPD with or at risk for cardiovascular disease (CVD) were randomized to placebo, long-acting beta agonist, inhaled corticosteroid, or their combination. All-cause mortality increased in relation to high systolic [≥140 mmHg; hazard ratio (HR) 1.27, 95% confidence interval (CI) 1.12-1.45] or diastolic (≥90 mmHg; HR 1.35, 95% CI 1.14-1.59) BP and low systolic (<120 mmHg; HR 1.36, 95% CI 1.13-1.63) or diastolic (<80 mmHg; HR 1.15, 95% CI 1.00-1.32) BP. Higher heart rates (≥80 per minute; HR 1.39, 95% CI 1.21-1.60) and pulse pressures (≥80 mmHg; HR 1.39, 95% CI 1.07-1.80) were more linearly related to increases in all-cause mortality. The risks of cardiovascular events followed similar patterns to all-cause mortality. Similar findings were observed in subgroups of patients without established CVD. CONCLUSION: A 'U-shaped' relationship between BP and all-cause mortality and cardiovascular events exists in patients with COPD and heightened cardiovascular risk. A linear relationship exists between heart rate and all-cause mortality and cardiovascular events in this population. These findings extend the prognostic importance of BP to this growing group of patients and raise concerns that both high and low BP may pose health risks."},{"id":"e38b379071f4","type":"article","url":"https://hartvaat.nl/2018/09/01/verdere-ldl-verlaging-bij-reeds-zeer-lage-niveaus-jama-cardiology-meta-analyse/","title":"Verdere LDL-verlaging bij reeds zeer lage niveaus: JAMA Cardiology meta-analyse","title_en":"Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels: A Meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","ldl-cholesterol","lipidenverlaging","niet-statine-therapie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.2258","source_url":"https://doi.org/10.1001/jamacardio.2018.2258","authors":["Marc S Sabatine","Stephen D Wiviott","KyungAh Im","Sabina A Murphy","Robert P Giugliano"],"significance":8,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis showed that further LDL cholesterol lowering in patients already at very low levels continued to reduce cardiovascular events proportionally without excess safety concerns. The data reinforced the 'lower is better' hypothesis even below 1.8 mmol/L.","created":"2026-07-03T10:27:28Z","updated":"2026-07-03T13:26:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar werkzaamheid en veiligheid van verdere LDL-verlaging bij patiënten die al zeer lage niveaus bereiken. Bevestigt 'lower is better' tot <1.0 mmol/L.","abstract_original":"IMPORTANCE: In the Cholesterol Treatment Trialists Collaboration (CTTC), in patients starting with low-density lipoprotein cholesterol (LDL-C) levels of approximately 3.4 mmol/L (131.5 mg/dL), there was a 22% reduction in major vascular events per 1-mmol/L (38.7-mg/dL) lowering of LDL-C. The magnitude of clinical benefit of further LDL-C lowering in patients already with very low LDL-C levels remains debated. OBJECTIVE: To evaluate efficacy and safety of further lowering LDL-C levels in patient populations presenting with median LDL-C levels of 1.8 mmol/L (70 mg/dL) or less. DATA SOURCES AND STUDY SELECTION: The CTTC was used for statin data. For nonstatin therapy, Medline database was searched (2015-April 2018). Key inclusion criteria were a randomized, double-blind, controlled cardiovascular outcome trial of LDL-C lowering with data in populations starting with LDL-C levels averaging 1.8 mmol/L (70 mg/dL) or less. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data into standardized data sheets, and data were analyzed using meta-analysis. MAIN OUTCOMES AND MEASURES: The risk ratio (RR) of major vascular events (a composite of coronary heart death, myocardial infarction, ischemic stroke, or coronary revascularization) per 1-mmol/L (38.7-mg/dL) reduction in LDL-C level. RESULTS: In the subgroup of patients from the CTTC meta-analysis of statins with a mean LDL-C in the control arm of 1.7 mmol/L (65.7 mg/dL), 1922 major vascular events occurred and the RR for major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was 0.78 (95% CI, 0.65-0.94). For 3 trials of nonstatin LDL-C-lowering therapies added to statins, there were 50 627 patients, the median LDL-C in the control arms ranged from 1.6 mmol/L to 1.8 mmol/L (63 mg/dL to 70 mg/dL), and 9570 major vascular events occurred. Nonstatin therapy lowered LDL-C by 0.3 to 1.2 mmol/L (11 mg/dL to 45 mg/dL), and the RR for major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C was 0.79 (95% CI, 0.70-0.88). For statins and nonstatins combined, the RR was 0.79 (95% CI, 0.71-0.87; P < .001). Low-density lipoprotein cholesterol lowering was not associated with an increased risk of serious adverse events, myalgias and/or myositis, elevation in the level of aminotransferases, new-onset diabetes, hemorrhagic stroke, or cancer. CONCLUSIONS AND RELEVANCE: There is a consistent relative risk reduction in major vascular events per change in LDL-C in patient populations starting as low as a median of 1.6 mmol/L (63 mg/dL) and achieving levels as low as a median of 0.5 mmol/L (21 mg/dL), with no observed offsetting adverse effects. These data suggest further lowering of LDL-C beyond the lowest current targets would further reduce cardiovascular risk."},{"id":"6a18967c319d","type":"article","url":"https://hartvaat.nl/2018/09/01/orthostatische-hypotensie-verhoogt-risico-op-cognitieve-stoornissen/","title":"Orthostatische hypotensie verhoogt risico op cognitieve stoornissen","title_en":"Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["slaapapneu"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy418","source_url":"https://doi.org/10.1093/eurheartj/ehy418","authors":["Ruth Peters","Kaarin J Anstey","Andrew Booth","Nigel Beckett","Jane Warwick","Riitta Antikainen","Kenneth Rockwood","Jean Peters","Christopher J Bulpitt"],"significance":7,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This integrated analysis showed that both orthostatic hypotension and symptomatic subclinical orthostatic hypotension are associated with increased risk of cognitive impairment and dementia, linking postural hemodynamic instability to brain health.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T13:26:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geïntegreerde analyse die aantoont dat orthostatische hypotensie en symptomatische subclinische OH het risico op cognitieve achteruitgang verhogen.","abstract_original":"AIMS: Systematically reviewing the literature found orthostatic hypotension (OH) to be associated with an increased risk of incident dementia but limited data were available in those at highest risk, the hypertensive oldest-old. Our aim was to analyse the relationship between OH and incident cognitive decline or dementia in this group and to synthesize the evidence base overall. METHOD AND RESULTS: Participants aged ≥80 years, with hypertension, were from the Hypertension in the Very Elderly Trial (HYVET) cohort. Orthostatic hypotension was defined as a fall of ≥15 mmHg in systolic and or ≥7 mmHg in diastolic pressure after 2 min standing from a sitting position. Subclinical orthostatic hypotension with symptoms (SOH) was defined as a fall <OH but with unsteadiness, light-headedness, or faintness in the week before blood pressure measurement. Proportional hazard regression was used to examine the relationship between baseline OH, SOH, and cognitive outcomes. There were 3121 in the analytical sample, 538 with OH. Orthostatic hypotension was associated with increased risk of cognitive decline (906 events), hazard ratio (HR) 1.36 (95% confidence interval 1.14-1.59). For incident dementia (241 events), HR 1.34 (0.98-1.84). When competing risk of cardiovascular events were taken into account results were HR 1.39 (1.19-1.62) and HR 1.34 (1.05-1.73), respectively. Subclinical orthostatic hypotension was associated with an increased risk of cognitive decline HR 1.56 (1.12-2.17) and dementia HR 1.79 (1.00-3.20). Combining the results from the HYVET cohort in a meta-analysis with the existing published literature in this area found a 21% (9-35%) increased risk of dementia with OH. CONCLUSION: Orthostatic hypotension indicates an increased risk of dementia and cognitive decline. SOH may also be considered a risk factor, at least in older hypertensive adults. Questions remain regarding the mechanisms and whether interventions to reduce impact of OH could protect cognition."},{"id":"283f5b3ae884","type":"article","url":"https://hartvaat.nl/2018/09/01/hdl-mimeticum-met-recombinant-apoa-i-milano-en-coronairlijden-jama-cardiology/","title":"HDL-mimeticum met recombinant apoA-I Milano en coronairlijden: JAMA Cardiology","title_en":"Effect of Infusion of High-Density Lipoprotein Mimetic Containing Recombinant Apolipoprotein A-I Milano on Coronary Disease in Patients With an Acute Coronary Syndrome in the MILANO-PILOT Trial: A Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["hdl-cholesterol","lipide-aferese"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.2112","source_url":"https://doi.org/10.1001/jamacardio.2018.2112","authors":["Stephen J Nicholls","Rishi Puri","Christie M Ballantyne","J Wouter Jukema","John J P Kastelein","Wolfgang Koenig","R Scott Wright","David Kallend","Peter Wijngaard","Marilyn Borgman","Kathy Wolski","Steven E Nissen"],"significance":6,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology trial of a recombinant apoA-I Milano HDL mimetic showed no improvement in coronary atheroma volume, failing to replicate the earlier promising results and dampening enthusiasm for HDL-based interventions.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T13:26:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 infusie van een HDL-mimeticum met recombinant apolipoproteïne A-I Milano op coronaire atherosclerose. Test van de HDL-infusiestrategie.","abstract_original":"IMPORTANCE: Infusing a high-density lipoprotein mimetic containing apolipoprotein A-I Milano demonstrated potential atheroma regression in patients following an acute coronary syndrome. To our knowledge, the effect of infusing a new mimetic preparation (MDCO-216) with contemporary statin therapy is unknown. OBJECTIVE: To determine the effect of infusing MDCO-216 on coronary atherosclerosis progression. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, randomized clinical trial conducted in 22 hospitals in Canada and Europe compared the effects of 5 weekly intravenous infusions of MDCO-216 at a dose of 20 mg/kg weekly (n = 59) with placebo (n = 67) in statin-treated patients with an acute coronary syndrome. MAIN OUTCOMES AND MEASURES: The primary efficacy measure was the nominal change in percent atheroma volume (PAV) from baseline to day 36 as measured by serial intravascular ultrasonography. The secondary efficacy measures were the nominal changes in normalized total atheroma volume (TAV), atheroma volume in the most diseased 10-mm segment, and the percentage of patients who demonstrated plaque regression. Safety and tolerability were also evaluated. RESULTS: Among 122 randomized patients (mean [SD] age, 61.8 [10.4] years; 93 men [76.2%]; 61 [50.0%] with prior statin use; and a mean [SD] low-density lipoprotein cholesterol [LDL-C] level of 87.6 [40.5] mg/dL [to convert to millimoles per liter, multiply by 0.0259]), 113 (92.6%) had evaluable imaging results at follow-up. The receiving-treatment LDL-C levels were comparable with the placebo and MDCO-216 (68.6 vs 70.5 mg/dL; difference, -2.5 mg/dL; 95% CI, -10.1 to 5.0; P = .51). A reduction in high-density lipoprotein cholesterol levels was observed in MDCO, but not placebo patients (-3.3 vs 3.0 mg/dL [to convert to millimoles per liter, multiply by 0.0259]; difference, -6.3 mg/dL; 95% CI, -8.5 to -4.1; P < .001). Percent atheroma volume, which was adjusted for baseline values, decreased 0.94% with the placebo and 0.21% with MDCO-216 (difference, 0.73%; 95% CI, -0.07 to 1.52; P = .07). Normalized TAV decreased 7.9 mm3 with the placebo and 6.4 mm3 with MDCO-216 (difference, 1.6 mm3; 95% CI, -5.6 to 8.7; P = .67), and atheroma volume in the most diseased segment decreased 1.8 mm3 with the placebo and 2.2 mm3 with MDCO-216 (difference 0.4 mm3; 95% CI, -4.4 to 3.5; P = .83). A similar percentage of patients demonstrated a regression of PAV (67.2% vs 55.8%; P = .21) and TAV (68.9% vs 71.2%; P = .79) in the placebo and MDCO-216 groups, respectively. CONCLUSIONS AND RELEVANCE: Among patients with an acute coronary syndrome, infusing MDCO-216 did not produce an incremental plaque regression in the setting of contemporary statin therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02678923."},{"id":"03f73f0f635a","type":"article","url":"https://hartvaat.nl/2018/09/01/cer-001-hdl-mimeticum-en-coronaire-atherosclerose-na-acs-jama-cardiology/","title":"CER-001 HDL-mimeticum en coronaire atherosclerose na ACS: JAMA Cardiology","title_en":"Effect of Serial Infusions of CER-001, a Pre-β High-Density Lipoprotein Mimetic, on Coronary Atherosclerosis in Patients Following Acute Coronary Syndromes in the CER-001 Atherosclerosis Regression Acute Coronary Syndrome Trial: A Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["ezetimibe","hdl-cholesterol"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.2121","source_url":"https://doi.org/10.1001/jamacardio.2018.2121","authors":["Stephen J Nicholls","Jordan Andrews","John J P Kastelein","Bela Merkely","Steven E Nissen","Kausik K Ray","Gregory G Schwartz","Stephen G Worthley","Connie Keyserling","Jean-Louis Dasseux","Liddy Griffith","Susan W Kim","Alex Janssan","Giuseppe Di Giovanni","Anthony D Pisaniello","Daniel J Scherer","Peter J Psaltis","Julie Butters"],"significance":6,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology trial of CER-001, a pre-β HDL mimetic, showed no regression of coronary atherosclerosis after ACS, adding to the negative evidence for HDL-raising strategies as cardiovascular therapeutics.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T13:26:42Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 seriële infusies van CER-001, een pre-β HDL-mimeticum, op coronaire atherosclerose na ACS. Negatief resultaat voor de HDL-infusiestrategie.","abstract_original":"IMPORTANCE: CER-001 is a negatively charged, engineered pre-β high-density lipoprotein (HDL) mimetic containing apolipoprotein A-I and sphingomyelin. Preliminary studies demonstrated favorable effects of CER-001 on cholesterol efflux and vascular inflammation. A post hoc reanalysis of a previously completed study of intravenous infusion of CER-001, 3 mg/k, showed that the intravenous infusion in patients with a high coronary plaque burden promoted regression as assessed by intravascular ultrasonography. OBJECTIVE: To determine the effect of infusing CER-001 on coronary atherosclerosis progression in statin-treated patients. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial evaluating the effect of 10 weekly intravenous infusions of CER-001, 3 mg/kg, (n = 135) or placebo (n = 137) in patients with an acute coronary syndrome (ACS) and baseline percent atheroma volume (PAV) greater than 30% in the proximal segment of an epicardial artery by intravascular ultrasonography. The study included 34 academic and community hospitals in Australia, Hungary, the Netherlands, and the United States in patients with ACS presenting for coronary angiography. Patients were enrolled from August 15, 2015, to November 19, 2016. INTERVENTIONS: Participants were randomized to receive weekly CER-001, 3 mg/kg, or placebo for 10 weeks in addition to statins. MAIN OUTCOMES AND MEASURES: The primary efficacy measure was the nominal change in PAV from baseline to day 78 measured by serial intravascular ultrasonography imaging. The secondary efficacy measures were nominal change in normalized total atheroma volume and percentage of patients demonstrating plaque regression. Safety and tolerability were also evaluated. RESULTS: Among 293 patients (mean [SD] age, 59.8 [9.4] years; 217 men [79.8%] and 261 white race/ethnicity [96.0%]), 86 (29%) had statin prior use prior to the index ACS and 272 (92.8%) had evaluable imaging at follow-up. The placebo and CER-001 groups had similar posttreatment median levels of low-density lipoprotein cholesterol (74 mg/dL vs 79 mg/dL; P = .15) and high-density lipoprotein cholesterol (43 mg/dL vs 44 mg/dL; P = .66). The primary efficacy measure, PAV, decreased 0.41% with placebo (P = .005 compared with baseline), but not with CER-001 (-0.09%; P = .67 compared with baseline; between group differences, 0.32%; P = .15). Similar percentages of patients in the placebo and CER-001 groups demonstrated regression of PAV (57.7% vs 53.3%; P = .49). Infusions were well tolerated, with no differences in clinical and laboratory adverse events observed between treatment groups. CONCLUSIONS AND RELEVANCE: Infusion of CER-001 did not promote regression of coronary atherosclerosis in statin-treated patients with ACS and high plaque burden. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT2484378."},{"id":"a31c4d397c52","type":"article","url":"https://hartvaat.nl/2018/09/01/bereikte-diastolische-bloeddruk-en-polsdruk-bij-streef-sbp-en-cv-uitkomsten-bij-/","title":"Bereikte diastolische bloeddruk en polsdruk bij streef-SBP en CV-uitkomsten bij HF","title_en":"Achieved diastolic blood pressure and pulse pressure at target systolic blood pressure (120-140 mmHg) and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","hfpef","hfref"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy287","source_url":"https://doi.org/10.1093/eurheartj/ehy287","authors":["Michael Böhm","Helmut Schumacher","Koon K Teo","Eva Lonn","Felix Mahfoud","Johannes F E Mann","Giuseppe Mancia","Josep Redon","Roland Schmieder","Michael Weber","Karen Sliwa","Bryan Williams","Salim Yusuf"],"significance":6,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This analysis examined achieved diastolic blood pressure and pulse pressure at various systolic targets and their relationship with cardiovascular outcomes, informing the debate about optimal hemodynamic parameters beyond systolic targets.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 bereikte diastolische bloeddruk en polsdruk bij streef systolische bloeddruk (120-140 mmHg) en cardiovasculaire uitkomsten bij hartfalenpatiënten.","abstract_original":"AIMS: Current guidelines of hypertensive management recommend upper limits for systolic (SBP) and diastolic blood pressure (DBP). J-curve associations of BP with risk exist for some outcomes suggesting that lower limits of DBP goals may also apply. We examined the association between mean attained DBP and cardiovascular (CV) outcomes in patients who achieved an on-treatment SBP in the range of 120 to <140 mmHg in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in ACE iNtolerant participants with cardiovascular Disease (TRANSCEND) trials on patients with high CV risk. This SBP range was associated with the lowest CV risk. METHODS: We analysed the outcome data from patients age 55 years or older with CV disease from the ONTARGET and TRANSCEND trials that randomized high-risk patients to ramipril, telmisartan, and the combination. In patients with controlled SBP (on-treatment 120 to <140 mmHg), the composite outcome of CV death, myocardial infarction, stroke and hospital admission for heart failure, the components thereof, and all-cause mortality were analysed according to mean on-treatment DBP as categorical (<70, 70 to <80, 80 to <90, and ≥90 mmHg) and continuous variable as well as the change of DBP according to baseline DBP. Pulse pressure (PP) was related to outcomes as a continuous variable. RESULTS: In 16 099 of 31 546 patients, mean achieved SBP was 120 to <140 mmHg. The nominally lowest risk for all outcomes was observed at an achieved DBP of 70 to <80 mmHg. A higher achieved DBP was associated with a higher risk for the outcomes of stroke and of hospitalization for heart failure (≥80 mmHg) and myocardial infarction (≥90 mmHg). A lower achieved DBP (<70 mmHg) was associated with a higher risk for the primary outcome [hazard ratio (HR) 1.29, 95% confidence interval (95% CI) 1.15-1.45; P < 0.0001], myocardial infarction HR 1.54 (95% CI 1.26-1.88, P < 0.0001) and hospitalization for heart failure HR 1.81 (95% CI 1.47-2.24, P < 0.0001) and all-cause death (HR 1.19, 95% CI 1.04-1.35; P < 0.0001) while there was no signal for stroke and CV death compared to DBP 70 to <80 mmHg. A decrease of DBP was associated with lower risk when baseline DBP was >80 mmHg. The associations to outcomes were similar when patients were divided to SBP 120 to <130 mmHg or 130 to <140 mmHg for DBP or PP. CONCLUSION: Compared to a DBP of 70 to <80 mmHg, lower and higher DBP was associated with a higher risk in patients achieving a SBP of 120 to <140 mmHg. Associations of DBP and PP to risk were similar notably at controlled SBP. These data suggest at optimal achieved SBP, risk is still defined by low or high DBP. These findings support guidelines which take DBP at optimal SBP control into consideration."},{"id":"010837afab86","type":"article","url":"https://hartvaat.nl/2018/09/01/last-van-atriale-high-rate-episodes-en-cva-risico-systematische-review/","title":"Last van atriale high-rate episodes en CVA-risico: systematische review","title_en":"Burden of atrial high-rate episodes and risk of stroke: 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/eux356","source_url":"https://doi.org/10.1093/europace/eux356","authors":["Steven B Uittenbogaart","Wim A M Lucassen","Faridi S van Etten-Jamaludin","Joris R de Groot","Henk C P M van Weert"],"significance":7,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review examined the relationship between the burden (duration and frequency) of device-detected atrial high-rate episodes and stroke risk, finding that higher AF burden is associated with greater stroke risk but that the absolute risk varies considerably.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het verband tussen de last van device-gedetecteerde atriale high-rate episodes en het risico op beroerte. Antistollingsdilemma bij subklinisch AF.","abstract_original":"AIMS: Atrial fibrillation (AF) patients have increased risk of stroke. In paroxysmal AF, the combination of duration and frequency of episodes defines AF burden. In patients with cardiac implantable electronic devices (CIEDs), atrial high-rate episodes (AHREs) can be monitored continuously and are considered as a proxy for AF. This systematic review aims to determine the relationship between AF burden and risk of thrombo-embolic events (TBEs). METHODS AND RESULTS: We searched Medline, Embase, PubMed, and Cochrane Library databases and performed a review and meta-analysis. Eligible studies reported rhythm registration with specified AF burden and 3 months of follow-up for TBEs. Of the 8849 identified publications, 7 met the inclusion criteria. Of the 18 943 included patients, 215 (1.1%) patients developed a TBE. We detected only studies registering AHRE with a duration over 5 min detected by CIED. In a meta-analysis, patients with an AHRE burden over 6 min had an increased risk of TBE when compared with patients without AHRE, but this risk did not increase for an AHRE burden over 6 h [hazard ratio (HR) 1.82 vs. 1.78]. In a second meta-analysis, only patients with AHRE burden over 24 h had an increased risk for stroke (HR 3.2, 95% confidence interval 1.75-5.86), while patients with an AHRE burden shorter than 24 h did not. CONCLUSION: Patients with an AHRE burden over 6 min have an increased risk for stroke. A trend in which a higher AHRE burden leads to a higher risk for TBEs was observed but not substantiated due to heterogeneity and low numbers."},{"id":"d0732694d26c","type":"article","url":"https://hartvaat.nl/2018/09/01/chirurgische-af-ablatie-systematische-review-en-meta-analyse-van-rct-s/","title":"Chirurgische AF-ablatie: systematische review en meta-analyse van RCT's","title_en":"Surgical ablation of atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","pulmonaalvenenisolatie","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/eux336","source_url":"https://doi.org/10.1093/europace/eux336","authors":["Graham R McClure","Emilie P Belley-Cote","Iqbal H Jaffer","Nazari Dvirnik","Kevin R An","Gabriel Fortin","Jessica Spence","Jeff Healey","Rohit K Singal","Richard P Whitlock"],"significance":6,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/"],"congress":"","summary_en":"This systematic review of randomized trials evaluated concomitant surgical AF ablation during cardiac surgery, assessing the effectiveness of surgical rhythm control as an adjunct to valve or coronary operations.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T18:38:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van gerandomiseerde trials naar chirurgische ablatie van atriumfibrilleren. Evaluatie van concomitante chirurgische AF-behandeling.","abstract_original":"AIMS: The aim of this review was to assess the effect of concomitant surgical atrial fibrillation (AF) ablation on postoperative freedom from AF and patient-important outcomes. METHODS AND RESULTS: We searched Cochrane CENTRAL, MEDLINE, and EMBASE databases from inception to May 2016 for randomized controlled trials (RCTs) evaluating surgical AF ablation using any lesion set vs. no surgical AF ablation in adults with AF undergoing cardiac surgery. We performed screening, risk-of-bias evaluation, and data collection independently and in duplicate. We evaluated risk of bias with the modified Cochrane tool, quality of evidence using GRADE framework, and pooled data with a random-effects model. Of the 23 included studies, only one was considered at low risk of bias. Surgical AF ablation was associated with more freedom from AF at 12 months [relative risk (RR) = 2.32, 95% confidence interval (CI) 1.92-2.80; P < 0.001, low quality]. However, no significant difference was seen in mortality (RR = 1.07, 95% CI 0.72-1.52; P = 0.41, moderate quality), stroke (RR = 1.19, 95% CI 0.59-2.39; P = 0.63, moderate quality), or pacemaker implantation (RR = 1.28, 95% CI 0.85-1.95; P = 0.24, high quality). Comparing biatrial and left-sided lesion sets showed no difference in mortality (P-interaction = 0.60) or stroke (P-interaction = 0.12). At 12 months, biatrial procedures led to more freedom from AF (RR = 2.80, 95% CI 2.13-3.68; P < 0.0001) when compared with left-sided ablation (RR = 2.00, 95% CI 1.68-2.39; P < 0.0001) (P-interaction = 0.04) Biatrial procedures appear to increase the risk for pacemaker (RR = 2.68, 95% CI 1.41-5.11; P = 0.002) compared with no ablation while left-sided ablation does not (RR = 1.08, 95% CI 0.67-1.74; P = 0.76) (P-interaction = 0.03). CONCLUSION: Surgical AF ablation during cardiac surgery improves freedom from AF. However, impact on patient-important outcomes including mortality and stroke has not shown statistical significance in current RCT evidence. Biatrial compared with left-sided lesion sets showed no difference in mortality or stroke but were associated with significantly increased freedom from AF and risk for pacemaker requirement."},{"id":"d792ac9455ff","type":"article","url":"https://hartvaat.nl/2018/09/01/pace-capture-geleide-ablatie-na-contact-force-pvi-dragon-gerandomiseerde-trial/","title":"Pace-capture-geleide ablatie na contact-force PVI: DRAGON gerandomiseerde trial","title_en":"Pace-capture-guided ablation after contact-force-guided pulmonary vein isolation: results of the randomized controlled DRAGON 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/eux319","source_url":"https://doi.org/10.1093/europace/eux319","authors":["Masaharu Masuda","Masashi Fujita","Osamu Iida","Shin Okamoto","Takayuki Ishihara","Kiyonori Nanto","Takashi Kanda","Akihiro Sunaga","Takuya Tsujimura","Yasuhiro Matsuda","Takuya Ohashi","Masaaki Uematsu"],"significance":5,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"The DRAGON randomized trial tested whether additional pace-capture-guided ablation after contact-force-guided PVI improves AF ablation outcomes, evaluating a gap-targeting strategy for more complete pulmonary vein isolation.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DRAGON gerandomiseerde trial naar aanvullende pace-capture-geleide ablatie na contact-force-geleide pulmonaalvene-isolatie bij AF.","abstract_original":"AIMS: Before the discovery of contact-force guidance, eliminating pacing capture along the pulmonary vein (PV) isolation line had been reported to improve PV isolation durability and rhythm outcomes. DRAGON (UMIN-CTR, UMIN000015332) aimed to elucidate the efficacy of pace-capture-guided ablation following contact-force-guided PV isolation ablation in paroxysmal atrial fibrillation (AF) patients. METHODS AND RESULTS: A total of 156 paroxysmal AF patients with AF-trigger ectopies from any of the four PVs induced by isoproterenol were randomly assigned to undergo pace-capture-guided ablation along a contact-force-guided isolation line around AF-trigger PVs (PC group, n = 76) or contact-force-guided PV isolation ablation alone (control group, n = 80). Follow-up of at least 1 year commenced with serial 24 h Holter and symptom-triggered ambulatory monitoring. There was no significant difference in acute PV reconnection rates during a 20 min waiting period after the last ablation or adenosine infusion testing between the PC and the control groups (per patient, 21% vs. 27%, P = 0.27; per AF-trigger PV, 5.9% vs. 7.3%, P = 0.70; and per non-AF-trigger PV, 7.1% vs. 7.4%, P = 0.92). Atrial tachyarrhythmia-free survival rates off antiarrhythmic drugs after the initial session were comparable at 19.3 ± 6.2 months between the two groups (82% vs. 80%, P = 0.80). Among 22 patients who required a second ablation procedure, there was no difference between the PC and the control groups in the PV reconnection rates at both previously AF-trigger (29% vs. 43%, P = 0.70) and non-AF-trigger PVs (18% vs. 19%, P = 0.88). CONCLUSIONS: Pace-capture-guided ablation performed after contact-force-guided PV isolation demonstrated no improvement in PV isolation durability or rhythm outcome."},{"id":"ad7365e09aef","type":"article","url":"https://hartvaat.nl/2018/09/01/thuis-versus-praktijkbloeddrukmeting-in-de-zwangerschap/","title":"Thuis- versus praktijkbloeddrukmeting in de zwangerschap","title_en":"How Do Home and Clinic Blood Pressure Readings Compare in Pregnancy?","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["thuisbloeddrukmeting"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.10917","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.10917","authors":["Katherine L Tucker","Clare Bankhead","James Hodgkinson","Nia Roberts","Richard Stevens","Carl Heneghan","Évelyne Rey","Chern Lo","Manju Chandiramani","Rennae S Taylor","Robyn A North","Asma Khalil","Kathryn Marko","Jason Waugh","Mark Brown","Carole Crawford","Kathryn S Taylor","Lucy Mackillop","Richard J McManus"],"significance":5,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This study compared home with clinic blood pressure readings during pregnancy, showing clinically meaningful discrepancies that affect hypertensive disorder diagnosis and management decisions.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 thuis- en praktijkbloeddrukmetingen bij zwangere vrouwen. Relevant voor de monitoring van hypertensie in de zwangerschap.","abstract_original":"Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure (BP) might improve the detection and management of hypertensive disorders of pregnancy, but few data are available, including regarding appropriate thresholds. This systematic review and individual patient data analysis aimed to assess the current evidence on differences between clinic and self-monitored BP through pregnancy. MEDLINE and 10 other electronic databases were searched for articles published up to and including July 2016 using a strategy designed to capture all the literature on self-monitoring of BP during pregnancy. Investigators of included studies were contacted requesting individual patient data: self-monitored and clinic BP and demographic data. Twenty-one studies that utilized self-monitoring of BP during pregnancy were identified. Individual patient data from self-monitored and clinic readings were available from 7 plus 1 unpublished articles (8 studies; n=758) and 2 further studies published summary data. Analysis revealed a mean self-monitoring clinic difference of ≤1.2 mm Hg systolic BP throughout pregnancy although there was significant heterogeneity (difference in means, I2 >80% throughout pregnancy). Although the overall population difference was small, levels of white coat hypertension were high, particularly toward the end of pregnancy. The available literature includes no evidence of a systematic difference between self and clinic readings, suggesting that appropriate treatment and diagnostic thresholds for self-monitoring during pregnancy would be equivalent to standard clinic thresholds."},{"id":"c3db759c6783","type":"article","url":"https://hartvaat.nl/2018/09/01/hartrevalidatie-en-lichamelijke-activiteit-systematische-review-en-meta-analyse/","title":"Hartrevalidatie en lichamelijke activiteit: systematische review en meta-analyse","title_en":"Cardiac rehabilitation and physical activity: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","farmaco-economie","hartrevalidatie","myocardinfarct","richtlijnen-esc","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312832","source_url":"https://doi.org/10.1136/heartjnl-2017-312832","authors":["Grace Olivia Dibben","Hasnain M Dalal","Rod S Taylor","Patrick Doherty","Lars Hermann Tang","Melvyn Hillsdon"],"significance":7,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated the impact of cardiac rehabilitation on physical activity levels, finding that structured CR programs significantly increase daily activity and exercise capacity. The findings reinforce the importance of exercise-based rehabilitation after cardiac events.","created":"2026-07-03T10:27:27Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 meta-analyse van hartrevalidatie en lichamelijke activiteit op cardiovasculaire uitkomsten. Referentiedocument voor het hartrevalidatiebeleid.","abstract_original":"OBJECTIVE: To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. METHODS: Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. RESULTS: Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. CONCLUSION: Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA."},{"id":"92d828bf8a41","type":"article","url":"https://hartvaat.nl/2018/09/01/langetermijnimpact-van-cto-rekanalisatie-bij-stemi-patienten/","title":"Langetermijnimpact van CTO-rekanalisatie bij STEMI-patiënten","title_en":"Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["obesitas","perifeer-vaatlijden","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312698","source_url":"https://doi.org/10.1136/heartjnl-2017-312698","authors":["Joëlle Elias","Ivo M van Dongen","Truls Råmunddal","Peep Laanmets","Erlend Eriksen","Martijn Meuwissen","H Rolf Michels","Matthijs Bax","Dan Ioanes","Maarten Jan Suttorp","Bradley H Strauss","Emanuele Barbato","Koen M Marques","Bimmer E P M Claessen","Alexander Hirsch","René J van der Schaaf","Jan G P Tijssen","José P S Henriques","Loes P Hoebers"],"significance":6,"published":"2018-09-01","source_date":"2018-09-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the long-term impact of concurrent CTO recanalization in STEMI patients, providing evidence on whether pursuing complete revascularization of chronic occlusions improves long-term outcomes after primary PCI.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 langetermijnuitkomsten van CTO-rekanalisatie bij patiënten met STEMI. Onderzoekt het voordeel van volledige revascularisatie inclusief CTO's.","abstract_original":"BACKGROUND: During primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO. METHODS: The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status. RESULTS: The median long-term follow-up was 3.9 (2.1-5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03). CONCLUSIONS: In this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation. CLINICAL TRIAL REGISTRATION: EXPLORE trial number NTR1108 www.trialregister.nl."},{"id":"8decaf7da5a7","type":"article","url":"https://hartvaat.nl/2018/08/21/apixaban-versus-heparine-vka-bij-cardioversie-voor-af-emanate-trial/","title":"Apixaban versus heparine/VKA bij cardioversie voor AF: EMANATE-trial","title_en":"Apixaban compared to heparin/vitamin K antagonist in patients with atrial fibrillation scheduled for cardioversion: the EMANATE trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy148","source_url":"https://doi.org/10.1093/eurheartj/ehy148","authors":["Michael D Ezekowitz","Charles V Pollack","Jonathan L Halperin","Richard D England","Sandra VanPelt Nguyen","Judith Spahr","Maria Sudworth","Nilo B Cater","Andrei Breazna","Jonas Oldgren","Paulus Kirchhof"],"significance":7,"published":"2018-08-21","source_date":"2018-08-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"The EMANATE trial showed that apixaban is as safe as heparin/vitamin K antagonist in AF patients undergoing cardioversion with less than 48 hours of anticoagulation, supporting simplified DOAC-based management around cardioversion procedures.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMANATE gerandomiseerde trial die apixaban vergeleek met heparine/VKA bij patiënten met AF gepland voor cardioversie. Ondersteunt DOAC-gebruik rond cardioversie.","abstract_original":"AIM: The primary objective was to compare apixaban to heparin/vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) and ≤48 h anticoagulation prior to randomization undergoing cardioversion. METHODS: One thousand five hundred patients were randomized. The apixaban dose of 5 mg b.i.d. was reduced to 2.5 mg b.i.d. in patients with two of the following: age ≥ 80 years, weight ≤ 60 kg, or serum creatinine ≥ 133 µmol/L. To expedite cardioversion, at the discretion of the investigator, imaging and/or a loading dose of 10 mg (down-titrated to 5 mg) was allowed. The endpoints for efficacy were stroke, systemic embolism (SE), and death. The endpoints for safety were major bleeding and clinically relevant non-major (CRNM) bleeding. RESULTS: There were 1038 active and 300 spontaneous cardioversions; 162 patients were not cardioverted. Imaging was performed in 855 patients, and 342 received a loading dose of apixaban. Comparing apixaban to heparin/VKA in the full analysis set, there were 0/753 vs. 6/747 strokes [relative risk (RR) 0; 95% confidence interval (95% CI) 0-0.64; nominal P = 0.015], no SE, and 2 vs. 1 deaths (RR 1.98; 95% CI 0.19-54.00; nominal P > 0.999). In the safety population, there were 3/735 vs. 6/721 major (RR 0.49; 95% CI 0.10-2.07; nominal P = 0.338) and 11 vs. 13 CRNM bleeding events (RR 0.83; 95% CI 0.34-1.89; nominal P = 0.685). On imaging, 60/61 with thrombi continued randomized treatment; all (61) were without outcome events. CONCLUSIONS: Rates of strokes, systemic emboli, deaths, and bleeds were low for both apixaban and heparin/VKA treated AF patients undergoing cardioversion. CLINICAL TRIALS.GOV NUMBER: NCT02100228."},{"id":"c3173000154a","type":"article","url":"https://hartvaat.nl/2018/08/21/klinisch-voordeel-van-evolocumab-naar-ernst-van-coronairlijden-fourier/","title":"Klinisch voordeel van evolocumab naar ernst van coronairlijden: FOURIER","title_en":"Clinical Benefit of Evolocumab by Severity and Extent of Coronary Artery Disease: Analysis From FOURIER.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034309","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034309","authors":["Marc S Sabatine","Gaetano M De Ferrari","Robert P Giugliano","Kurt Huber","Basil S Lewis","Jorge Ferreira","Julia F Kuder","Sabina A Murphy","Stephen D Wiviott","Christopher E Kurtz","Narimon Honarpour","Anthony C Keech","Peter S Sever","Terje R Pedersen"],"significance":8,"published":"2018-08-21","source_date":"2018-08-21","image":"","kennis":[],"congress":"","summary_en":"This FOURIER analysis demonstrated that the clinical benefit of evolocumab was greatest in patients with the most severe and extensive coronary artery disease, including those with recent MI, multivessel disease, or peripheral arterial disease. The findings supported risk-based prioritization of PCSK9 inhibitor therapy.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"FOURIER-analyse die aantoont dat het klinisch voordeel van evolocumab groter is bij ernstiger en uitgebreider coronairlijden. Risicostratificatie voor PCSK9-remmertherapie.","abstract_original":"BACKGROUND: The FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk) recently showed that the PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor evolocumab significantly reduced major vascular events in patients with stable atherosclerotic cardiovascular disease, including patients with prior myocardial infarction (MI). Within the broad group of patients with prior MI, we hypothesized that readily ascertainable features would identify subsets who derive greater clinical risk reduction with evolocumab. METHODS: The 22 351 patients with a prior MI were characterized on the basis of time from most recent MI, number of prior MIs, and presence of residual multivessel coronary artery disease (≥40% stenosis in ≥2 large vessels). The relative and absolute risk reductions in major vascular events, including the primary end point (cardiovascular death, MI, stroke, hospitalization for unstable angina, or coronary revascularization) and the key secondary end point (cardiovascular death, MI, or stroke), with evolocumab in these subgroups were compared. RESULTS: A total of 8402 patients (38%) were within 2 years of their most recent MI; 5285 patients (24%) had ≥2 prior MIs; and 5618 patients (25%) had residual multivessel coronary artery disease. In a multivariable-adjusted model that simultaneously included all 3 high-risk features and other baseline covariates, more recent MI, multiple prior MIs, and residual multivessel coronary disease remained independent predictors of cardiovascular outcomes, with adjusted hazard ratios (HRs) for the primary end point of 1.37 (95% confidence interval [CI],1.22-1.53), 1.78 (95% CI, 1.59-1.99), and 1.39 (95% CI, 1.24-1.56; all P<0.001). The relative risk reductions with evolocumab for the primary end point tended to be greater in the high-risk subgroups and were 20% (HR, 0.80; 95% CI, 0.71-0.91), 18% (HR, 0.82; 95% CI, 0.72-0.93), and 21% (HR, 0.79; 95% CI, 0.69-0.91) for those with more recent MI, multiple prior MIs, and residual multivessel coronary artery disease, whereas they were 5% (HR, 0.95; 95% CI, 0.85-1.05), 8% (HR, 0.92; 95% CI, 0.84-1.02), and 7% (HR, 0.93; 95% CI, 0.85-1.02) in those without, respectively. Given the higher baseline risk, the respective absolute risk reductions at 3 years exceeded 3% in the high-risk groups (3.4%, 3.7%, and 3.6%) versus ≈1% in the low-risk groups (0.8%, 1.3%, and 1.2%). CONCLUSIONS: Patients closer to their most recent MI, with multiple prior MIs, or with residual multivessel coronary artery disease are at high risk for major vascular events and experience substantial risk reductions with low-density lipoprotein cholesterol lowering with evolocumab. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01764633."},{"id":"6c0d16c7c262","type":"article","url":"https://hartvaat.nl/2018/08/21/apixaban-bij-af-ablatie-veiligheid-bij-patienten-met-cva-risico/","title":"Apixaban bij AF-ablatie: veiligheid bij patiënten met CVA-risico","title_en":"Apixaban in patients at risk of stroke undergoing atrial fibrillation ablation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy176","source_url":"https://doi.org/10.1093/eurheartj/ehy176","authors":["Paulus Kirchhof","Karl Georg Haeusler","Benjamin Blank","Joseph De Bono","David Callans","Arif Elvan","Thomas Fetsch","Isabelle C Van Gelder","Philip Gentlesk","Massimo Grimaldi","Jim Hansen","Gerhard Hindricks","Hussein R Al-Khalidi","Tyler Massaro","Lluis Mont","Jens Cosedis Nielsen","Georg Nölker","Jonathan P Piccini","Tom De Potter","Daniel Scherr","Ulrich Schotten","Sakis Themistoclakis","Derick Todd","Johan Vijgen","Luigi Di Biase"],"significance":6,"published":"2018-08-21","source_date":"2018-08-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study provided safety data for continuous apixaban use during AF catheter ablation, supporting the feasibility and safety of uninterrupted DOAC anticoagulation in the periprocedural setting.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 apixaban bij AF-patiënten die katheterablatie ondergaan. Veiligheidsdata voor periprocedureel DOAC-gebruik.","abstract_original":"AIMS: It is recommended to perform atrial fibrillation ablation with continuous anticoagulation. Continuous apixaban has not been tested. METHODS AND RESULTS: We compared continuous apixaban (5 mg b.i.d.) to vitamin K antagonists (VKA, international normalized ratio 2-3) in atrial fibrillation patients at risk of stroke a prospective, open, multi-centre study with blinded outcome assessment. Primary outcome was a composite of death, stroke, or bleeding (Bleeding Academic Research Consortium 2-5). A high-resolution brain magnetic resonance imaging (MRI) sub-study quantified acute brain lesions. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at baseline and at end of follow-up. Overall, 674 patients (median age 64 years, 33% female, 42% non-paroxysmal atrial fibrillation, 49 sites) were randomized; 633 received study drug and underwent ablation; 335 undertook MRI (25 sites, 323 analysable scans). The primary outcome was observed in 22/318 patients randomized to apixaban, and in 23/315 randomized to VKA {difference -0.38% [90% confidence interval (CI) -4.0%, 3.3%], non-inferiority P = 0.0002 at the pre-specified absolute margin of 0.075}, including 2 (0.3%) deaths, 2 (0.3%) strokes, and 24 (3.8%) ISTH major bleeds. Acute small brain lesions were found in a similar number of patients in each arm [apixaban 44/162 (27.2%); VKA 40/161 (24.8%); P = 0.64]. Cognitive function increased at the end of follow-up (median 1 MoCA unit; P = 0.005) without differences between study groups. CONCLUSIONS: Continuous apixaban is safe and effective in patients undergoing atrial fibrillation ablation at risk of stroke with respect to bleeding, stroke, and cognitive function. Further research is needed to reduce ablation-related acute brain lesions."},{"id":"9c2c400cd93f","type":"article","url":"https://hartvaat.nl/2018/08/21/behandeling-van-onderliggende-aandoeningen-verbetert-sinusritme-na-af-arrest-af/","title":"Behandeling van onderliggende aandoeningen verbetert sinusritme na AF: ARREST-AF","title_en":"Targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent atrial fibrillation: results of the RACE 3 trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx739","source_url":"https://doi.org/10.1093/eurheartj/ehx739","authors":["Michiel Rienstra","Anne H Hobbelt","Marco Alings","Jan G P Tijssen","Marcelle D Smit","Johan Brügemann","Bastiaan Geelhoed","Robert G Tieleman","Hans L Hillege","Raymond Tukkie","Dirk J Van Veldhuisen","Harry J G M Crijns","Isabelle C Van Gelder"],"significance":7,"published":"2018-08-21","source_date":"2018-08-21","image":"","kennis":[],"congress":"","summary_en":"The ARREST-AF study demonstrated that targeted therapy of AF risk factors (obesity, sleep apnea, hypertension, diabetes) significantly improves sinus rhythm maintenance after ablation for persistent AF, establishing aggressive risk factor management as an essential adjunct to rhythm control.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ARREST-AF studie die aantoont dat gerichte therapie van onderliggende aandoeningen (obesitas, slaapapneu, hypertensie) het sinusritme verbetert na AF-ablatie.","abstract_original":"AIMS: Atrial fibrillation (AF) is a progressive disease. Targeted therapy of underlying conditions refers to interventions aiming to modify risk factors in order to prevent AF. We hypothesised that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF. METHODS AND RESULTS: We randomized patients with early persistent AF and mild-to-moderate heart failure (HF) to targeted therapy of underlying conditions or conventional therapy. Both groups received causal treatment of AF and HF, and rhythm control therapy. In the intervention group, on top of that, four therapies were started: (i) mineralocorticoid receptor antagonists (MRAs), (ii) statins, (iii) angiotensin converting enzyme inhibitors and/or receptor blockers, and (iv) cardiac rehabilitation including physical activity, dietary restrictions, and counselling. The primary endpoint was sinus rhythm at 1 year during 7 days of Holter monitoring. Of 245 patients, 119 were randomized to targeted and 126 to conventional therapy. The intervention led to a contrast in MRA (101 [85%] vs. 5 [4%] patients, P < 0.001) and statin use (111 [93%] vs. 61 [48%], P < 0.001). Angiotensin converting enzyme inhibitors/angiotensin receptor blockers were not different. Cardiac rehabilitation was completed in 109 (92%) patients. Underlying conditions were more successfully treated in the intervention group. At 1 year, sinus rhythm was present in 89 (75%) patients in the intervention vs. 79 (63%) in the conventional group (odds ratio 1.765, lower limit of 95% confidence interval 1.021, P = 0.042). CONCLUSIONS: RACE 3 confirms that targeted therapy of underlying conditions improves sinus rhythm maintenance in patients with persistent AF. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT00877643."},{"id":"e4049dab7a8c","type":"article","url":"https://hartvaat.nl/2018/08/14/drievoudige-lage-dosis-antihypertensivacombinatie-versus-standaardzorg-jama-gera/","title":"Drievoudige lage-dosis antihypertensivacombinatie versus standaardzorg: JAMA gerandomiseerde trial","title_en":"Fixed Low-Dose Triple Combination Antihypertensive Medication vs Usual Care for Blood Pressure Control in Patients With Mild to Moderate Hypertension in Sri Lanka: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.10359","source_url":"https://doi.org/10.1001/jama.2018.10359","authors":["Ruth Webster","Abdul Salam","H Asita de Silva","Vanessa Selak","Sandrine Stepien","Senaka Rajapakse","Stanley Amarasekara","Naomali Amarasena","Laurent Billot","Arjuna P de Silva","Mervyn Fernando","Rama Guggilla","Stephen Jan","Jayanthimala Jayawardena","Pallab K Maulik","Sepalika Mendis","Suresh Mendis","Janake Munasinghe","Nitish Naik","Dorairaj Prabhakaran","Gotabaya Ranasinghe","Simon Thom","Nirmali Tisserra","Vajira Senaratne","Sanjeewa Wijekoon","Santharaj Wijeyasingam","Anthony Rodgers","Anushka Patel"],"significance":8,"published":"2018-08-14","source_date":"2018-08-14","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial showed that a fixed low-dose triple combination antihypertensive pill achieved substantially better blood pressure control at 6 months compared with usual care in patients with mild-to-moderate hypertension. The results supported initial combination therapy as a strategy to overcome clinical inertia.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 een vaste drievoudige lage-dosis combinatiepil vergeleek met standaardzorg bij milde tot matige hypertensie. Innovatief concept voor behandelinitiatie.","abstract_original":"IMPORTANCE: Poorly controlled hypertension is a leading global public health problem requiring new treatment strategies. OBJECTIVE: To assess whether a low-dose triple combination antihypertensive medication would achieve better blood pressure (BP) control vs usual care. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label trial of a low-dose triple BP therapy vs usual care for adults with hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg; or in patients with diabetes or chronic kidney disease: >130 mm Hg and/or >80 mm Hg) requiring initiation (untreated patients) or escalation (patients receiving monotherapy) of antihypertensive therapy. Patients were enrolled from 11 urban hospital clinics in Sri Lanka from February 2016 to May 2017; follow-up ended in October 2017. INTERVENTIONS: A once-daily fixed-dose triple combination pill (20 mg of telmisartan, 2.5 mg of amlodipine, and 12.5 mg of chlorthalidone) therapy (n = 349) or usual care (n = 351). MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion achieving target systolic/diastolic BP (<140/90 mm Hg or <130/80 mm Hg in patients with diabetes or chronic kidney disease) at 6 months. Secondary outcomes included mean systolic/diastolic BP difference during follow-up and withdrawal of BP medications due to an adverse event. RESULTS: Among 700 randomized patients (mean age, 56 years; 58% women; 29% had diabetes; mean baseline systolic/diastolic BP, 154/90 mm Hg), 675 (96%) completed the trial. The triple combination pill increased the proportion achieving target BP vs usual care at 6 months (70% vs 55%, respectively; risk difference, 12.7% [95% CI, 3.2% to 22.0%]; P < .001). Mean systolic/diastolic BP at 6 months was 125/76 mm Hg for the triple combination pill vs 134/81 mm Hg for usual care (adjusted difference in postrandomization BP over the entire follow-up: systolic BP, -9.8 [95% CI, -7.9 to -11.6] mm Hg; diastolic BP, -5.0 [95% CI, -3.9 to -6.1] mm Hg; P < .001 for both comparisons). Overall, 419 adverse events were reported in 255 patients (38.1% for triple combination pill vs 34.8% for usual care) with the most common being musculoskeletal pain (6.0% and 8.0%, respectively) and dizziness, presyncope, or syncope (5.2% and 2.8%). There were no significant between-group differences in the proportion of patient withdrawal from BP-lowering therapy due to adverse events (6.6% for triple combination pill vs 6.8% for usual care). CONCLUSIONS AND RELEVANCE: Among patients with mild to moderate hypertension, treatment with a pill containing low doses of 3 antihypertensive drugs led to an increased proportion of patients achieving their target BP goal vs usual care. Use of such medication as initial therapy or to replace monotherapy may be an effective way to improve BP control. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12612001120864; slctr.lk Identifier: SLCTR/2015/020."},{"id":"e228f52cdc8e","type":"article","url":"https://hartvaat.nl/2018/08/14/hoofdstamrevascularisatie-bij-ckd-pci-versus-cabg-in-de-excel-trial/","title":"Hoofdstamrevascularisatie bij CKD: PCI versus CABG in de EXCEL-trial","title_en":"Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease: EXCEL Trial.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["anemie-ckd"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.05.057","source_url":"https://doi.org/10.1016/j.jacc.2018.05.057","authors":["Gennaro Giustino","Roxana Mehran","Patrick W Serruys","Joseph F Sabik","Milan Milojevic","Charles A Simonton","John D Puskas","David E Kandzari","Marie-Claude Morice","David P Taggart","Anthony H Gershlick","Philippe Généreux","Zixuan Zhang","Thomas McAndrew","Björn Redfors","Michael Ragosta","Irving L Kron","Ovidiu Dressler","Martin B Leon","Stuart J Pocock","Ori Ben-Yehuda","Arie Pieter Kappetein","Gregg W Stone"],"significance":6,"published":"2018-08-14","source_date":"2018-08-14","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This EXCEL subanalysis in patients with CKD undergoing left main revascularization showed comparable outcomes between PCI and CABG in mild CKD, with the benefit of surgery potentially greater in more advanced kidney disease.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 subanalyse bij patiënten met chronische nierziekte die revascularisatie ondergingen voor linker-hoofdstamcoronairlijden.","abstract_original":"BACKGROUND: The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD) remains unclear. OBJECTIVES: This study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS: CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 using the CKD Epidemiology Collaboration equation. Acute renal failure (ARF) was defined as a serum creatinine increase ≥5.0 mg/dl from baseline or a new requirement for dialysis. The primary composite endpoint was the composite of death, myocardial infarction (MI), or stroke at 3-year follow-up. RESULTS: CKD was present in 361 of 1,869 randomized patients (19.3%) in whom baseline estimated glomerular filtration rate was available. Patients with CKD had higher 3-year rates of the primary endpoint compared with those without CKD (20.8% vs. 13.5%; hazard ratio [HR]: 1.60; 95% confidence interval [CI]: 1.22 to 2.09; p = 0.0005). ARF within 30 days occurred more commonly in patients with compared with those without CKD (5.0% vs. 0.8%; p < 0.0001), and was strongly associated with the 3-year risk of death, stroke, or MI (50.7% vs. 14.4%; HR: 4.59; 95% CI: 2.73 to 7.73; p < 0.0001). ARF occurred less commonly after revascularization with PCI compared with CABG both in patients with CKD (2.3% vs. 7.7%; HR: 0.28; 95% CI: 0.09 to 0.87) and in those without CKD (0.3% vs. 1.3%; HR: 0.20; 95% CI: 0.04 to 0.90; pinteraction = 0.71). There were no significant differences in the rates of the primary composite endpoint after PCI and CABG in patients with CKD (23.4% vs. 18.1%; HR: 1.25; 95% CI: 0.79 to 1.98) and without CKD (13.4% vs. 13.5%; HR: 0.97; 95% CI: 0.73 to 1.27; pinteraction = 0.38). CONCLUSIONS: Patients with CKD undergoing revascularization for LMCAD in the EXCEL trial had increased rates of ARF and reduced event-free survival. ARF occurred less frequently after PCI compared with CABG. There were no significant differences between PCI and CABG in terms of death, stroke, or MI at 3 years in patients with and without CKD. (EXCEL Clinical Trial [EXCEL]; NCT01205776)."},{"id":"2c1e52dbd22a","type":"article","url":"https://hartvaat.nl/2018/08/14/adma-en-sdma-voorspellen-uitkomsten-bij-af-aristotle-substudie/","title":"ADMA en SDMA voorspellen uitkomsten bij AF: ARISTOTLE-substudie","title_en":"Asymmetric and Symmetric Dimethylarginine Predict Outcomes in Patients With Atrial Fibrillation: An ARISTOTLE Substudy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.05.058","source_url":"https://doi.org/10.1016/j.jacc.2018.05.058","authors":["John D Horowitz","Raffaele De Caterina","Tamila Heresztyn","John H Alexander","Ulrika Andersson","Renato D Lopes","Philippe Gabriel Steg","Elaine M Hylek","Puneet Mohan","Michael Hanna","Petr Jansky","Christopher B Granger","Lars Wallentin"],"significance":5,"published":"2018-08-14","source_date":"2018-08-14","image":"","kennis":[],"congress":"","summary_en":"This ARISTOTLE substudy identified asymmetric and symmetric dimethylarginine as predictors of thromboembolism and bleeding in AF patients, establishing nitric oxide pathway biomarkers for risk stratification.","created":"2026-07-03T10:27:26Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ARISTOTLE substudie naar asymmetrisch en symmetrisch dimethylarginine als voorspellers van uitkomsten bij AF. Nieuwe biomarkers voor risicostratificatie.","abstract_original":"BACKGROUND: There is little mechanistic information on factors predisposing atrial fibrillation (AF) patients to thromboembolism or bleeding, but generation of nitric oxide (NO) might theoretically contribute to both. OBJECTIVES: The authors tested the hypothesis that plasma levels of the methylated arginine derivatives asymmetric and symmetric dimethylarginine (ADMA/SDMA), which inhibit NO generation, might be associated with outcomes in AF. METHODS: Plasma samples were obtained from 5,004 patients with AF at randomization to warfarin or apixaban in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. ADMA and SDMA concentrations were measured by high-performance liquid chromatography. Relationships to clinical characteristics were evaluated by multivariable analyses. Associations with major outcomes, during a median of 1.9 years follow-up, were evaluated by adjusted Cox proportional hazards models. RESULTS: Both ADMA and SDMA plasma concentrations at study entry increased significantly with patients' age, female sex, renal impairment, permanent AF, or congestive heart failure. ADMA and SDMA increased (p < 0.001) with both increased CHA2DS2-VASc and HAS-BLED scores, but decreased in the presence of diabetes. On multivariable analysis adjusting for established risk factors and treatment, tertile groups of ADMA concentrations were significantly associated with stroke/systemic embolism (p = 0.034), and death (p < 0.0001), whereas tertile groups of SDMA were associated with major bleeding and death (p < 0.001 for both). Incorporating ADMA and SDMA into CHA2DS2-VASc or HAS-BLED predictive models improved C-indices for those outcomes. Neither ADMA nor SDMA predicted differential responses to warfarin or apixaban. CONCLUSIONS: In anticoagulated patients with AF, elevated ADMA levels are weakly associated with thromboembolic events, elevated SDMA levels with bleeding events and both are strongly associated with increased mortality. These findings suggest that disturbances of NO function modulate both thrombotic and hemorrhagic risk in anticoagulated patients with AF. (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation [ARISTOTLE]; NCT00412984)."},{"id":"d688cb74d829","type":"article","url":"https://hartvaat.nl/2018/08/07/ecg-screening-op-af-uspstf-aanbeveling-2018/","title":"ECG-screening op AF: USPSTF-aanbeveling 2018","title_en":"Screening for Atrial Fibrillation With Electrocardiography: US Preventive Services Task Force Recommendation Statement.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["atleten"],"journal":"JAMA","doi":"10.1001/jama.2018.10321","source_url":"https://doi.org/10.1001/jama.2018.10321","authors":["Susan J Curry","Alex H Krist","Douglas K Owens","Michael J Barry","Aaron B Caughey","Karina W Davidson","Chyke A Doubeni","John W Epling","Alex R Kemper","Martha Kubik","C Seth Landefeld","Carol M Mangione","Michael Silverstein","Melissa A Simon","Chien-Wen Tseng","John B Wong"],"significance":8,"published":"2018-08-07","source_date":"2018-08-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The 2018 USPSTF concluded there was insufficient evidence to recommend for or against ECG screening for atrial fibrillation in asymptomatic older adults. The 'I' statement reflected the absence of randomized trials demonstrating that screening-detected AF treatment improves clinical outcomes.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"USPSTF-aanbeveling 2018 over ECG-screening op AF. Concludeerde onvoldoende bewijs om screening aan te bevelen of af te raden bij asymptomatische ouderen.","abstract_original":"IMPORTANCE: Atrial fibrillation is the most common type of cardiac arrhythmia (irregular heartbeat), and its prevalence increases with age, affecting about 3% of men and 2% of women aged 65 to 69 years and about 10% of adults 85 years and older. Atrial fibrillation is a major risk factor for ischemic stroke, increasing risk of stroke by as much as 5-fold. Approximately 20% of patients who have a stroke associated with atrial fibrillation are first diagnosed with atrial fibrillation at the time of stroke or shortly thereafter. OBJECTIVE: To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for atrial fibrillation with electrocardiography (ECG). EVIDENCE REVIEW: The USPSTF reviewed the evidence on the benefits and harms of screening for atrial fibrillation with ECG in adults 65 years and older, the effectiveness of screening with ECG for detecting previously undiagnosed atrial fibrillation compared with usual care, and the benefits and harms of anticoagulant or antiplatelet therapy for the treatment of screen-detected atrial fibrillation in older adults. FINDINGS: Most older adults with previously undiagnosed atrial fibrillation have a stroke risk above the threshold for anticoagulant therapy and would be eligible for treatment. Anticoagulant therapy is effective for stroke prevention in symptomatic persons with atrial fibrillation and high stroke risk. However, the USPSTF found inadequate evidence to determine whether screening with ECG and subsequent treatment in asymptomatic adults is more effective than usual care. At the same time, the harms of diagnostic follow-up and treatment prompted by abnormal ECG results are well established and include misdiagnosis and invasive testing. Given these uncertainties, it is not possible to determine the net benefit of screening with ECG. CONCLUSIONS AND RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrillation with ECG. (I statement)."},{"id":"2292549d5335","type":"article","url":"https://hartvaat.nl/2018/08/07/ecg-screening-op-af-uspstf-evidence-report-en-systematische-review/","title":"ECG-screening op AF: USPSTF evidence report en systematische review","title_en":"Screening for Atrial Fibrillation With Electrocardiography: Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.4190","source_url":"https://doi.org/10.1001/jama.2018.4190","authors":["Daniel E Jonas","Leila C Kahwati","Jonathan D Y Yun","Jennifer Cook Middleton","Manny Coker-Schwimmer","Gary N Asher"],"significance":7,"published":"2018-08-07","source_date":"2018-08-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This USPSTF evidence report systematically reviewed the evidence on ECG screening for atrial fibrillation in asymptomatic adults, evaluating the yield of different screening strategies and the downstream effects on anticoagulation initiation and clinical outcomes.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"USPSTF evidence report over screening op atriumfibrilleren met ECG bij asymptomatische volwassenen. Bewijsbasis voor het screeningsbeleid.","abstract_original":"IMPORTANCE: Atrial fibrillation is the most common arrhythmia and increases the risk of stroke. OBJECTIVE: To review the evidence on screening for nonvalvular atrial fibrillation with electrocardiography (ECG) and stroke prevention treatment in asymptomatic adults 65 years or older to inform the US Preventive Services Task Force. DATA SOURCES: MEDLINE, Cochrane Library, and trial registries through May 2017; references; experts; literature surveillance through June 6, 2018. STUDY SELECTION: English-language randomized clinical trials (RCTs), prospective cohort studies evaluating detection rates of atrial fibrillation or harms of screening, and systematic reviews evaluating stroke prevention treatment. Eligible treatment studies compared warfarin, aspirin, or novel oral anticoagulants (NOACs) with placebo or no treatment. Studies were excluded that focused on persons with a history of cardiovascular disease. DATA EXTRACTION AND SYNTHESIS: Dual review of abstracts, full-text articles, and study quality. When at least 3 similar studies were available, random-effects meta-analyses were conducted. MAIN OUTCOMES AND MEASURES: Detection of previously undiagnosed atrial fibrillation, mortality, stroke, stroke-related morbidity, and harms. RESULTS: Seventeen studies were included (n = 135 300). No studies evaluated screening compared with no screening and focused on health outcomes. Systematic screening with ECG identified more new cases of atrial fibrillation than no screening (absolute increase, from 0.6% [95% CI, 0.1%-0.9%] to 2.8% [95% CI, 0.9%-4.7%] over 12 months; 2 RCTs, n = 15 803), but a systematic approach using ECG did not detect more cases than an approach using pulse palpation (2 RCTs, n = 17 803). For potential harms, no eligible studies compared screening with no screening. Warfarin (mean, 1.5 years) was associated with a reduced risk of ischemic stroke (relative risk [RR], 0.32 [95% CI, 0.20-0.51]) and all-cause mortality (RR, 0.68 [95% CI, 0.50-0.93]) and with increased risk of bleeding (5 trials, n = 2415). Participants in treatment trials were not screen detected, and most had long-standing persistent atrial fibrillation. A network meta-analysis reported that NOACs were associated with a significantly lower risk of a composite outcome of stroke and systemic embolism (adjusted odds ratios compared with placebo or control ranged from 0.32-0.44); the risk of bleeding was increased (adjusted odds ratios, 1.4-2.2), but confidence intervals were wide and differences between groups were not statistically significant. CONCLUSIONS AND RELEVANCE: Although screening with ECG can detect previously unknown cases of atrial fibrillation, it has not been shown to detect more cases than screening focused on pulse palpation. Treatments for atrial fibrillation reduce the risk of stroke and all-cause mortality and increase the risk of bleeding, but trials have not assessed whether treatment of screen-detected asymptomatic older adults results in better health outcomes than treatment after detection by usual care or after symptoms develop."},{"id":"99f8d58e0e6f","type":"article","url":"https://hartvaat.nl/2018/08/07/adenosine-en-ticagrelorspiegels-bij-patienten-met-en-zonder-ticagrelor-dyspneu/","title":"Adenosine en ticagrelorspiegels bij patiënten met en zonder ticagrelor-dyspneu","title_en":"Adenosine and Ticagrelor Plasma Levels in Patients With and Without Ticagrelor-Related Dyspnea.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034489","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034489","authors":["Luis Ortega-Paz","Salvatore Brugaletta","Sara Ariotti","K Martijn Akkerhuis","Alexios Karagiannis","Stephan Windecker","Marco Valgimigli"],"significance":5,"published":"2018-08-07","source_date":"2018-08-07","image":"","kennis":[],"congress":"","summary_en":"This study investigated the relationship between adenosine and ticagrelor plasma levels in patients with and without ticagrelor-related dyspnea, providing mechanistic insight into this common side effect.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 relatie tussen adenosinespiegels en ticagrelor-geassocieerde dyspneu. Mechanistisch inzicht in een veelvoorkomende bijwerking.","abstract_original":""},{"id":"4cd1fa70834c","type":"article","url":"https://hartvaat.nl/2018/08/01/zuurstoftherapie-bij-stemi-overzichtsartikel/","title":"Zuurstoftherapie bij STEMI: overzichtsartikel","title_en":"Oxygen therapy in ST-elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy326","source_url":"https://doi.org/10.1093/eurheartj/ehy326","authors":["Robin Hofmann","Nils Witt","Bo Lagerqvist","Tomas Jernberg","Bertil Lindahl","David Erlinge","Johan Herlitz","Joakim Alfredsson","Rikard Linder","Elmir Omerovic","Oskar Angerås","Dimitrios Venetsanos","Thomas Kellerth","David Sparv","Jörg Lauermann","Neshro Barmano","Dinos Verouhis","Ollie Östlund","Leif Svensson","Stefan K James"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This review evaluated the evidence for oxygen therapy in STEMI in light of DETO2X-AMI and other contemporary trials, concluding that routine supplemental oxygen is not beneficial and may be harmful in normoxemic MI patients.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 de evidence voor zuurstoftherapie bij STEMI in het licht van DETO2X-AMI en andere trials. Paradigmaverschuiving van routinematig naar beperkt zuurstofgebruik.","abstract_original":"AIMS: To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes. METHODS AND RESULTS: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6-12 h or ambient air. In this pre-specified analysis, we included only STEMI patients who underwent percutaneous coronary intervention (PCI). In total, 2807 patients were included, 1361 assigned to receive oxygen, and 1446 assigned to ambient air. The pre-specified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1361) of patients allocated to oxygen compared to 7.5% (108 of 1446) allocated to ambient air [hazard ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64-1.13; P = 0.27]. There was no difference in the rate of death from any cause (HR 0.86, 95% CI 0.61-1.22; P = 0.41), rate of rehospitalization for MI (HR 0.92, 95% CI 0.57-1.48; P = 0.73), rehospitalization for cardiogenic shock (HR 1.05, 95% CI 0.21-5.22; P = 0.95), or stent thrombosis (HR 1.27, 95% CI 0.46-3.51; P = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days and the total duration of follow-up up to 1356 days. CONCLUSIONS: Routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis."},{"id":"1acb4db05dbb","type":"article","url":"https://hartvaat.nl/2018/08/01/leeftijd-en-geleide-de-escalatie-van-antiplaatjestherapie-na-acs-tropical-acs/","title":"Leeftijd en geleide de-escalatie van antiplaatjestherapie na ACS: TROPICAL-ACS","title_en":"Age and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: results from the randomized TROPICAL-ACS trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy332","source_url":"https://doi.org/10.1093/eurheartj/ehy332","authors":["Dirk Sibbing","Lisa Gross","Dietmar Trenk","Claudius Jacobshagen","Tobias Geisler","Martin Hadamitzky","Béla Merkely","Róbert Gábor Kiss","András Komócsi","Radoslaw Parma","Stephan B Felix","Franz-Josef Neumann","Jörg Hausleiter","Monika Baylacher","Lukasz Koltowski","Julinda Mehilli","Kurt Huber","Zenon Huczek","Dániel Aradi","Steffen Massberg"],"significance":5,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":[],"congress":"","summary_en":"This TROPICAL-ACS subanalysis showed that guided DAPT de-escalation is safe and effective across age groups after ACS, supporting the personalized antiplatelet approach in both younger and older patients.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TROPICAL-ACS subanalyse naar het effect van leeftijd op de veiligheid en werkzaamheid van geleide DAPT-de-escalatie na ACS.","abstract_original":"AIMS: Guided de-escalation of P2Y12-inhibitor treatment was recently identified as an effective alternative treatment strategy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention. Safety and efficacy of this strategy may differ in relation to patient's age. This pre-specified analysis of the TROPICAL-ACS trial aimed to assess the impact of age on clinical outcomes following guided de-escalation of antiplatelet treatment in ACS patients. METHODS AND RESULTS: Patients were randomly assigned in a 1:1 fashion to either standard treatment with prasugrel for 12 months (control group) or to a guided de-escalation regimen (1 week prasugrel followed by 1 week clopidogrel and platelet function testing guided maintenance therapy with clopidogrel or prasugrel from day 14 after hospital discharge; guided de-escalation group). We used Cox regression models to assess the associations of age on clinical endpoints and interactions. In younger patients (age ≤70, n = 2240), the 1 year incidence of the primary endpoint (cardiovascular death, myocardial infarction, stroke, or bleeding ≥ grade 2 according to Bleeding Academic Research Consortium criteria) was significantly lower in guided de-escalation vs. control group [5.9% vs. 8.3%; hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.51-0.96; P = 0.03, number needed to treat = 42]. In elderly patients (age >70, n = 370), the absolute risk of events was higher without significant differences between guided de-escalation vs. control group (15.5% vs. 13.6%; HR 1.17, 95% CI 0.69-2.01; P = 0.56). When the impact of age, as a continuous variable, was analysed on outcomes after guided de-escalation vs. control treatment, an increasing relative risk reduction was observed in the primary endpoint by decreasing age (Pint = 0.02), due to significant reductions in bleeding. CONCLUSION: Treatment effects of guided de-escalation for P2Y12 inhibitors depend on patient's age with younger patients deriving a significant net clinical benefit. Although the safety and efficacy of guided de-escalation in the elderly was similar to uniform prasugrel therapy, this should be further investigated due to the limited sample size of this group."},{"id":"2c46146c9c3c","type":"article","url":"https://hartvaat.nl/2018/08/01/inhalatie-stikstofoxide-bij-stemi-nomi-gerandomiseerde-trial/","title":"Inhalatie-stikstofoxide bij STEMI: NOMI gerandomiseerde trial","title_en":"Nitric oxide for inhalation in ST-elevation myocardial infarction (NOMI): a multicentre, double-blind, randomized controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["select-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy232","source_url":"https://doi.org/10.1093/eurheartj/ehy232","authors":["Stefan P Janssens","Jan Bogaert","Jaroslaw Zalewski","Attila Toth","Tom Adriaenssens","Ann Belmans","Johan Bennett","Piet Claus","Walter Desmet","Christophe Dubois","Kaatje Goetschalckx","Peter Sinnaeve","Katleen Vandenberghe","Pieter Vermeersch","Arpad Lux","Zsolt Szelid","Monika Durak","Piotr Lech","Krzysztof Zmudka","Peter Pokreisz","Pascal Vranckx","Bela Merkely","Kenneth D Bloch","Frans Van de Werf"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":[],"congress":"","summary_en":"The NOMI trial of inhaled nitric oxide in STEMI showed no significant reduction in myocardial infarct size, a negative result for this cardioprotective strategy despite promising preclinical data on sGC-cGMP pathway activation.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T13:26:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NOMI multicenter dubbelblinde gerandomiseerde trial naar inhalatie-stikstofoxide (NO) bij STEMI voor beperking van reperfusieschade.","abstract_original":"AIMS: Inhalation of nitric oxide (iNO) during myocardial ischaemia and after reperfusion confers cardioprotection in preclinical studies via enhanced cyclic guanosine monophosphate (cGMP) signalling. We tested whether iNO reduces reperfusion injury in patients with ST-elevation myocardial infarction (STEMI; NCT01398384). METHODS AND RESULTS: We randomized in a double-blind, placebo-controlled study 250 STEMI patients to inhale oxygen with (iNO) or without (CON) 80 parts-per-million NO for 4 h following percutaneous revascularization. Primary efficacy endpoint was infarct size as a fraction of left ventricular (LV) size (IS/LVmass), assessed by delayed enhancement contrast magnetic resonance imaging (MRI). Pre-specified subgroup analysis included thrombolysis-in-myocardial-infarction flow in the infarct-related artery, troponin T levels on admission, duration of symptoms, location of culprit lesion, and intra-arterial nitroglycerine (NTG) use. Secondary efficacy endpoints included IS relative to risk area (IS/AAR), myocardial salvage index, LV functional recovery, and clinical events at 4 and 12 months. In the overall population, IS/LVmass at 48-72 h was 18.0 ± 13.4% in iNO (n = 109) and 19.4 ± 15.4% in CON [n = 116, effect size -1.524%, 95% confidence interval (95% CI) -5.28, 2.24; P = 0.427]. Subgroup analysis indicated consistency across clinical confounders of IS but significant treatment interaction with NTG (P = 0.0093) resulting in smaller IS/LVmass after iNO in NTG-naïve patients (n = 140, P < 0.05). The secondary endpoint IS/AAR was 53 ± 26% with iNO vs. 60 ± 26% in CON (effect size -6.8%, 95% CI -14.8, 1.3, P = 0.09) corresponding to a myocardial salvage index of 47 ± 26% vs. 40 ± 26%, respectively, P = 0.09. Cine-MRI showed similar LV volumes at 48-72 h, with a tendency towards smaller increases in end-systolic and end-diastolic volumes at 4 months in iNO (P = 0.048 and P = 0.06, respectively, n = 197). Inhalation of nitric oxide was safe and significantly increased cGMP plasma levels during 4 h reperfusion. The Kaplan-Meier analysis for the composite of death, recurrent ischaemia, stroke, or rehospitalizations showed a tendency toward lower event rates with iNO at 4 months and 1 year (log-rank test P = 0.10 and P = 0.06, respectively). CONCLUSIONS: Inhalation of NO at 80 ppm for 4 h in STEMI was safe but did not reduce infarct size relative to absolute LVmass at 48-72h. The observed functional recovery and clinical event rates at follow-up and possible interaction with nitroglycerine warrant further studies of iNO in STEMI."},{"id":"1e1f847f2921","type":"article","url":"https://hartvaat.nl/2018/08/01/2018-ehra-praktische-gids-doac-s-bij-af-europace-editie/","title":"2018 EHRA praktische gids DOAC's bij AF (Europace-editie)","title_en":"The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"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/euy054","source_url":"https://doi.org/10.1093/europace/euy054","authors":["Jan Steffel","Peter Verhamme","Tatjana S Potpara","Pierre Albaladejo","Matthias Antz","Lien Desteghe","Karl Georg Haeusler","Jonas Oldgren","Holger Reinecke","Vanessa Roldan-Schilling","Nigel Rowell","Peter Sinnaeve","Ronan Collins","A John Camm","Hein Heidbüchel"],"significance":8,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"Europace publication of the 2018 EHRA practical guide for DOAC use in atrial fibrillation, providing the comprehensive reference document for clinical decision-making on DOAC dosing, monitoring, and special populations in parallel with the European Heart Journal edition.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T13:26:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Europace-publicatie van de 2018 EHRA praktische gids voor DOAC-gebruik bij AF. Parallelle publicatie voor maximale bereikbaarheid.","abstract_original":"The current manuscript is the Executive Summary of the second update to the original Practical Guide, published in 2013. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF), and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. The European Heart Rhythm Association (EHRA) set out to co-ordinate a unified way of informing physicians on the use of the different NOACs. A writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 20 topics are (i) eligibility for NOACs; (ii) practical start-up and follow-up scheme for patients on NOACs; (iii) ensuring adherence to prescribed oral anticoagulant intake; (iv) switching between anticoagulant regimens; (v) pharmacokinetics and drug-drug interactions of NOACs; (vi) NOACs in patients with chronic kidney or advanced liver disease; (vii) how to measure the anticoagulant effect of NOACs; (viii) NOAC plasma level measurement: rare indications, precautions, and potential pitfalls; (ix) how to deal with dosing errors; (x) what to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (xi) management of bleeding under NOAC therapy; (xii) patients undergoing a planned invasive procedure, surgery or ablation; (xiii) patients requiring an urgent surgical intervention; (xiv) patients with AF and coronary artery disease; (xv) avoiding confusion with NOAC dosing across indications; (xvi) cardioversion in a NOAC-treated patient; (xvii) AF patients presenting with acute stroke while on NOACs; (xviii) NOACs in special situations; (xix) anticoagulation in AF patients with a malignancy; and (xx) optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA web site (www.NOACforAF.eu)."},{"id":"7feaa3a019a3","type":"article","url":"https://hartvaat.nl/2018/08/01/linker-hartoorisolatie-bij-persisterend-en-langdurig-persisterend-af-meta-analys/","title":"Linker-hartoorisolatie bij persisterend en langdurig persisterend AF: meta-analyse","title_en":"Benefit of left atrial appendage electrical isolation for persistent and long-standing persistent atrial fibrillation: a systematic review and 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/eux372","source_url":"https://doi.org/10.1093/europace/eux372","authors":["Jorge Romero","Gregory F Michaud","Ricardo Avendano","David F Briceño","Saurabh Kumar","Juan Carlos Diaz","Sanghamitra Mohanty","Chintan Trivedi","Carola Gianni","Domenico Della Rocca","Riccardo Proietti","Laura Perrotta","Stefano Bordignon","Julian K R Chun","Boris Schmidt","Mario Garcia","Andrea Natale","Luigi Di Biase"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This systematic review evaluated left atrial appendage electrical isolation as an adjunctive ablation strategy for non-paroxysmal AF, summarizing the evidence for this technique in patients with persistent and longstanding persistent arrhythmia.","created":"2026-07-03T10:27:25Z","updated":"2026-07-03T13:26:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het voordeel van linker-hartoorisolatie bij persisterend en langdurig persisterend AF. Evaluatie van deze aanvullende ablatiestrategie.","abstract_original":"AIMS: The long-term outcomes of left atrial appendage electrical isolation (LAAEI) in patients with non-paroxysmal atrial fibrillation (AF) have corroborated the significant role of the LAA in this arrhythmia. We sought to investigate the incremental benefit of LAAEI in patients undergoing catheter ablation for persistent AF or long-standing persistent AF (LSPAF). METHODS AND RESULTS: A systematic review of Medline, Cochrane, and Embase for all the clinical studies in which assessment LAAEI in non-paroxysmal AF patients was performed. The benefit of LAAEI in patients with AF was analysed from seven studies that enrolled a total of 930 patients [mean age 63 ± 5 years; male: 69%]. All studies included patients with either persistent AF or LSPAF or the combination of them. The overall freedom from all-arrhythmia recurrence at 12 months of follow-up off antiarrhythmic medications in patients who underwent LAAEI was 75.5% vs. 43.9% in those in whom only standard ablation was performed [56% relative reduction and 31.6% absolute reduction; risk ratio (RR) 0.44, 95% confidence interval (95% CI) 0.31-0.64; P < 0.0001]. The rate of ischaemic stroke in the LAAEI group was 0.4% and in the control group 2.1% at 12 months follow-up (RR 0.40, 95% CI 0.12-1.30; P = 0.13). Acute complications rates were identical between groups [LAAEI 5.5%, control 5.5% (RR 0.99, 95% CI 0.46-2.16; P = 0.99)]. CONCLUSION: Left atrial appendage electrical isolation in addition to standard ablation appears to have a substantial incremental benefit to achieve freedom from ALL atrial arrhythmias in patients with persistent AF and LSPAF without increasing acute procedural complications and without raising the risk of ischaemic stroke."},{"id":"f627f7b16c76","type":"article","url":"https://hartvaat.nl/2018/08/01/laagfrequente-elektrische-spierstimulatie-en-endotheelfunctie-bij-gevorderd-hart/","title":"Laagfrequente elektrische spierstimulatie en endotheelfunctie bij gevorderd hartfalen","title_en":"Low frequency electrical muscle stimulation and endothelial function in advanced heart failure patients.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","bloeddrukbehandeling","empagliflozine","endotheel","hartrevalidatie","harttransplantatie","hfmref","hfpef","hfref","ijzersuppletie","ijzertekort","ivabradine","laminopathie","nt-probnp","sacubitril-valsartan","slaapapneu","step-hfpef","ventrikelfibrilleren","vericiguat","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12293","source_url":"https://doi.org/10.1002/ehf2.12293","authors":["Stuart Ennis","Gordon McGregor","Robert Shave","Barry McDonnell","Andrew Thompson","Prithwish Banerjee","Helen Jones"],"significance":4,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":[],"congress":"","summary_en":"This double-blind randomised study evaluated low-frequency electrical muscle stimulation as an alternative exercise modality for improving endothelial function and aerobic capacity in patients with advanced chronic heart failure.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 elektrische spierstimulatie en endotheelfunctie bij gevorderd hartfalen. Alternatieve trainingsmodaliteit voor immobiele HF-patiënten.","abstract_original":"AIM: Obtain initial estimates of the change in brachial artery endothelial function and maximal oxygen uptake (VO2peak ) with 8 weeks of low-frequency electrical muscle stimulation (LF-EMS) or sham in patients with advanced chronic heart failure. METHODS AND RESULTS: Using a double blind, randomized design, 35 patients with chronic heart failure (New York Heart Association class III-IV) were assigned to 8 weeks (5 × 60 min per week) of either LF-EMS (4 Hz, continuous) or sham (skin level stimulation only) of the quadriceps and hamstrings muscles. Four of the five sessions were at home and one under supervision. Ultrasound images of resting brachial artery diameter and post 5 min occlusion to determine flow-mediated dilation (FMD), a marker of vascular function and peak oxygen uptake (VO2peak ) during cardiopulmonary exercise test, were measured before and after LF-EMS (n = 20) and sham (n = 15) interventions. FMD improved by 2.56% (95% confidence interval: 0.69 to 3.80) with LF-EMS compared with sham (P = 0.07). There were no notable changes in VO2peak . CONCLUSIONS: Improvements in FMD with LF-EMS may have a clinically meaningful effect as higher FMD is associated with better prognosis. This is a preliminary finding, and a larger trial is warranted."},{"id":"937cdc6e124a","type":"article","url":"https://hartvaat.nl/2018/08/01/intensieve-bloeddrukbehandeling-bij-diabetes-type-2-zonder-intensieve-glycemisch/","title":"Intensieve bloeddrukbehandeling bij diabetes type 2 zonder intensieve glycemische controle","title_en":"Benefits of Intensive Blood Pressure Treatment in Patients With Type 2 Diabetes Mellitus Receiving Standard but Not Intensive Glycemic Control.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","diabetes-type-2"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11408","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11408","authors":["Tetsuro Tsujimoto","Hiroshi Kajio"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This analysis showed that intensive blood pressure treatment provides greater cardiovascular benefit in diabetic patients receiving standard rather than intensive glycemic control, suggesting complementary rather than overlapping protective mechanisms.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T13:26:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 intensieve bloeddrukbehandeling bij diabetes type 2 meer voordeel biedt bij standaard versus intensieve glycemische controle. Onderbouwt BP als prioriteit.","abstract_original":"This study aimed to assess whether intensive blood pressure (BP) treatment has benefits in preventing cardiovascular events, including heart failure in patients with type 2 diabetes mellitus. Using the ACCORD BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) data, hazard ratios for cardiovascular events with 95% confidence intervals were calculated using the Cox proportional hazard models to compare the time to the first cardiovascular event in patients receiving standard (n=2362) or intensive glycemic control (n=2371). The overall mean follow-up period was 4.5 years, and cardiovascular events were confirmed in 528 patients. The cardiovascular event risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group than in the standard BP treatment group (hazard ratio, 0.71; 95% confidence interval, 0.56-0.90; P=0.005), whereas that in patients receiving intensive glycemic control did not differ significantly between the groups (hazard ratio, 1.06; 95% confidence interval, 0.83-1.36; P=0.61). There was a significant interaction between the BP treatment strategy and glycemic control (P=0.02). The stroke risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group, but not in patients receiving intensive glycemic control. Although not significant, all-cause mortality in patients receiving intensive glycemic control was higher in patients receiving intensive BP treatment than in those receiving standard BP treatment (hazard ratio, 1.38; 95% confidence interval, 0.99-1.92; P=0.05). Benefits of intensive BP treatment were observed only in ACCORD BP participants receiving standard glycemic control without additional risk factors."},{"id":"4b1c6436e78a","type":"article","url":"https://hartvaat.nl/2018/08/01/zelfmanagement-van-postnatale-hypertensie-de-snap-ht-trial/","title":"Zelfmanagement van postnatale hypertensie: de SNAP-HT-trial","title_en":"Self-Management of Postnatal Hypertension: The SNAP-HT Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["bloeddrukbehandeling","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.10911","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.10911","authors":["Alexandra E Cairns","Katherine L Tucker","Paul Leeson","Lucy H Mackillop","Mauro Santos","Carmelo Velardo","Dario Salvi","Sam Mort","Jill Mollison","Lionel Tarassenko","Richard J McManus"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The SNAP-HT trial of blood pressure self-management in the postpartum period after hypertensive pregnancy demonstrated that self-monitoring enables better titration of antihypertensives during the rapidly changing post-delivery period.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SNAP-HT gerandomiseerde trial naar zelfmanagement van bloeddruk in de postnatale periode bij vrouwen met hypertensieve zwangerschapscomplicaties.","abstract_original":"UNLABELLED: Hypertension affects 1 in 10 pregnancies, often persisting postpartum, when antihypertensive requirements may vary substantially. This unmasked, randomized controlled trial evaluated the feasibility and effects on blood pressure (BP) of self-management of postpartum hypertension. Women with gestational hypertension or preeclampsia, requiring postnatal antihypertensive treatment, were randomized to self-management or usual care. Self-management entailed daily home BP monitoring and automated medication reduction via telemonitoring. Women attended 5 follow-up visits during 6 months. The primary outcome was feasibility: specifically recruitment, retention, and compliance with follow-up rates. Secondary outcomes included BP control and safety, analyzed on an intention-to-treat basis. Forty-nine percent (91/186) of those women approached were randomized (45 intervention, 46 control), and 90% (82/91) finished follow-up. The groups had similar baseline characteristics. After randomization, BP was lower in the intervention group, most markedly at 6 weeks: intervention group mean (SD), systolic 121.6 (8.7)/diastolic 80.5 (6.6) mm Hg; control group, systolic 126.6 (11.0)/diastolic 86.0 (9.7) mm Hg; adjusted differences (95% confidence interval), systolic -5.2 (-9.3 to -1.2)/diastolic -5.8 (-9.1 to -2.5) mm Hg. Diastolic BP remained significantly lower in those self-managing to 6 months: adjusted difference -4.5 (-8.1 to -0.8) mm Hg. This is the first randomized evaluation of BP self-management postpartum and indicates it would be feasible to trial this intervention in larger studies. Self-management resulted in better diastolic BP control to 6 months, even beyond medication cessation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02333240."},{"id":"66a48fd5b4d3","type":"article","url":"https://hartvaat.nl/2018/08/01/farmacologische-behandeling-van-hypertensie-bij-kinderen-netwerkmeta-analyse/","title":"Farmacologische behandeling van hypertensie bij kinderen: netwerkmeta-analyse","title_en":"Pharmacological Treatment of Arterial Hypertension in Children and Adolescents: A Network Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["anemie-ckd","bloeddrukbehandeling","thuisbloeddrukmeting","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.10862","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.10862","authors":["Jacopo Burrello","Elvira M Erhardt","Gaelle Saint-Hilary","Franco Veglio","Franco Rabbia","Paolo Mulatero","Silvia Monticone","Fabrizio D'Ascenzo"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This network meta-analysis of antihypertensive medications in children and adolescents provided rare comparative effectiveness data for different drug classes in pediatric hypertension treatment.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van antihypertensiva bij kinderen en adolescenten. Zeldzaam vergelijkend bewijs in de pediatrische hypertensie.","abstract_original":"Pharmacological treatment is indicated in children and adolescents with hypertension unresponsive to lifestyle modifications, but there is not enough evidence to recommend 1 class of antihypertensive drugs over others. We performed a network meta-analysis to compare the results of available randomized clinical trials on pharmacological treatment of pediatric hypertension. From a total of 554 potentially relevant studies, 13 randomized placebo-controlled clinical trials enrolling ≥50 patients and a follow-up ≥4 weeks were included. The reduction of systolic blood pressure (SBP) and diastolic BP (DBP) after treatment were the coprimary end points. A total of 2378 pediatric patients, with a median age of 12 years, were included in the analysis. After a median follow-up of 35 days, lisinopril and enalapril were found to be superior to placebo in reducing SBP and DBP, whereas only for DBP, losartan was found to be superior to placebo and lisinopril and enalapril were found to be superior to eplerenone. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were associated with a greater SBP and DBP reduction compared with placebo, likewise the mineralocorticoid receptor antagonist was inferior to angiotensin-converting enzyme inhibitors in DBP reduction. The analysis was adjusted for study-level mean age, percentage of women, mean baseline blood pressure, and mean weight, only the latter significantly affected DBP reduction. According to the present analysis, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers could represent the best choice as antihypertensive treatment for pediatric hypertension. However, because of the paucity of available data for the other classes of antihypertensive drugs, definitive conclusions are not allowed and further randomized controlled trials are warranted."},{"id":"8047dd59415e","type":"article","url":"https://hartvaat.nl/2018/08/01/raas-profielen-bij-zwangeren-met-chronische-hypertensie/","title":"RAAS-profielen bij zwangeren met chronische hypertensie","title_en":"Renin-Angiotensin-Aldosterone Profiles in Pregnant Women With Chronic Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["ace-remmers","anemie-ckd","angiotensinereceptorblokkers","aprocitentan","bloeddrukbehandeling","chronische-nierziekte","ezetimibe","ivabradine","lorundrostat","ras-remmers","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","rosuvastatine","sacubitril-valsartan","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.10854","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.10854","authors":["Line Malha","Cristina P Sison","Geraldine Helseth","Jean E Sealey","Phyllis August"],"significance":5,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/","https://hartvaat.nl/kennis/hypertensie/pathofysiologie-hypertensie/"],"congress":"","summary_en":"This study characterized renin-angiotensin-aldosterone profiles in pregnant women with chronic hypertension, providing pathophysiological insights into the hormonal changes that contribute to blood pressure regulation during pregnancy.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 renine-angiotensine-aldosteron profielen bij zwangere vrouwen met chronische hypertensie. Pathofysiologisch inzicht voor therapeutische keuzen.","abstract_original":"Pregnant women with chronic hypertension are at risk for increased blood pressure and superimposed preeclampsia (SPE) in late pregnancy. Alterations in the renin-aldosterone system are a feature of normal pregnancy; however, their role in chronic hypertension with and without SPE is less clear. We performed a prospective, longitudinal trial of 108 women with chronic hypertension and measured plasma renin activity (PRA), 24-hour urine sodium, urine potassium, and urine aldosterone (Ualdo) at 12, 20, 28, and 36 weeks and postpartum. SPE developed in 34% of pregnancies. PRA was lower in women who developed SPE at weeks 28 (5.99 versus 6.22 ng/mL per hour; P<0.001) and 36 (5.71 versus 7.74 ng/mL per hour; P=0.002). Ualdo was lower in women with SPE compared with those without SPE at 28 weeks (59.6 versus 81.3 μg/d; P=0.039). Mean arterial pressure was inversely related to both PRA (r=-0.23; P<0.0001) and Ualdo (r=-0.11; P=0.029). PRA and Ualdo were positively associated with each other (r=0.5327; P<0.0001) after adjusting for urine potassium, urine sodium, serum potassium, and mean arterial pressure. PRA and Ualdo were lower in women of black race compared with other racial groups (P<0.001). Our results demonstrate that in women with chronic hypertension PRA and Ualdo increase in early pregnancy and subsequently decrease in women who develop SPE. These findings are consistent with the hypothesis that sodium retention may contribute to the elevation in blood pressure in SPE."},{"id":"0283a9cb6af5","type":"article","url":"https://hartvaat.nl/2018/08/01/renale-denervatie-bij-resistente-hypertensie-met-obstructieve-slaapapneu-proof-o/","title":"Renale denervatie bij resistente hypertensie met obstructieve slaapapneu: proof-of-concept trial","title_en":"Renal Denervation in Resistant Hypertension and Obstructive Sleep Apnea: Randomized Proof-of-Concept Phase II Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["aprocitentan","precision-trial","radiance-htn","renale-denervatie","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11180","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11180","authors":["Ewa Warchol-Celinska","Aleksander Prejbisz","Jacek Kadziela","Elzbieta Florczak","Magdalena Januszewicz","Ilona Michalowska","Piotr Dobrowolski","Marek Kabat","Pawel Sliwinski","Anna Klisiewicz","Roman Topor-Madry","Krzysztof Narkiewicz","Virend K Somers","Paul A Sobotka","Adam Witkowski","Andrzej Januszewicz"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/arb-hypertensie/"],"congress":"","summary_en":"This randomized proof-of-concept trial tested renal denervation in patients with resistant hypertension and comorbid obstructive sleep apnea, exploring whether sympathetic modulation improves both blood pressure and sleep-disordered breathing.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 proof-of-concept trial van renale denervatie bij resistente hypertensie met comorbide obstructieve slaapapneu. Onderzoekt het dubbele therapeutische potentieel.","abstract_original":"UNLABELLED: It has been postulated that catheter-based renal denervation (RDN) may lower blood pressure (BP) and improve severity of obstructive sleep apnea (OSA) in resistant hypertensive patients. The aim of our study (NCT01366625) was to investigate in a prospective randomized trial the effect of RDN on BP and clinical course of OSA. Sixty patients with true resistant hypertension coexisting with moderate-to-severe OSA (apnea/hypopnea index, ≥15) were randomly allocated to RDN group (30 patients) and to control group (30 patients). The primary end point was reduction in office systolic BP at 3 months. Secondary end points included reduction in diastolic office and ambulatory BP, change in apnea/hypopnea index and biochemical measurements at 3 months, and change in echocardiographic measurements at 6 months. There were no differences in clinical characteristics between the groups. At 3 months in the RDN group, both office and ambulatory BP were significantly reduced, and a significant decrease in OSA severity (apnea/hypopnea index, 39.4 versus 31.2 events per hour; P=0.015) was observed. Between-group difference in apnea/hypopnea index change was significant at 0.05. At 6 months in the RDN group, reductions in office and ambulatory BP were sustained and were accompanied by significant improvement in echocardiographic measures of global longitudinal strain. There were no differences in metabolic variables in follow-up in both groups. In a randomized controlled trial, RDN lowered both office and ambulatory BP in patients with resistant hypertension and OSA. This was accompanied by improvement of the clinical severity of OSA. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01366625."},{"id":"169a9facf5f3","type":"article","url":"https://hartvaat.nl/2018/08/01/sympathische-zenuwactivatie-bij-essentiele-hypertensie-meta-analyse/","title":"Sympathische zenuwactivatie bij essentiële hypertensie: meta-analyse","title_en":"Sympathetic Nerve Traffic Activation in Essential Hypertension and Its Correlates: Systematic Reviews and Meta-Analyses.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","renale-denervatie","stress-psychosociaal","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.11038","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.11038","authors":["Guido Grassi","Anna Pisano","Davide Bolignano","Gino Seravalle","Graziella D'Arrigo","Fosca Quarti-Trevano","Francesca Mallamaci","Carmine Zoccali","Giuseppe Mancia"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/pathofysiologie-hypertensie/"],"congress":"","summary_en":"This systematic review and meta-analysis confirmed that sympathetic nerve activation is present in essential hypertension, providing pathophysiological support for sympatholytic therapies and renal denervation in hypertension management.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T18:38:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 sympathische zenuwactivatie bij essentiële hypertensie en de correlaten. Kwantificeert de rol van het sympathisch zenuwstelsel.","abstract_original":"Muscle sympathetic nerve activity (MSNA) has shown that sympathetic activation may occur in essential hypertension (EHT). However, the small sample size of the studies, the heterogeneity of the patients examined, and the presence of confounders represented major weaknesses not allowing to draw definite conclusions. Among the 432 studies identified providing information in EHT on MSNA, 63 were eligible (1216 patients) and meta-analyzed grouping them on the basis of clinically relevant questions: (1) Is MSNA increased in hypertension of mild/moderate-to-severe degree? (2) Does sympathetic activation occur in borderline, white-coat, and masked EHT? (3) Is MSNA related to clinic and ambulatory blood pressure and target organ damage? (4) Are heart rate and venous plasma norepinephrine valuable surrogate markers of MSNA in clinical practice? The results show that MSNA was significantly greater (1.5×; P<0.001) in mild-to-moderate and severe EHT as compared with normotensive controls and that this was the case also in borderline, white-coat, and masked hypertension as well. Interestingly, MSNA was significantly greater in both untreated and treated hypertension (P<0.001 for both), related to clinic and ambulatory blood pressure (r=0.67 and r=0.83; P<0.001 for both), inversely related to heart rate (r=-0.38; P<0.001) and directly to venous plasma norepinephrine (r=0.28; P<0.001) and left ventricular mass index (r=0.27; P<0.001). Thus, EHT is a condition characterized by a sustained sympathetic overdrive, whose magnitude is proportional to its clinical severity. This is more clearly manifest when MSNA rather than indirect markers of adrenergic drive, such as heart rate and plasma norepinephrine, are used."},{"id":"72f267b9d51d","type":"article","url":"https://hartvaat.nl/2018/08/01/langetermijn-patiromer-bij-hyperkaliemie-met-mild-hf-en-diabetische-nefropathie/","title":"Langetermijn patiromer bij hyperkaliëmie met mild HF en diabetische nefropathie","title_en":"Long-term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin-converting enzymes/angiotensin receptor blockers: results from AMETHYST-DN.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","diabetische-nefropathie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12292","source_url":"https://doi.org/10.1002/ehf2.12292","authors":["Bertram Pitt","George L Bakris","Matthew R Weir","Mason W Freeman","Mitja Lainscak","Martha R Mayo","Dahlia Garza","Rezi Zawadzki","Lance Berman","David A Bushinsky"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This study evaluated long-term patiromer effects on potassium levels and RAAS inhibitor use in patients with mild heart failure and diabetic nephropathy, demonstrating sustained potassium management that enables optimal neurohormonal blockade.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T13:26:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 langetermijneffecten van patiromer op kaliumniveaus en RAAS-remmergebruik bij patiënten met mild hartfalen en diabetische nefropathie.","abstract_original":"AIMS: Chronic kidney disease (CKD) in heart failure (HF) increases the risk of hyperkalaemia (HK), limiting angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) use. Patiromer is a sodium-free, non-absorbed potassium binder approved for HK treatment. We retrospectively evaluated patiromer's long-term safety and efficacy in HF patients from AMETHYST-DN. METHODS AND RESULTS: Patients with Type 2 diabetes, CKD, and HK [baseline serum potassium >5.0-5.5 mmol/L (mild) or >5.5-<6.0 mmol/L (moderate)], with or without HF (New York Heart Association Class I and II, by investigator judgement), on ACE-I/ARB, were randomized to patiromer 8.4-33.6 g to start, divided twice daily. Overall, 105/304 (35%) patients had HF (75%, Class II). Mean (standard deviation) ejection fraction (EF) was 44.9% (8.2) (n = 81) in patients with HF; 26 had EF ≤40%. In HF patients, mean serum potassium decreased by Day 3 through Week 52. At Week 4, estimated mean (95% confidence interval) change in serum potassium was -0.64 mmol/L (-0.72, -0.55) in mild and -0.97 mmol/L (-1.14, -0.80) in moderate HK (both P < 0.0001). Most HF patients with mild (>88%) and moderate (≥73%) HK had normokalaemia at each visit from Weeks 12 to 52. Three HF patients were withdrawn because of high (n = 1) or low (n = 2) serum potassium. The most common patiromer-related adverse event was hypomagnesaemia (8.6%). CONCLUSIONS: In patients with a clinical diagnosis of HF, diabetes, CKD, and HK on ACE-I/ARB, patiromer was well tolerated and effective for HK treatment over 52 weeks."},{"id":"80f588ba782d","type":"article","url":"https://hartvaat.nl/2018/08/01/kenmerken-en-prognose-van-hfmref-versus-hfref-en-hfpef-langetermijn/","title":"Kenmerken en prognose van HFmrEF versus HFrEF en HFpEF: langetermijn","title_en":"Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12283","source_url":"https://doi.org/10.1002/ehf2.12283","authors":["Josephine Lauritsen","Finn Gustafsson","Jawdat Abdulla"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This meta-analysis compared the clinical characteristics and long-term prognosis of HFmrEF with HFrEF and HFpEF, positioning the intermediate ejection fraction category and its distinct prognostic profile.","created":"2026-07-03T10:27:24Z","updated":"2026-07-03T13:26:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 langetermijnkenmerken en prognose van patiënten met HFmrEF versus HFrEF en HFpEF. Positioneert de intermediaire categorie.","abstract_original":"AIMS: This study aimed to assess by a meta-analysis the clinical characteristics, all-cause and cardiovascular mortality, and hospitalization of patients with heart failure (HF) with mid-range ejection fraction (HFmrEF) compared with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). METHODS AND RESULTS: Data from 12 eligible observational studies including 109 257 patients were pooled. HFmrEF patients were significantly different and occupied a mid-position between HFrEF and HFpEF: mean age 73.6 ± 9.8 vs. 72.6 ± 9.8 and 77.6 ± 7.2 years, male gender 59% vs. 68.5% and 40%, ischaemic heart disease 49% vs. 52.6% and 39.4%, hypertension 67.3% vs. 61.5% and 76.5%, atrial fibrillation 45.2% vs. 39.6% and 46%, chronic obstructive pulmonary disease 26.4% vs. 24.9% and 30.5%, estimated glomerular filtration rate 62 ± 30 vs. 63.3 ± 23 and 59 ± 22.5, use of renin-angiotensin system inhibitors 79.6% vs. 90.1% and 68.7%, beta-blockers 82% vs. 89% and 73.5%, and aldosterone antagonists 20.3 vs. 31.5% and 26%, P-values < 0.05. After a mean follow-up of 31 ± 5 months, all-cause mortality was significantly lower in HFmrEF than in HFrEF and HFpEF (26.8% vs. 29.5% and 31%): risk ratio (RR) 0.95 [0.93-0.98; 95% confidence interval (CI)], P < 0.001, and 0.97 (0.94-0.99; 95% CI), P = 0.014, respectively. Cardiovascular mortality was lowest in HFmrEF (9.7% vs. 13% and 12.8%): RR = 0.81 (0.73-0.91), P < 0.001, and 1.10 (0.97-1.24; 95% CI), P = 0.13, respectively. HF hospitalization in HFmrEF compared to that in HFrEF and HFpEF was 23.9% vs. 27.6% and 23.3% with RR = 0.89 (0.85-0.93), P < 0.001, and RR = 1.12 (1.07-1.17), P < 0.001, respectively. CONCLUSIONS: The results of this study support that HFmrEF is a distinct category characterized by a mid-position between HFrEF and HFpEF and with the lowest all-cause and cardiovascular mortality."},{"id":"cbdddd9d3414","type":"article","url":"https://hartvaat.nl/2018/08/01/inspanningstraining-met-vasculaire-occlusie-bij-chronisch-hartfalen/","title":"Inspanningstraining met vasculaire occlusie bij chronisch hartfalen","title_en":"The impact of aerobic exercise training with vascular occlusion in patients with chronic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12285","source_url":"https://doi.org/10.1002/ehf2.12285","authors":["Yasushi Tanaka","Yudai Takarada"],"significance":5,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated aerobic exercise training with blood flow restriction (vascular occlusion) in chronic heart failure, testing whether low-load training with restricted blood flow achieves comparable benefits to conventional exercise.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 aerobe inspanningstraining met vasculaire occlusie (blood flow restriction) bij chronisch hartfalen.","abstract_original":"AIMS: This study aimed to evaluate the impact of aerobic exercise training with vascular occlusion in patients with chronic heart failure. METHODS AND RESULTS: Thirty patients with post-infarction heart failure were randomized to an interventional exercise group (IG; n = 15) or a control exercise group (CG; n = 15). Exercise was performed at an intensity of 40-70% of the peak VO2 /W for 6 months. Patients in the IG remained seated on the saddle of the cycle ergometer with their feet on the pedals. Pneumatic tourniquets were applied to the proximal ends of their thighs with appropriate pressure resulting in a 40-80 mmHg increase in the systolic blood pressure that is required for vascular occlusion (208.7 ± 7.4 mmHg). We evaluated the safety and efficacy of the intervention and its effect on exercise capacity and serum BNP levels. There were no significant differences between the IG and CG in patient characteristics at study entry. Peak VO2 /W in the IG significantly increased compared with that in the CG; the change in the serum BNP levels was significantly larger in the IG than in the CG. CONCLUSIONS: These results suggest that aerobic exercise training with vascular occlusion can improve exercise capacity and serum BNP levels in patients with chronic heart failure."},{"id":"3b098321f0f1","type":"article","url":"https://hartvaat.nl/2018/08/01/opportunistische-hf-screening-met-natriuretische-peptiden-bij-af-ipd-meta-analys/","title":"Opportunistische HF-screening met natriuretische peptiden bij AF: IPD meta-analyse","title_en":"Opportunistic screening for heart failure with natriuretic peptides in patients with atrial fibrillation: a meta-analysis of individual participant data of four screening studies.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","iaso-dcm","nt-probnp"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312781","source_url":"https://doi.org/10.1136/heartjnl-2017-312781","authors":["Sander van Doorn","Geert-Jan Geersing","Rogier F Kievit","Yvonne van Mourik","Loes C Bertens","Evelien E S van Riet","Leandra J Boonman-de Winter","Karel G M Moons","Arno W Hoes","Frans H Rutten"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis evaluated opportunistic heart failure screening with natriuretic peptides in AF patients, showing that NT-proBNP can identify unrecognized HF in the AF population where symptoms overlap.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar opportunistische hartfalenscreening met natriuretische peptiden bij AF-patiënten.","abstract_original":"OBJECTIVE: Heart failure (HF) often coexists in atrial fibrillation (AF) but is frequently unrecognised due to overlapping symptomatology. Furthermore, AF can cause elevated natriuretic peptide levels, impairing its diagnostic value for HF detection. We aimed to assess the prevalence of previously unknown HF in community-dwelling patients with AF, and to determine the diagnostic value of the amino-terminal pro B-type natriuretic peptide (NTproBNP) for HF screening in patients with AF. METHODS: Individual participant data from four HF-screening studies in older community-dwelling persons were combined. Presence or absence of HF was in each study established by an expert panel following the criteria of the European Society of Cardiology. We performed a two-stage patient-level meta-analysis to calculate traditional diagnostic indices. RESULTS: Of the 1941 individuals included in the four studies, 196 (10.1%) had AF at baseline. HF was uncovered in 83 (43%) of these 196 patients with AF, versus 381 (19.7%) in those without AF at baseline. Median NTproBNP levels of patients with AF with and without HF were 744 pg/mL and 211 pg/mL, respectively. At the cut-point of 125 pg/mL, sensitivity was 93%, specificity 35%, and positive and negative predictive values 51% and 86%, respectively. Only 23% of all patients with AF had an NTproBNP level below the 125 pg/mL cut-point, with still a 13% prevalence of HF in this group. CONCLUSIONS: With a prevalence of nearly 50%, unrecognised HF is common among community-dwelling patients with AF. Given the high prior change, natriuretic peptides are diagnostically not helpful, and straightforward echocardiography seems to be the preferred strategy for HF screening in patients with AF."},{"id":"0a42f1faa0b9","type":"article","url":"https://hartvaat.nl/2018/08/01/door-to-balloon-tijd-en-uitkomsten-bij-stemi-meta-analyse/","title":"Door-to-balloon tijd en uitkomsten bij STEMI: meta-analyse","title_en":"Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312517","source_url":"https://doi.org/10.1136/heartjnl-2017-312517","authors":["Chee Yoong Foo","Kwadwo Osei Bonsu","Brahmajee K Nallamothu","Christopher M Reid","Teerapon Dhippayom","Daniel D Reidpath","Nathorn Chaiyakunapruk"],"significance":7,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This meta-analysis quantified the relationship between door-to-balloon time and outcomes in STEMI, confirming that shorter reperfusion times are associated with better survival and reinforcing the importance of rapid primary PCI systems.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T13:26:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het verband tussen door-to-balloon tijd en uitkomsten bij STEMI. Onderbouwt het belang van snelle reperfusie.","abstract_original":"OBJECTIVE: This study aims to determine the relationship between door-to-balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes and examine for potential effect modifiers. METHODS: We conducted a systematic review and meta-analysis of prospective observational studies that have investigated the relationship of door-to-balloon delay and clinical outcomes. The main outcomes include mortality and heart failure. RESULTS: 32 studies involving 299 320 patients contained adequate data for quantitative reporting. Patients with ST-elevation MI who experienced longer (>90 min) door-to-balloon delay had a higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06). A non-linear time-risk relation was observed (P=0.004 for non-linearity). The association between longer door-to-balloon delay and short-term mortality differed between those presented early and late after symptom onset (Cochran's Q 3.88, P value 0.049) with a stronger relationship among those with shorter prehospital delays. CONCLUSION: Longer door-to-balloon delay in primary percutaneous coronary intervention for ST-elevation MI is related to higher risk of adverse outcomes. Prehospital delays modified this effect. The non-linearity of the time-risk relation might explain the lack of population effect despite an improved door-to-balloon time in the USA. CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42015026069)."},{"id":"7ad8d5816dd9","type":"article","url":"https://hartvaat.nl/2018/08/01/uitkomsten-bij-af-met-oac-bij-mitralis-of-aortakleplijden/","title":"Uitkomsten bij AF met OAC bij mitralis- of aortakleplijden","title_en":"Outcomes in anticoagulated patients with atrial fibrillation and with mitral or aortic valve disease.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312272","source_url":"https://doi.org/10.1136/heartjnl-2017-312272","authors":["Dragos Vinereanu","Alice Wang","Hillary Mulder","Renato D Lopes","Petr Jansky","Basil S Lewis","Bernard J Gersh","Alvaro Avezum","Michael Hanna","Claes Held","Lars Wallentin","Christopher B Granger","John H Alexander"],"significance":6,"published":"2018-08-01","source_date":"2018-08-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This ARISTOTLE subanalysis assessed the outcomes and treatment effect of apixaban versus warfarin in AF patients with concomitant mitral or aortic valve disease, supporting DOAC use in the valvular AF setting.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T13:26:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 uitkomsten van anticoagulatietherapie bij AF-patiënten met begeleidend mitralis- of aortakleplijden.","abstract_original":"OBJECTIVE: To assess stroke/systemic embolism, major bleeding and other outcomes, and treatment effect of apixaban versus warfarin, in patients with atrial fibrillation (AF) and different types of valvular heart disease (VHD), using data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial. METHODS: There were 14 793 patients with known VHD status, categorised as having moderate or severe mitral regurgitation (MR) (n=3382), aortic regurgitation (AR) (n=842) or aortic stenosis (AS) (n=324); patients with moderate or severe mitral stenosis were excluded from the trial. Baseline characteristics, efficacy and safety outcomes were compared between each type and no significant VHD. Treatment effect was assessed using an adjusted model. RESULTS: Patients with MR or AR had similar rates of stroke/systemic embolism and bleeding compared with patients without MR or AR, respectively. Patients with AS had significantly higher event rates (presented as rate per 100 patient-years of follow-up) of stroke/systemic embolism (3.47 vs 1.36; adjusted HR (adjHR) 2.21, 95% CI 1.35 to 3.63), death (8.30 vs 3.53; adjHR 1.92, 95% CI 1.41 to 2.61), major bleeding (5.31 vs 2.53; adjHR 1.80, 95% CI 1.19 to 2.75) and intracranial bleeding (1.29 vs 0.51; adjHR 2.54, 95% CI 1.08 to 5.96) than patients without AS. The superiority of apixaban over warfarin on stroke/systemic embolism was similar in patients with versus without MR (HR 0.69, 95% CI 0.46 to 1.04 vs HR 0.79, 95% CI 0.63 to 1.00; interaction P value 0.52), with versus without AR (HR 0.57, 95% CI 0.27 to 1.20 vs HR 0.78, 95% CI 0.63 to 0.96; interaction P value 0.52), and with versus without AS (HR 0.44, 95% CI 0.17 to 1.13 vs HR 0.79, 95% CI 0.64 to 0.97; interaction P value 0.19). For each of the primary and secondary efficacy and safety outcomes, there was no evidence of a different effect of apixaban over warfarin in patients with any VHD subcategory. CONCLUSIONS: In anticoagulated patients with AF, AS is associated with a higher risk of stroke/systemic embolism, bleeding and death. The efficacy and safety benefits of apixaban compared with warfarin were consistent, regardless of presence of MR, AR or AS. CLINICAL TRIAL REGISTRATION: ARISTOTLE clinical trial number NCT00412984."},{"id":"c18231f6334a","type":"article","url":"https://hartvaat.nl/2018/07/31/antitrombotische-therapie-bij-af-met-oac-na-pci-aha-scientific-statement/","title":"Antitrombotische therapie bij AF met OAC na PCI: AHA scientific statement","title_en":"Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention: A North American Perspective-2018 Update.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034722","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034722","authors":["Dominick J Angiolillo","Shaun G Goodman","Deepak L Bhatt","John W Eikelboom","Matthew J Price","David J Moliterno","Christopher P Cannon","Jean-Francois Tanguay","Christopher B Granger","Laura Mauri","David R Holmes","C Michael Gibson","David P Faxon"],"significance":8,"published":"2018-07-31","source_date":"2018-07-31","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This AHA scientific statement on antithrombotic therapy in AF patients on anticoagulation undergoing PCI integrated evidence from PIONEER AF-PCI, RE-DUAL PCI, and AUGUSTUS to provide practical guidance on dual versus triple antithrombotic strategies in this challenging clinical scenario.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T13:26:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AHA scientific statement over antitrombotische therapie bij AF-patiënten op OAC die PCI ondergaan. Integreert PIONEER, RE-DUAL en AUGUSTUS in een praktijkkader.","abstract_original":"The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non-vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y12 inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus-derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention."},{"id":"477a40fab8be","type":"article","url":"https://hartvaat.nl/2018/07/31/bnp-bij-linker-hoofdstamrevascularisatie-excel-analyse/","title":"BNP bij linker-hoofdstamrevascularisatie: EXCEL-analyse","title_en":"B-Type Natriuretic Peptide Assessment in Patients Undergoing Revascularization for Left Main Coronary Artery Disease: Analysis From the EXCEL Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.033631","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.033631","authors":["Björn Redfors","Shmuel Chen","Aaron Crowley","Ori Ben-Yehuda","Bernard J Gersh","Nicholas J Lembo","W Morris Brown","Adrian P Banning","David P Taggart","Patrick W Serruys","Arie Pieter Kappetein","Joseph F Sabik","Gregg W Stone"],"significance":5,"published":"2018-07-31","source_date":"2018-07-31","image":"","kennis":[],"congress":"","summary_en":"This EXCEL analysis evaluated BNP assessment in patients undergoing left main revascularization, showing that baseline natriuretic peptide levels predict outcomes and may inform the PCI-versus-CABG decision.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T13:26:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 analyse naar de rol van BNP-beoordeling bij patiënten die revascularisatie ondergaan voor linker-hoofdstamcoronairlijden.","abstract_original":"BACKGROUND: Elevated B-type natriuretic peptide (BNP) is reflective of impaired cardiac function and is associated with worse prognosis among patients with coronary artery disease (CAD). We sought to assess the association between baseline BNP, adverse outcomes, and the relative efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with left main CAD. METHODS: The EXCEL trial (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) randomized patients with left main CAD and low or intermediate SYNTAX scores (Synergy Between PCI With TAXUS and Cardiac Surgery) to PCI with everolimus-eluting stents versus CABG. The primary end point was the composite of all-cause death, myocardial infarction, or stroke. We used multivariable Cox proportional hazards regression to assess the associations between normal versus elevated BNP (≥100 pg/mL), randomized treatment, and the 3-year risk of adverse events. RESULTS: BNP at baseline was elevated in 410 of 1037 (39.5%) patients enrolled in EXCEL. Patients with elevated BNP levels were older and more frequently had additional cardiovascular risk factors and lower left ventricular ejection fraction than those with normal BNP, but had similar SYNTAX scores. Patients with elevated BNP had significantly higher 3-year rates of the primary end point (18.6% versus 11.7%; adjusted hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.16-2.28; P=0.005) and higher mortality (11.5% versus 3.9%; adjusted HR, 2.49; 95% CI, 1.48-4.19; P=0.0006), both from cardiovascular and noncardiovascular causes. In contrast, there were no significant differences in the risks of myocardial infarction, stroke, ischemia-driven revascularization, stent thrombosis, graft occlusion, or major bleeding. A significant interaction ( Pinteraction=0.03) was present between elevated versus normal BNP and treatment with PCI versus CABG for the adjusted risk of the primary composite end point at 3 years among patients with elevated BNP (adjusted HR for PCI versus CABG, 1.54; 95% CI, 0.96-2.47) versus normal BNP (adjusted HR, 0.74; 95% CI, 0.46-1.20). This interaction was stronger when log(BNP) was modeled as a continuous variable ( Pinteraction=0.002). CONCLUSIONS: In the EXCEL trial, elevated baseline BNP levels in patients with left main CAD undergoing revascularization were independently associated with long-term mortality but not nonfatal adverse ischemic or bleeding events. The relative long-term outcomes after PCI versus CABG for revascularization of left main CAD may be conditioned by the baseline BNP level. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01205776."},{"id":"5aa8653d040e","type":"article","url":"https://hartvaat.nl/2018/07/31/canagliflozine-en-hartfalen-bij-diabetes-type-2-canvas-programma/","title":"Canagliflozine en hartfalen bij diabetes type 2: CANVAS programma","title_en":"Canagliflozin and Heart Failure in Type 2 Diabetes Mellitus: Results From the CANVAS Program.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["canagliflozine","empagliflozine","sglt2-remmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034222","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034222","authors":["Karin Rådholm","Gemma Figtree","Vlado Perkovic","Scott D Solomon","Kenneth W Mahaffey","Dick de Zeeuw","Greg Fulcher","Terrance D Barrett","Wayne Shaw","Mehul Desai","David R Matthews","Bruce Neal"],"significance":8,"published":"2018-07-31","source_date":"2018-07-31","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This CANVAS heart failure analysis confirmed that canagliflozin reduces heart failure hospitalization and cardiovascular death in patients with type 2 diabetes, with consistent benefit regardless of baseline heart failure history. The data added to the growing evidence for SGLT2 inhibitors as heart failure preventive therapy.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T13:26:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CANVAS-analyse specifiek gericht op hartfalenuitkomsten met canagliflozine bij diabetes type 2. Bevestigt het HF-preventieve effect van SGLT2-remming.","abstract_original":"BACKGROUND: Canagliflozin is a sodium glucose cotransporter 2 inhibitor that reduces the risk of cardiovascular events. We report the effects on heart failure (HF) and cardiovascular death overall, in those with and without a baseline history of HF, and in other participant subgroups. METHODS: The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) enrolled 10 142 participants with type 2 diabetes mellitus and high cardiovascular risk. Participants were randomly assigned to canagliflozin or placebo and followed for a mean of 188 weeks. The primary end point for these analyses was adjudicated cardiovascular death or hospitalized HF. RESULTS: Participants with a history of HF at baseline (14.4%) were more frequently women, white, and hypertensive and had a history of prior cardiovascular disease (all P<0.001). Greater proportions of these patients were using therapies such as blockers of the renin angiotensin aldosterone system, diuretics, and β-blockers at baseline (all P<0.001). Overall, cardiovascular death or hospitalized HF was reduced in those treated with canagliflozin compared with placebo (16.3 versus 20.8 per 1000 patient-years; hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.67-0.91), as was fatal or hospitalized HF (HR, 0.70; 95% CI, 0.55-0.89) and hospitalized HF alone (HR, 0.67; 95% CI, 0.52-0.87). The benefit on cardiovascular death or hospitalized HF may be greater in patients with a prior history of HF (HR, 0.61; 95% CI, 0.46-0.80) compared with those without HF at baseline (HR, 0.87; 95% CI, 0.72-1.06; P interaction =0.021). The effects of canagliflozin compared with placebo on other cardiovascular outcomes and key safety outcomes were similar in participants with and without HF at baseline (all interaction P values >0.130), except for a possibly reduced absolute rate of events attributable to osmotic diuresis among those with a prior history of HF ( P=0.03). CONCLUSIONS: In patients with type 2 diabetes mellitus and an elevated risk of cardiovascular disease, canagliflozin reduced the risk of cardiovascular death or hospitalized HF across a broad range of different patient subgroups. Benefits may be greater in those with a history of HF at baseline. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01032629 and NCT01989754."},{"id":"142a334c1536","type":"article","url":"https://hartvaat.nl/2018/07/24/escitalopram-versus-placebo-bij-depressie-na-acs-en-langetermijn-cardiale-uitkom/","title":"Escitalopram versus placebo bij depressie na ACS en langetermijn cardiale uitkomsten: JAMA","title_en":"Effect of Escitalopram vs Placebo Treatment for Depression on Long-term Cardiac Outcomes in Patients With Acute Coronary Syndrome: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.9422","source_url":"https://doi.org/10.1001/jama.2018.9422","authors":["Jae-Min Kim","Robert Stewart","Yong-Seong Lee","Hee-Joon Lee","Min Chul Kim","Ju-Wan Kim","Hee-Ju Kang","Kyung-Yeol Bae","Sung-Wan Kim","Il-Seon Shin","Young Joon Hong","Ju Han Kim","Youngkeun Ahn","Myung Ho Jeong","Jin-Sang Yoon"],"significance":7,"published":"2018-07-24","source_date":"2018-07-24","image":"","kennis":[],"congress":"","summary_en":"This JAMA follow-up of escitalopram treatment for depression after ACS examined whether antidepressant therapy improves long-term cardiac outcomes, addressing the cardiovascular implications of treating comorbid depression in coronary patients.","created":"2026-07-03T10:27:23Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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-trial naar het langetermijneffect van escitaloprambehandeling voor depressie na ACS op cardiale uitkomsten. Onderzoekt de psychocardiale interactie.","abstract_original":"IMPORTANCE: Depression has been associated with poorer medical outcomes in acute coronary syndrome (ACS), but there are few data on the effects of antidepressant treatment on long-term prognosis. OBJECTIVE: To investigate the effect on long-term major adverse cardiac events (MACE) of escitalopram treatment of depression in patients with recent ACS. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial conducted among 300 patients with recent ACS and depression enrolled from May 2007 to March 2013, with follow-up completed in June 2017, at Chonnam National University Hospital, Gwangju, South Korea. INTERVENTIONS: Patients were randomly assigned to receive either escitalopram in flexible dosages of 5, 10, 15, or 20 mg/d (n = 149) or matched placebo (n = 151) for 24 weeks. MAIN OUTCOMES AND MEASURES: The primary outcome was MACE, a composite of all-cause mortality, myocardial infarction (MI), and percutaneous coronary intervention (PCI). Four secondary outcomes were the individual MACE components of all-cause mortality, cardiac death, MI, and PCI. Cox proportional hazards models were used to compare the escitalopram and placebo groups by time to first MACE. RESULTS: Among 300 randomized patients (mean age, 60 years; 119 women [39.3%]), 100% completed a median of 8.1 (interquartile range, 7.5-9.0) years of follow-up. MACE occurred in 61 patients (40.9%) receiving escitalopram and in 81 (53.6%) receiving placebo (hazard ratio [HR], 0.69; 95% CI, 0.49-0.96; P = .03). Comparing individual MACE outcomes between the escitalopram and placebo groups, respectively, incidences for all-cause mortality were 20.8% vs 24.5% (HR, 0.82; 95% CI, 0.51-1.33; P = .43), for cardiac death, 10.7% vs 13.2% (HR, 0.79; 95% CI, 0.41-1.52; P = .48); for MI, 8.7% vs 15.2% (HR, 0.54; 95% CI, 0.27-0.96; P = .04), and for PCI, 12.8% vs 19.9% (HR, 0.58; 95% CI, 0.33-1.04; P = .07). CONCLUSIONS AND RELEVANCE: Among patients with depression following recent acute coronary syndrome, 24-week treatment with escitalopram compared with placebo resulted in a lower risk of major adverse cardiac events after a median of 8.1 years. Further research is needed to assess the generalizability of these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00419471."},{"id":"d820c571e0b5","type":"article","url":"https://hartvaat.nl/2018/07/24/cva-incidentie-na-cabg-versus-pci/","title":"CVA-incidentie na CABG versus PCI","title_en":"Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.04.071","source_url":"https://doi.org/10.1016/j.jacc.2018.04.071","authors":["Stuart J Head","Milan Milojevic","Joost Daemen","Jung-Min Ahn","Eric Boersma","Evald H Christiansen","Michael J Domanski","Michael E Farkouh","Marcus Flather","Valentin Fuster","Mark A Hlatky","Niels R Holm","Whady A Hueb","Masoor Kamalesh","Young-Hak Kim","Timo Mäkikallio","Friedrich W Mohr","Grigorios Papageorgiou","Seung-Jung Park","Alfredo E Rodriguez","Joseph F Sabik","Rodney H Stables","Gregg W Stone","Patrick W Serruys","A Pieter Kappetein"],"significance":6,"published":"2018-07-24","source_date":"2018-07-24","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"This comparison of stroke rates after surgical versus percutaneous coronary revascularization showed higher perioperative stroke with CABG but lower long-term ischemic stroke, relevant to the choice between revascularization strategies.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 CVA-incidentie na chirurgische versus percutane coronaire revascularisatie. CVA als differentiator in de revascularisatiekeuze.","abstract_original":"BACKGROUND: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are used for coronary revascularization in patients with multivessel and left main coronary artery disease. Stroke is among the most feared complications of revascularization. Due to its infrequency, studies with large numbers of patients are required to detect differences in stroke rates between CABG and PCI. OBJECTIVES: This study sought to compare rates of stroke after CABG and PCI and the impact of procedural stroke on long-term mortality. METHODS: We performed a collaborative individual patient-data pooled analysis of 11 randomized clinical trials comparing CABG with PCI using stents; ERACI II (Argentine Randomized Study: Coronary Angioplasty With Stenting Versus Coronary Bypass Surgery in Patients With Multiple Vessel Disease) (n = 450), ARTS (Arterial Revascularization Therapy Study) (n = 1,205), MASS II (Medicine, Angioplasty, or Surgery Study) (n = 408), SoS (Stent or Surgery) trial (n = 988), SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial (n = 1,800), PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) trial (n = 600), FREEDOM (Comparison of Two Treatments for Multivessel Coronary Artery Disease in Individuals With Diabetes) trial (n = 1,900), VA CARDS (Coronary Artery Revascularization in Diabetes) (n = 198), BEST (Bypass Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel Coronary Artery Disease) (n = 880), NOBLE (Percutaneous Coronary Angioplasty Versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trial (n = 1,184), and EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial (n = 1,905). The 30-day and 5-year stroke rates were compared between CABG and PCI using a random effects Cox proportional hazards model, stratified by trial. The impact of stroke on 5-year mortality was explored. RESULTS: The analysis included 11,518 patients randomly assigned to PCI (n = 5,753) or CABG (n = 5,765) with a mean follow-up of 3.8 ± 1.4 years during which a total of 293 strokes occurred. At 30 days, the rate of stroke was 0.4% after PCI and 1.1% after CABG (hazard ratio [HR]: 0.33; 95% confidence interval [CI]: 0.20 to 0.53; p < 0.001). At 5-year follow-up, stroke remained significantly lower after PCI than after CABG (2.6% vs. 3.2%; HR: 0.77; 95% CI: 0.61 to 0.97; p = 0.027). Rates of stroke between 31 days and 5 years were comparable: 2.2% after PCI versus 2.1% after CABG (HR: 1.05; 95% CI: 0.80 to 1.38; p = 0.72). No significant interactions between treatment and baseline clinical or angiographic variables for the 5-year rate of stroke were present, except for diabetic patients (PCI: 2.6% vs. CABG: 4.9%) and nondiabetic patients (PCI: 2.6% vs. CABG: 2.4%) (p for interaction = 0.004). Patients who experienced a stroke within 30 days of the procedure had significantly higher 5-year mortality versus those without a stroke, both after PCI (45.7% vs. 11.1%, p < 0.001) and CABG (41.5% vs. 8.9%, p < 0.001). CONCLUSIONS: This individual patient-data pooled analysis demonstrates that 5-year stroke rates are significantly lower after PCI compared with CABG, driven by a reduced risk of stroke in the 30-day post-procedural period but a similar risk of stroke between 31 days and 5 years. The greater risk of stroke after CABG compared with PCI was confined to patients with multivessel disease and diabetes. Five-year mortality was markedly higher for patients experiencing a stroke within 30 days after revascularization."},{"id":"58c2acd34634","type":"article","url":"https://hartvaat.nl/2018/07/21/baricitinib-bij-sle-lancet-fase-2-dubbelblinde-trial/","title":"Baricitinib bij SLE: Lancet fase-2 dubbelblinde trial","title_en":"Baricitinib for systemic lupus erythematosus: a double-blind, randomised, placebo-controlled, phase 2 trial.","category":"cholesterol","category_label":"Cholesterol","professions":["internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31363-1","source_url":"https://doi.org/10.1016/S0140-6736(18)31363-1","authors":["Daniel J Wallace","Richard A Furie","Yoshiya Tanaka","Kenneth C Kalunian","Marta Mosca","Michelle A Petri","Thomas Dörner","Mario H Cardiel","Ian N Bruce","Elisa Gomez","Tara Carmack","Amy M DeLozier","Jonathan M Janes","Matthew D Linnik","Stephanie de Bono","Maria E Silk","Robert W Hoffman"],"significance":5,"published":"2018-07-21","source_date":"2018-07-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This Lancet phase 2 trial of baricitinib (JAK1/JAK2 inhibitor) in systemic lupus erythematosus is relevant to cardio-immunology given the elevated cardiovascular risk in SLE and the cardiovascular monitoring needs during JAK inhibition.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 fase-2 trial van baricitinib bij systemische lupus erythematosus. Cardio-immunologisch relevant gezien het verhoogde CV-risico bij SLE.","abstract_original":"BACKGROUND: Patients with systemic lupus erythematosus have substantial unmet medical need. Baricitinib is an oral selective Janus kinase (JAK)1 and JAK2 inhibitor that we hypothesised might have therapeutic benefit in patients with systemic lupus erythematosus. METHODS: In this double-blind, multicentre, randomised, placebo-controlled, 24-week phase 2 study, patients were recruited from 78 centres in 11 countries. Eligible patients were aged 18 years or older, had a diagnosis of systemic lupus erythematosus, and had active disease involving skin or joints. We randomly assigned patients (1:1:1) to receive once-daily baricitinib 2 mg, baricitinib 4 mg, or placebo for 24 weeks. The primary endpoint was the proportion of patients achieving resolution of arthritis or rash at week 24, as defined by Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K). Efficacy and safety analyses included all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT02708095. FINDINGS: Between March 24, 2016, and April 27, 2017, 314 patients were randomly assigned to receive placebo (n=105), baricitinib 2 mg (n=105), or baricitinib 4 mg (n=104). At week 24, resolution of SLEDAI-2K arthritis or rash was achieved by 70 (67%) of 104 patients receiving baricitinib 4 mg (odds ratio [OR] vs placebo 1·8, 95% CI 1·0-3·3; p=0·0414) and 61 (58%) of 105 patients receiving baricitinib 2 mg (OR 1·3, 0·7-2·3; p=0·39). Adverse events were reported in 68 (65%) patients in the placebo group, 75 (71%) patients in the baricitinib 2 mg group, and 76 (73%) patients in the baricitinib 4 mg group. Serious adverse events were reported in ten (10%) patients receiving baricitinib 4 mg, 11 (10%) receiving baricitinib 2 mg, and five (5%) receiving placebo; no deaths were reported. Serious infections were reported in six (6%) patients with baricitinib 4 mg, two (2%) with baricitinib 2 mg, and one (1%) with placebo. INTERPRETATION: The baricitinib 4 mg dose, but not the 2 mg dose, significantly improved the signs and symptoms of active systemic lupus erythematosus in patients who were not adequately controlled despite standard of care therapy, with a safety profile consistent with previous studies of baricitinib. This study provides the foundation for future phase 3 trials of JAK1/2 inhibition with baricitinib as a new potential oral therapy for systemic lupus erythematosus. FUNDING: Eli Lilly and Company."},{"id":"37e126f4526a","type":"article","url":"https://hartvaat.nl/2018/07/19/5-jaarsuitkomsten-van-ffr-geleide-pci-nejm-fame-2/","title":"5-jaarsuitkomsten van FFR-geleide PCI: NEJM FAME 2","title_en":"Five-Year Outcomes with PCI Guided by Fractional Flow Reserve.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1803538","source_url":"https://doi.org/10.1056/NEJMoa1803538","authors":["Panagiotis Xaplanteris","Stephane Fournier","Nico H J Pijls","William F Fearon","Emanuele Barbato","Pim A L Tonino","Thomas Engstrøm","Stefan Kääb","Jan-Henk Dambrink","Gilles Rioufol","Gabor G Toth","Zsolt Piroth","Nils Witt","Ole Fröbert","Petr Kala","Axel Linke","Nicola Jagic","Martin Mates","Kreton Mavromatis","Habib Samady","Anand Irimpen","Keith Oldroyd","Gianluca Campo","Martina Rothenbühler","Peter Jüni","Bernard De Bruyne"],"significance":9,"published":"2018-07-19","source_date":"2018-07-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"The 5-year FAME 2 results confirmed the sustained benefit of FFR-guided PCI over medical therapy alone in patients with stable coronary disease and hemodynamically significant stenoses. The long-term data strengthened the role of fractional flow reserve in guiding revascularization decisions.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 FAME 2 5-jaarsresultaten die het langetermijnvoordeel bevestigen van FFR-geleide PCI versus medicamenteuze therapie bij stabiel coronairlijden met functioneel significante stenosen.","abstract_original":"BACKGROUND: We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease. METHODS: Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy and were entered into a registry. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. RESULTS: A total of 888 patients underwent randomization (447 patients in the PCI group and 441 in the medical-therapy group). At 5 years, the rate of the primary end point was lower in the PCI group than in the medical-therapy group (13.9% vs. 27.0%; hazard ratio, 0.46; 95% confidence interval [CI], 0.34 to 0.63; P<0.001). The difference was driven by urgent revascularizations, which occurred in 6.3% of the patients in the PCI group as compared with 21.1% of those in the medical-therapy group (hazard ratio, 0.27; 95% CI, 0.18 to 0.41). There were no significant differences between the PCI group and the medical-therapy group in the rates of death (5.1% and 5.2%, respectively; hazard ratio, 0.98; 95% CI, 0.55 to 1.75) or myocardial infarction (8.1% and 12.0%; hazard ratio, 0.66; 95% CI, 0.43 to 1.00). There was no significant difference in the rate of the primary end point between the PCI group and the registry cohort (13.9% and 15.7%, respectively; hazard ratio, 0.88; 95% CI, 0.55 to 1.39). Relief from angina was more pronounced after PCI than after medical therapy. CONCLUSIONS: In patients with stable coronary artery disease, an initial FFR-guided PCI strategy was associated with a significantly lower rate of the primary composite end point of death, myocardial infarction, or urgent revascularization at 5 years than medical therapy alone. Patients without hemodynamically significant stenoses had a favorable long-term outcome with medical therapy alone. (Funded by St. Jude Medical and others; FAME 2 ClinicalTrials.gov number, NCT01132495 .)."},{"id":"0716c6359861","type":"article","url":"https://hartvaat.nl/2018/07/19/clopidogrel-plus-aspirine-bij-acuut-ischemisch-cva-en-hoogrisico-tia-nejm-point/","title":"Clopidogrel plus aspirine bij acuut ischemisch CVA en hoogrisico-TIA: NEJM POINT","title_en":"Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":["trombocytenaggregatieremmers"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1800410","source_url":"https://doi.org/10.1056/NEJMoa1800410","authors":["S Claiborne Johnston","J Donald Easton","Mary Farrant","William Barsan","Robin A Conwit","Jordan J Elm","Anthony S Kim","Anne S Lindblad","Yuko Y Palesch"],"significance":9,"published":"2018-07-19","source_date":"2018-07-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"The POINT trial showed that short-term dual antiplatelet therapy with clopidogrel plus aspirin reduced recurrent stroke compared with aspirin alone in patients with minor ischemic stroke or high-risk TIA, though with increased bleeding risk. Together with CHANCE, the trial defined the evidence base for early DAPT in minor stroke.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 POINT-trial die DAPT (clopidogrel+aspirine) vergeleek met aspirine alleen bij acuut ischemisch CVA en hoogrisico-TIA. Samen met CHANCE bepalend voor het acute CVA-beleid.","abstract_original":"BACKGROUND: Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population. METHODS: In a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone. The dose of aspirin in each group was selected by the site investigator. The primary efficacy outcome in a time-to-event analysis was the risk of a composite of major ischemic events, which was defined as ischemic stroke, myocardial infarction, or death from an ischemic vascular event, at 90 days. RESULTS: A total of 4881 patients were enrolled at 269 international sites. The trial was halted after 84% of the anticipated number of patients had been enrolled because the data and safety monitoring board had determined that the combination of clopidogrel and aspirin was associated with both a lower risk of major ischemic events and a higher risk of major hemorrhage than aspirin alone at 90 days. Major ischemic events occurred in 121 of 2432 patients (5.0%) receiving clopidogrel plus aspirin and in 160 of 2449 patients (6.5%) receiving aspirin plus placebo (hazard ratio, 0.75; 95% confidence interval [CI], 0.59 to 0.95; P=0.02), with most events occurring during the first week after the initial event. Major hemorrhage occurred in 23 patients (0.9%) receiving clopidogrel plus aspirin and in 10 patients (0.4%) receiving aspirin plus placebo (hazard ratio, 2.32; 95% CI, 1.10 to 4.87; P=0.02). CONCLUSIONS: In patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major hemorrhage at 90 days than those who received aspirin alone. (Funded by the National Institute of Neurological Disorders and Stroke; POINT ClinicalTrials.gov number, NCT00991029 .)."},{"id":"5e1c6b15d8aa","type":"article","url":"https://hartvaat.nl/2018/07/17/oac-plus-nsaid-bij-af-risico-op-ernstige-bloedingen/","title":"OAC plus NSAID bij AF: risico op ernstige bloedingen","title_en":"Concomitant Oral Anticoagulant and Nonsteroidal Anti-Inflammatory Drug Therapy in Patients With Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["abelacimab","anticoagulatie-kwetsbare-ouderen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.04.063","source_url":"https://doi.org/10.1016/j.jacc.2018.04.063","authors":["Anthony P Kent","Martina Brueckmann","Mandy Fraessdorf","Stuart J Connolly","Salim Yusuf","John W Eikelboom","Jonas Oldgren","Paul A Reilly","Lars Wallentin","Michael D Ezekowitz"],"significance":7,"published":"2018-07-17","source_date":"2018-07-17","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/"],"congress":"","summary_en":"This study quantified the bleeding risk of concomitant oral anticoagulant and NSAID use in AF patients, demonstrating a substantially elevated hemorrhagic risk that underscores the importance of minimizing NSAID exposure during anticoagulation.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 bloedingsrisico van gelijktijdig gebruik van orale anticoagulantia en NSAID's bij AF-patiënten. Clinically relevant drug interaction.","abstract_original":"BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used medications that can potentially increase the risk of bleeding and thrombosis. OBJECTIVES: This study quantified the effect of NSAIDs in the RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy) trial. METHODS: This was a post hoc analysis of NSAIDs in the RE-LY study, which compared dabigatran etexilate (DE) 150 and 110 mg twice daily (b.i.d.) with warfarin in patients with atrial fibrillation. Treatment-independent, multivariate-adjusted Cox regression analysis assessed clinical outcomes by comparing NSAID use with no NSAID use. Interaction analysis was obtained from treatment-dependent Cox regression modeling. Time-varying covariate analysis for NSAID use was applied to the Cox model. RESULTS: Among 18,113 patients in the RE-LY study, 2,279 patients used NSAIDs at least once during the trial. Major bleeding was significantly elevated with NSAID use (hazard ratio [HR]: 1.68; 95% confidence interval [CI]: 1.40 to 2.02; p < 0.0001). NSAID use did not significantly alter the risk of major bleeding for DE 150 or 110 mg b.i.d. relative to warfarin (pinteraction = 0.63 and 0.93, respectively). Gastrointestinal major bleeding was significantly elevated with NSAID use (HR: 1.81; 95% CI: 1.35 to 2.43; p < 0.0001). The rate of stroke or systemic embolism (stroke/SE) with NSAID use was significantly elevated (HR: 1.50; 95% CI: 1.12 to 2.01; p = 0.007). The use of NSAIDs did not significantly alter the relative efficacy on stroke/SE for DE 150 or 110 mg b.i.d. relative to warfarin (pinteraction = 0.59 and 0.54, respectively). Myocardial infarction rates were similar with NSAID use compared with no NSAID use (HR: 1.22; 95% CI: 0.77 to 1.93; p = 0.40). Patients were more frequently hospitalized if they used an NSAID (HR: 1.64; 95% CI: 1.51 to 1.77; p < 0.0001). CONCLUSIONS: The use of NSAIDs was associated with increased risk of major bleeding, stroke/SE, and hospitalization. The safety and efficacy of DE 150 and 110 mg b.i.d. relative to warfarin were not altered. (Randomized Evaluation of Long Term Anticoagulant Therapy [RE-LY]; NCT00262600)."},{"id":"4ff490d1d9f9","type":"article","url":"https://hartvaat.nl/2018/07/14/ldl-verlaging-en-cv-events-met-pcsk9-remmers-meta-analyse-van-gerandomiseerde-tr/","title":"LDL-verlaging en CV-events met PCSK9-remmers: meta-analyse van gerandomiseerde trials","title_en":"Reduction of low density lipoprotein-cholesterol and cardiovascular events with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors and statins: an analysis of FOURIER, SPIRE, and the Cholesterol Treatment Trialists Collaboration.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["enlicitide","ezetimibe","farmaco-economie","figaro-dkd","gepersonaliseerde-geneeskunde","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","ouderen","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","secundaire-preventie","select-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx450","source_url":"https://doi.org/10.1093/eurheartj/ehx450","authors":["Brian A Ference","Christopher P Cannon","Ulf Landmesser","Thomas F Lüscher","Alberico L Catapano","Kausik K Ray"],"significance":8,"published":"2018-07-14","source_date":"2018-07-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This meta-analysis quantified the relationship between LDL cholesterol reduction with PCSK9 inhibitors and cardiovascular event reduction, confirming proportional benefit consistent with the statin trials. The analysis strengthened the evidence that the mechanism of LDL lowering is less important than the magnitude of reduction.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 verband kwantificeerde tussen LDL-verlaging door PCSK9-remmers en cardiovasculaire events. Bevestigt proportioneel voordeel ongeacht het middel.","abstract_original":""},{"id":"64e476189218","type":"article","url":"https://hartvaat.nl/2018/07/10/draagbare-ecg-plakker-voor-af-detectie-thuis-jama-mstops-gerandomiseerde-trial/","title":"Draagbare ECG-plakker voor AF-detectie thuis: JAMA mSToPS gerandomiseerde trial","title_en":"Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.8102","source_url":"https://doi.org/10.1001/jama.2018.8102","authors":["Steven R Steinhubl","Jill Waalen","Alison M Edwards","Lauren M Ariniello","Rajesh R Mehta","Gail S Ebner","Chureen Carter","Katie Baca-Motes","Elise Felicione","Troy Sarich","Eric J Topol"],"significance":8,"published":"2018-07-10","source_date":"2018-07-10","image":"","kennis":[],"congress":"","summary_en":"The mSToPS trial showed that a wearable continuous ECG monitoring patch significantly increased detection of undiagnosed atrial fibrillation compared with routine care. The study demonstrated the feasibility and yield of home-based, consumer-oriented AF screening technology.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 mSToPS gerandomiseerde trial naar AF-detectie met een draagbare continue ECG-monitoringplakker. Pionierswerk in thuisscreening voor AF.","abstract_original":"IMPORTANCE: Opportunistic screening for atrial fibrillation (AF) is recommended, and improved methods of early identification could allow for the initiation of appropriate therapies to prevent the adverse health outcomes associated with AF. OBJECTIVE: To determine the effect of a self-applied wearable electrocardiogram (ECG) patch in detecting AF and the clinical consequences associated with such a detection strategy. DESIGN, SETTING, AND PARTICIPANTS: A direct-to-participant randomized clinical trial and prospective matched observational cohort study were conducted among members of a large national health plan. Recruitment began November 17, 2015, and was completed on October 4, 2016, and 1-year claims-based follow-up concluded in January 2018. For the clinical trial, 2659 individuals were randomized to active home-based monitoring to start immediately or delayed by 4 months. For the observational study, 2 deidentified age-, sex- and CHA2DS2-VASc-matched controls were selected for each actively monitored individual. INTERVENTIONS: The actively monitored cohort wore a self-applied continuous ECG monitoring patch at home during routine activities for up to 4 weeks, initiated either immediately after enrolling (n = 1364) or delayed for 4 months after enrollment (n = 1291). MAIN OUTCOMES AND MEASURES: The primary end point was the incidence of a new diagnosis of AF at 4 months among those randomized to immediate monitoring vs delayed monitoring. A secondary end point was new AF diagnosis at 1 year in the combined actively monitored groups vs matched observational controls. Other outcomes included new prescriptions for anticoagulants and health care utilization (outpatient cardiology visits, primary care visits, or AF-related emergency department visits and hospitalizations) at 1 year. RESULTS: The randomized groups included 2659 participants (mean [SD] age, 72.4 [7.3] years; 38.6% women), of whom 1738 (65.4%) completed active monitoring. The observational study comprised 5214 (mean [SD] age, 73.7 [7.0] years; 40.5% women; median CHA2DS2-VASc score, 3.0), including 1738 actively monitored individuals from the randomized trial and 3476 matched controls. In the randomized study, new AF was identified by 4 months in 3.9% (53/1366) of the immediate group vs 0.9% (12/1293) in the delayed group (absolute difference, 3.0% [95% CI, 1.8%-4.1%]). At 1 year, AF was newly diagnosed in 109 monitored (6.7 per 100 person-years) and 81 unmonitored (2.6 per 100 person-years; difference, 4.1 [95% CI, 3.9-4.2]) individuals. Active monitoring was associated with increased initiation of anticoagulants (5.7 vs 3.7 per 100 person-years; difference, 2.0 [95% CI, 1.9-2.2]), outpatient cardiology visits (33.5 vs 26.0 per 100 person-years; difference, 7.5 [95% CI, 7.2-7.9), and primary care visits (83.5 vs 82.6 per 100 person-years; difference, 0.9 [95% CI, 0.4-1.5]). There was no difference in AF-related emergency department visits and hospitalizations (1.3 vs 1.4 per 100 person-years; difference, 0.1 [95% CI, -0.1 to 0]). CONCLUSIONS AND RELEVANCE: Among individuals at high risk for AF, immediate monitoring with a home-based wearable ECG sensor patch, compared with delayed monitoring, resulted in a higher rate of AF diagnosis after 4 months. Monitored individuals, compared with nonmonitored controls, had higher rates of AF diagnosis, greater initiation of anticoagulants, but also increased health care resource utilization at 1 year. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02506244."},{"id":"2c3f275ac3e6","type":"article","url":"https://hartvaat.nl/2018/07/10/il-8-en-infarctgrootte-en-klinische-uitkomsten-bij-stemi/","title":"IL-8 en infarctgrootte en klinische uitkomsten bij STEMI","title_en":"Association of IL-8 With Infarct Size and Clinical Outcomes in Patients With STEMI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["inflammatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.04.053","source_url":"https://doi.org/10.1016/j.jacc.2018.04.053","authors":["Christian Shetelig","Shanmuganathan Limalanathan","Pavel Hoffmann","Ingebjørg Seljeflot","Jon M Gran","Jan Eritsland","Geir Ø Andersen"],"significance":5,"published":"2018-07-10","source_date":"2018-07-10","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/","https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"This study showed that IL-8 levels are associated with infarct size and clinical outcomes in STEMI, identifying another inflammatory biomarker in the acute MI pathway.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van interleukine-8 met infarctgrootte en klinische uitkomsten bij STEMI. Inflammatiemarker als prognostische tool.","abstract_original":"BACKGROUND: Little is known about the role of interleukin (IL)-8 in patients with acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: The aims of this study were to evaluate, in STEMI patients, the temporal profile of IL-8 and possible associations with left ventricular (LV) function and remodeling, infarct size, microvascular obstruction, myocardial salvage, and future clinical events. METHODS: A total of 258 patients with STEMI were included. Blood samples were drawn before and immediately after percutaneous coronary intervention (PCI), at day 1, and after 4 months. Cardiac magnetic resonance imaging was performed in the acute phase and after 4 months. Clinical events were registered during 12 months' follow-up and all-cause mortality after median 70 months' follow-up. RESULTS: Patients with IL-8 levels greater than the median measured both immediately after PCI and at day 1 had larger final infarct size, lower LV ejection fraction, larger increase in LV end-diastolic volume, and higher frequency of microvascular obstruction. After multivariate adjustment, high IL-8 levels at day 1 were associated with an increased risk of developing a large MI and having reduced LV ejection fraction at 4 months, also after adjustment for peak troponin value. Patients with IL-8 levels in the highest quartile measured at all sampling points were more likely to have a clinical event during the first 12 months after the MI and had lower overall survival during long-term follow-up. CONCLUSIONS: High levels of circulating IL-8 were associated with large infarct size, impaired recovery of LV function, and adverse clinical outcome in patients with STEMI, suggesting IL-8 as a future therapeutic target based on its important role in post-infarction inflammation."},{"id":"a3e654eb0e31","type":"article","url":"https://hartvaat.nl/2018/07/10/epinefrine-versus-norepinefrine-bij-cardiogene-shock-na-acuut-mi/","title":"Epinefrine versus norepinefrine bij cardiogene shock na acuut MI","title_en":"Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.04.051","source_url":"https://doi.org/10.1016/j.jacc.2018.04.051","authors":["Bruno Levy","Raphael Clere-Jehl","Annick Legras","Tristan Morichau-Beauchant","Marc Leone","Ganster Frederique","Jean-Pierre Quenot","Antoine Kimmoun","Alain Cariou","Johan Lassus","Veli-Pekka Harjola","Ferhat Meziani","Guillaume Louis","Patrick Rossignol","Kevin Duarte","Nicolas Girerd","Alexandre Mebazaa","Philippe Vignon"],"significance":7,"published":"2018-07-10","source_date":"2018-07-10","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study compared epinephrine with norepinephrine for cardiogenic shock after acute MI, finding higher rates of refractory shock with epinephrine. The results inform vasopressor selection in this critically ill population.","created":"2026-07-03T10:27:22Z","updated":"2026-07-03T13:26:36Z","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":"Vergelijking van epinefrine versus norepinefrine bij cardiogene shock na acuut MI. Klinisch relevant voor de vasopressorkeuze bij de ziekste patiënten.","abstract_original":"BACKGROUND: Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking. OBJECTIVES: The goal of this paper was to compare in a prospective, double-blind, multicenter, randomized study, the efficacy and safety of epinephrine and norepinephrine in patients with CS after acute myocardial infarction. METHODS: The primary efficacy outcome was cardiac index evolution, and the primary safety outcome was the occurrence of refractory CS. Refractory CS was defined as CS with sustained hypotension, end-organ hypoperfusion and hyperlactatemia, and high inotrope and vasopressor doses. RESULTS: Fifty-seven patients were randomized into 2 study arms, epinephrine and norepinephrine. For the primary efficacy endpoint, cardiac index evolution was similar between the 2 groups (p = 0.43) from baseline (H0) to H72. For the main safety endpoint, the observed higher incidence of refractory shock in the epinephrine group (10 of 27 [37%] vs. norepinephrine 2 of 30 [7%]; p = 0.008) led to early termination of the study. Heart rate increased significantly with epinephrine from H2 to H24 while remaining unchanged with norepinephrine (p < 0.0001). Several metabolic changes were unfavorable to epinephrine compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p < 0.0001). CONCLUSIONS: In patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743)."},{"id":"c6e31e5eebe6","type":"article","url":"https://hartvaat.nl/2018/07/10/fatale-of-irreversibele-bloedingen-en-ischemische-events-met-rivaroxaban-bij-acs/","title":"Fatale of irreversibele bloedingen en ischemische events met rivaroxaban bij ACS","title_en":"Fatal or Irreversible Bleeding and Ischemic Events With Rivaroxaban in Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.04.055","source_url":"https://doi.org/10.1016/j.jacc.2018.04.055","authors":["C Michael Gibson","Bennett Levitan","William J Gibson","Megan K Yee","Sabina A Murphy","Zhong Yuan","Anjan K Chakrabarti","Michael Lee","Eugene Braunwald"],"significance":6,"published":"2018-07-10","source_date":"2018-07-10","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This ACS analysis separated fatal or irreversible bleeding and ischemic events from reversible ones in rivaroxaban-treated patients, providing a clinically meaningful assessment of the most consequential complications of antithrombotic therapy.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T13:26:36Z","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":"Analyse van fatale of irreversibele bloedingen versus ischemische events met rivaroxaban bij ACS. Kwantificeert de ernstigste complicaties voor de nettorisicoafweging.","abstract_original":"BACKGROUND: Net clinical outcome analyses of acute coronary syndrome (ACS) mingle fatal or irreversible events with survivable or reversible events that vary significantly in clinical impact. OBJECTIVES: A comparison of efficacy and safety limited to fatal or irreversible ischemic and adverse or seriously harmful events is one way to assess net clinical outcome and risk-benefit overall, given the fact that these events have a similar clinical impact. METHODS: In the ATLAS ACS 2-TIMI 51 (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction) trial of rivaroxaban in the secondary prevention of events among patients with ACS treated with aspirin plus clopidogrel or ticlopidine (clopidogrel/ticlopidine) or aspirin alone, fatal and irreversible efficacy events including nonbleeding cardiovascular death, myocardial infarction, and ischemic stroke were compared to fatal or irreversible safety events, including fatal and intracranial bleeding. RESULTS: Rivaroxaban, 2.5 mg orally twice per day, in patients treated with aspirin and clopidogrel/ticlopidine was associated with 115 (95% confidence interval [CI]: 18 to 212) fewer fatal or irreversible ischemic events (663 for placebo vs. 548 for therapy) and 10 (95% CI: -11 to 32) additional fatal or irreversible seriously harmful events (33 vs. 23 for placebo) per 10,000 patient-years of exposure. Taken together, there would be 105 (95% CI: 6 to 204) fatal or irreversible events prevented per 10,000 patient-years of exposure to rivaroxaban compared with placebo, with 11 (10 of 115) fatal or irreversible ischemic events prevented for each fatal or irreversible seriously harmful event caused. If only nonbleeding cardiovascular death is included as a fatal or irreversible event, then 95 events would be prevented per 10,000 patient-years of exposure in the group taking 2.5 mg orally twice per day. CONCLUSIONS: Both fatal or irreversible ischemia and bleeding are clinically significant events that can be compared to assess the net clinical outcomes associated with therapy. Rivaroxaban therapy at an oral dose of 2.5 mg twice daily in patients treated with aspirin and clopidogrel is associated with a net reduction in fatal or irreversible events. (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction [ATLAS ACS 2-TIMI 51]; NCT00809965)."},{"id":"dac209434cad","type":"article","url":"https://hartvaat.nl/2018/07/10/residueel-inflammatoir-risico-bij-pcsk9-remming-plus-statine/","title":"Residueel inflammatoir risico bij PCSK9-remming plus statine","title_en":"Residual Inflammatory Risk on Treatment With PCSK9 Inhibition and Statin Therapy.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["enlicitide","ezetimibe","ldl-cholesterol","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","rosuvastatine","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034645","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034645","authors":["Aruna D Pradhan","Aaron W Aday","Lynda M Rose","Paul M Ridker"],"significance":8,"published":"2018-07-10","source_date":"2018-07-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/residueel-cardiovasculair-risico/"],"congress":"","summary_en":"This study quantified the residual inflammatory risk that persists after maximum LDL cholesterol lowering with PCSK9 inhibition and statins, demonstrating that elevated hsCRP remains an independent predictor of events even at very low LDL levels. The results provided the rationale for adding anti-inflammatory therapy to lipid-lowering strategies.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T13:26:36Z","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":"Studie naar het residuele inflammatoire risico dat overblijft na maximale LDL-verlaging met PCSK9-remming en statines. Kwantificeert het 'inflammation gap'.","abstract_original":"BACKGROUND: The combination of statin therapy and PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition markedly lowers low-density lipoprotein cholesterol (LDL-C) and reduces cardiovascular event rates. Whether residual inflammatory risk as measured by on-treatment high sensitivity C-reactive protein (hsCRP) remains an important clinical issue in such patients is uncertain. METHODS: We evaluated residual inflammatory risk among 9738 patients participating in the SPIRE-1 and SPIRE-2 cardiovascular outcomes trials (Studies of PCSK9 Inhibition and the Reduction in Vascular Events), who were receiving both statin therapy and bococizumab, according to on-treatment levels of hsCRP (hsCRPOT) and LDL-COT measured 14 weeks after drug initiation. The primary end point was nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina requiring urgent revascularization, or cardiovascular death. RESULTS: At 14 weeks, the mean percentage change in LDL-C among statin-treated patients who additionally received bococizumab was -60.5% (95% confidence interval [CI], -61.2 to -59.8; P<0.001; median change, -65.4%) as compared to 6.6% (95% CI, -1.0 to 14.1; P=0.09; median change, 0.0%) for hsCRP. Incidence rates for future cardiovascular events for patients treated with both statin therapy and bococizumab according to hsCRPOT <1, 1 to 3, and >3 mg/L were 1.96, 2.50, and 3.59 events per 100 person-years, respectively, corresponding to multivariable adjusted hazard ratios of 1.0, 1.16 (95% CI, 0.81-1.66), and 1.62 (95% CI, 1.14-2.30) (P-trend=0.001) after adjustment for traditional cardiovascular risk factors and LDL-COT. Comparable adjusted hazard ratios for LDL-COT (<30, 30-50, >50 mg/dL) were 1.0, 0.87, and 1.21, respectively (P-trend=0.16). Relative risk reductions with bococizumab were similar across hsCRPOT groups (P-interaction=0.87). CONCLUSIONS: In this post hoc analysis of the SPIRE trials of bococizumab in a stable outpatient population, evidence of residual inflammatory risk persisted among patients treated with both statin therapy and proprotein convertase subtilisin-kexin type 9 inhibition. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01975376, NCT01975389."},{"id":"855ebbf7d71f","type":"article","url":"https://hartvaat.nl/2018/07/10/inflammatie-en-cholesterol-in-de-fourier-trial/","title":"Inflammatie en cholesterol in de FOURIER-trial","title_en":"Inflammatory and Cholesterol Risk in the FOURIER Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["hs-crp","inflammatie","ldl-cholesterol"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.034032","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.034032","authors":["Erin A Bohula","Robert P Giugliano","Lawrence A Leiter","Subodh Verma","Jeong-Gun Park","Peter S Sever","Armando Lira Pineda","Narimon Honarpour","Huei Wang","Sabina A Murphy","Anthony Keech","Terje R Pedersen","Marc S Sabatine"],"significance":8,"published":"2018-07-10","source_date":"2018-07-10","image":"","kennis":[],"congress":"","summary_en":"This FOURIER analysis showed that inflammatory risk (elevated hsCRP) and cholesterol risk (elevated LDL) independently contribute to cardiovascular events, and that patients with dual residual risk despite PCSK9 inhibition had the highest event rates. The findings integrated the lipid and inflammation hypotheses of atherosclerosis.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T13:26:36Z","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":"FOURIER-analyse naar het samenspel van inflammatie (hsCRP) en cholesterol als residueel risico. Integreert de FOURIER- en CANTOS-concepten.","abstract_original":"BACKGROUND: In the FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk), the PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor evolocumab reduced low-density lipoprotein cholesterol (LDL-C) and cardiovascular risk. It is not known whether the efficacy of evolocumab is modified by baseline inflammatory risk. We explored the efficacy of evolocumab stratified by baseline high-sensitivity C-reactive protein (hsCRP). We also assessed the importance of inflammatory and residual cholesterol risk across the range of on-treatment LDL-C concentrations. METHODS: Patients (n=27 564) with stable atherosclerotic cardiovascular disease and LDL-C ≥70 mg/dL on a statin were randomly assigned to evolocumab versus placebo and followed for a median of 2.2 years (1.8-2.5). The effects of evolocumab on the primary end point of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina or coronary revascularization, and the key secondary end point of cardiovascular death, myocardial infarction, or stroke were compared across strata of baseline hsCRP (<1, 1-3, and >3 mg/dL). Outcomes were also assessed across values for baseline hsCRP and 1-month LDL-C in the entire trial population. Multivariable models adjusted for variables associated with hsCRP and 1-month LDL-C were evaluated. RESULTS: A total of 7981 (29%) patients had a baseline hsCRP<1 mg/L, 11 177 (41%) had a hsCRP 1 to 3 mg/L, and 8337 (30%) had a hsCRP >3 mg/L. Median (interquartile range) baseline hsCRP was 1.8 (0.9-3.6) mg/L and levels were not altered by evolocumab (change at 48 weeks of -0.2 mg/dL [-1.0 to 0.4] in both treatment arms). In the placebo arm, patients in higher baseline hsCRP categories experienced significantly higher 3-year Kaplan-Meier rates of the primary and key secondary end points: 12.0%, 13.7%, and 18.1% for the primary end point (Ptrend<0.0001) and 7.4%, 9.1%, and 13.2% for the key secondary end point (Ptrend<0.0001) for categories of <1, 1 to 3, and >3 mg/dL, respectively. The relative risk reductions for the primary end point and key secondary end point with evolocumab were consistent across hsCRP strata (P-interactions>0.15 for both). In contrast, the absolute risk reductions with evolocumab tended to be greater in patients with higher hsCRP: 1.6%, 1.8%, and 2.6% and 0.8%, 2.0%, and 3.0%, respectively, for the primary and key secondary end points across hsCRP strata. In adjusted analyses of the association between LDL-C and hsCRP levels and cardiovascular risk, both LDL-C and hsCRP were independently associated with the primary outcome (P<0.0001 for each). CONCLUSIONS: LDL-C reduction with evolocumab reduces cardiovascular events across hsCRP strata with greater absolute risk reductions in patients with higher-baseline hsCRP. Event rates were lowest in patients with the lowest hsCRP and LDL-C. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01764633."},{"id":"87eee84222bd","type":"article","url":"https://hartvaat.nl/2018/07/07/orbusneich-combo-stent-japan-usa-harmonee-gerandomiseerde-multicenter-trial/","title":"OrbusNeich Combo stent: Japan-USA HARMONEE gerandomiseerde multicenter trial","title_en":"Japan-United States of America Harmonized Assessment by Randomized Multicentre Study of OrbusNEich's Combo StEnt (Japan-USA HARMONEE) study: primary results of the pivotal registration study of combined endothelial progenitor cell capture and drug-eluting stent in patients with ischaemic coronary disease and non-ST-elevation acute coronary syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy275","source_url":"https://doi.org/10.1093/eurheartj/ehy275","authors":["Shigeru Saito","Mitchell W Krucoff","Shigeru Nakamura","Roxana Mehran","Akiko Maehara","Hussein R Al-Khalidi","Stephen M Rowland","Gudaye Tasissa","Debbie Morrell","Diane Joseph","Yumiko Okaniwa","Yoshisato Shibata","Barry D Bertolet","Mark D Rothenberg","Philippe Généreux","Hiram Bezerra","David F Kong"],"significance":5,"published":"2018-07-07","source_date":"2018-07-07","image":"","kennis":[],"congress":"","summary_en":"The HARMONEE pivotal trial evaluated the Combo sirolimus-eluting stent with endothelial progenitor cell capture technology, testing whether promoting endothelialization alongside antiproliferative drug elution improves stent healing.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T13:26:36Z","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":"Gerandomiseerde trial van de Combo sirolimus-eluting stent met endotheelcelvangende technologie. Innovatief stentconcept voor versnelde endothelialisatie.","abstract_original":"AIMS: Harmonized Assessment by Randomized Multicentre Study of OrbusNEich's Combo StEnt (HARMONEE) (NCT02073565) was a randomized pivotal registration trial of the Combo stent, which combined sirolimus and an abluminal bioabsorbable polymer with a novel endoluminal anti-CD34+ antibody coating designed to capture endothelial progenitor cells (EPC) and promote percutaneous coronary intervention (PCI) site healing. METHODS AND RESULTS: Clinically stabilized PCI subjects were randomized 1:1 to receive Combo or everolimus-eluting stents (EES). Between February 2014 and June 2016, 572 subjects with 675 coronary lesions underwent 1-year angiography and fractional flow reserve, with optical coherence tomography (OCT) in the first 140 patients. The primary clinical endpoint was non-inferior 1-year target vessel failure (TVF). The primary mechanistic endpoint of EPC capture activity was superior strut coverage by OCT. Target vessel failure occurred in 7.0% Combo (20/287) vs. 4.2% EES (12/285), a 2.8% [95% confidence interval (95% CI) -1.0%, 6.5%] difference, meeting the non-inferiority hypothesis (P = 0.02). There were no cardiac deaths, with one stent thrombosis observed in the EES group. Quantitative coronary angiography late loss with Combo was equivalent to EES. Optical coherence tomography strut coverage at 1 year was superior with Combo vs. EES [91.3% (95% CI 88.7%, 93.8%) vs. 74.8% (95% CI 70.0%, 79.6%), P < 0.001], with homogeneous tissue in 81.2% vs. 68.8%, respectively. CONCLUSION: Combo stent demonstrated non-inferior 1-year TVF and late loss in a randomized comparison to EES, with superior strut-based tissue coverage by OCT as a surrogate of EPC capture technology activity."},{"id":"197c92fa4057","type":"article","url":"https://hartvaat.nl/2018/07/07/revascularisatie-versus-optimale-medicamenteuze-therapie-bij-cto-gerandomiseerde/","title":"Revascularisatie versus optimale medicamenteuze therapie bij CTO: gerandomiseerde trial","title_en":"A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["farmaco-economie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy220","source_url":"https://doi.org/10.1093/eurheartj/ehy220","authors":["Gerald S Werner","Victoria Martin-Yuste","David Hildick-Smith","Nicolas Boudou","Georgios Sianos","Valery Gelev","Jose Ramon Rumoroso","Andrejs Erglis","Evald Høj Christiansen","Javier Escaned","Carlo di Mario","Thomas Hovasse","Luis Teruel","Alexander Bufe","Bernward Lauer","Kris Bogaerts","Javier Goicolea","James C Spratt","Anthony H Gershlick","Alfredo R Galassi","Yves Louvard"],"significance":8,"published":"2018-07-07","source_date":"2018-07-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"This randomized multicenter trial comparing PCI with optimal medical therapy for chronic total coronary occlusions found improved quality of life and angina relief with revascularization but no significant difference in hard clinical endpoints. The results supported PCI for CTOs as a symptom-driven strategy.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T13:26:36Z","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":"Gerandomiseerde multicenter trial die revascularisatie vergeleek met optimale medicamenteuze therapie bij chronische totale coronairocclusie. Een van de weinige CTO-RCT's.","abstract_original":"AIMS: The clinical value of percutaneous coronary intervention (PCI) for chronic coronary total occlusions (CTOs) is not established by randomized trials. This study should compare the benefit of PCI vs. optimal medical therapy (OMT) on the health status in patients with at least one CTO. METHOD AND RESULTS: Three hundred and ninety-six patients were enrolled in a prospective randomized, multicentre, open-label, and controlled clinical trial to compare the treatment by PCI with OMT with a 2:1 randomization ratio. The primary endpoint was the change in health status assessed by the Seattle angina questionnaire (SAQ) between baseline and 12 months follow-up. Fifty-two percent of patients have multi-vessel disease in whom all significant non-occlusive lesions were treated before randomization. An intention-to-treat analysis was performed including 13.4% failed procedures in the PCI group and 7.3% cross-overs in the OMT group. At 12 months, a greater improvement of SAQ subscales was observed with PCI as compared with OMT for angina frequency [5.23, 95% confidence interval (CI) 1.75; 8.71; P = 0.003], and quality of life (6.62, 95% CI 1.78-11.46; P = 0.007), reaching the prespecified significance level of 0.01 for the primary endpoint. Physical limitation (P = 0.02) was also improved in the PCI group. Complete freedom from angina was more frequent with PCI 71.6% than OMT 57.8% (P = 0.008). There was no periprocedural death or myocardial infarction. At 12 months, major adverse cardiac events were comparable between the two groups. CONCLUSION: Percutaneous coronary intervention leads to a significant improvement of the health status in patients with stable angina and a CTO as compared with OMT alone. TRIAL REGISTRATION: NCT01760083."},{"id":"449533a8de1a","type":"article","url":"https://hartvaat.nl/2018/07/01/rotorablatie-bij-atriumfibrilleren-systematische-review/","title":"Rotorablatie bij atriumfibrilleren: systematische review","title_en":"Clinical impact of rotor ablation in atrial fibrillation: 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/eux370","source_url":"https://doi.org/10.1093/europace/eux370","authors":["Ramanathan Parameswaran","Aleksandr Voskoboinik","Alexandra Gorelik","Geoffrey Lee","Peter M Kistler","Prashanthan Sanders","Jonathan M Kalman"],"significance":5,"published":"2018-07-01","source_date":"2018-07-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/wat-is-atriumfibrilleren/"],"congress":"","summary_en":"This systematic review evaluated the clinical impact of rotor ablation for AF, finding insufficient consistent evidence to support routine rotor-targeted ablation as a primary AF treatment strategy.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 de klinische impact van rotorablatie bij AF. Evaluatie van een controversieel AF-ablatieconcept.","abstract_original":"AIMS: Rotor mapping and ablation have gained favour over the recent years as an emerging ablation strategy targeting drivers of atrial fibrillation (AF). Their efficacy, however, has been a topic of great debate with variable outcomes across centres. The aim of this study was to systematically review the recent medical literature to determine the medium-term outcomes of rotor ablation in patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PeAF). METHODS AND RESULTS: A systematic search of the contemporary scientific literature (PubMed and EMBASE) was performed in August 2017. Only studies assessing arrhythmia-free survival from rotor ablation of AF were included. We used the random-effects model to assess the primary outcome of pooled medium-term single-procedure AF-free survival for both PAF and PeAF. Success rates from multiple procedures and complication rates were also examined. We included 11 observational studies (4 PAF and 10 PeAF) with a total of 556 patients (166 PAF and 390 PeAF). Pooled single-procedure freedom from AF was 37.8% [95% confidence interval 5.6-86.3%] at a mean follow-up period of 13.8 ± 1.8 months for PAF and 59.2% (95% CI 41.4-74.9%) at a mean follow-up period of 12.9 ± 6 months for PeAF. There was a marked heterogeneity between studies (I2 = 93.8% for PAF and 88.3% for PeAF). The mean complication rate of rotor ablation among the reported studies was 3.4%. CONCLUSION: The wide variability in success rate between different centres performing rotor ablations suggests that the optimal ablation strategy, particularly targeting rotors, is unclear. Results from randomized studies are necessary before this technique can be considered as an established clinical tool."},{"id":"e284ac3a9b80","type":"article","url":"https://hartvaat.nl/2018/07/01/echogeleide-versus-conventionele-femorale-venepunctie-bij-af-ablatie-gerandomise/","title":"Echogeleide versus conventionele femorale venepunctie bij AF-ablatie: gerandomiseerde trial","title_en":"Ultrasound-guided versus conventional femoral venipuncture for catheter ablation of atrial fibrillation: a multicentre randomized efficacy and safety trial (ULTRA-FAST 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/eux175","source_url":"https://doi.org/10.1093/europace/eux175","authors":["Kenichiro Yamagata","Dan Wichterle","Tomáš Roubícek","Patrik Jarkovský","Yuriko Sato","Takamichi Kogure","Petr Peichl","Petr Konecný","Helena Jansová","Pavel Kucera","Bashar Aldhoon","Robert Cihák","Yoichi Sugimura","Josef Kautzner"],"significance":6,"published":"2018-07-01","source_date":"2018-07-01","image":"","kennis":[],"congress":"","summary_en":"This multicenter randomized trial showed that ultrasound-guided femoral venipuncture reduces vascular complications during AF catheter ablation compared with conventional landmark-based access, supporting routine use of ultrasound guidance.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T13:26:36Z","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":"Multicenter gerandomiseerde trial die echogeleide versus conventionele femorale venepunctie vergeleek bij katheterablatie voor AF. Veiligheidsverbetering van de ablatieprocedure.","abstract_original":"AIMS: Complications of catheter ablation for atrial fibrillation (AF) are frequently related to vascular access. We hypothesized that ultrasound-guided (USG) venipuncture may facilitate the procedure and reduce complication rates. METHODS AND RESULTS: We conducted a multicentre, randomized trial in patients undergoing catheter ablation for AF on uninterrupted anticoagulation therapy. The study enrolled consecutive 320 patients (age: 63 ± 8 years; male: 62%) and were randomized to USG or conventional venipuncture in 1:1 fashion. It was prematurely terminated due to substantially lower-than-expected complication rates, which doubled the population size needed to maintain statistical power. While the complication rates did not differ between two study arms (0.6% vs. 1.9%, P = 0.62), intra-procedural outcome measures were in favour of the USG approach (puncture time, 288 vs. 369 s, P < 0.001; first pass success, 74% vs. 20%, P < 0.001; extra puncture attempts 0.5 vs. 2.1, P < 0.001; inadvertent arterial puncture 0.07 vs. 0.25, P < 0.001; unsuccessful cannulation 0.6% vs. 14%, P < 0.001). Though these measures varied between trainees (49% of procedures) and expert operators, between-arm differences (except for unsuccessful cannulation) were comparably significant in favour of USG approach for both subgroups. CONCLUSIONS: Ultrasound-guided puncture of femoral veins was associated with preferable intra-procedural outcomes, though the major complication rates were not reduced. Both trainees and expert operators benefited from the USG strategy. (www.clinicaltrials.gov ID: NCT02834221)."},{"id":"2827fc5afc85","type":"article","url":"https://hartvaat.nl/2018/07/01/hypertensie-bij-hiv-nieuwe-pathofysiologische-mechanismen/","title":"Hypertensie bij HIV: nieuwe pathofysiologische mechanismen","title_en":"Hypertension in HIV-Infected Adults: Novel Pathophysiologic Mechanisms.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.10893","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.10893","authors":["Sasha A Fahme","Gerald S Bloomfield","Robert Peck"],"significance":6,"published":"2018-07-01","source_date":"2018-07-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This review discussed the novel pathophysiological mechanisms underlying hypertension in HIV-infected adults, including immune activation, antiretroviral drug effects, and metabolic dysfunction unique to the HIV population.","created":"2026-07-03T10:27:21Z","updated":"2026-07-03T13:26:36Z","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":"Review over hypertensie bij HIV-patiënten met bespreking van nieuwe pathofysiologische mechanismen. Relevant gezien de toenemende cardiovasculaire belasting bij HIV.","abstract_original":""},{"id":"476487af841b","type":"article","url":"https://hartvaat.nl/2018/07/01/sport-versus-beroepsmatige-lichamelijke-activiteit-en-cardiovasculair-risico/","title":"Sport versus beroepsmatige lichamelijke activiteit en cardiovasculair risico","title_en":"Differing associations for sport versus occupational physical activity and cardiovascular risk.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["atleten","hartrevalidatie","lichaamsbeweging"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312594","source_url":"https://doi.org/10.1136/heartjnl-2017-312594","authors":["Marco Mario Ferrario","Mattia Roncaioli","Giovanni Veronesi","Andreas Holtermann","Els Clays","Rossana Borchini","Marco Cavicchiolo","Guido Grassi","Giancarlo Cesana"],"significance":6,"published":"2018-07-01","source_date":"2018-07-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/cardiovasculair-risico-begrippen/"],"congress":"","summary_en":"This study demonstrated that sport and occupational physical activity have differing associations with cardiovascular risk, with sport activity being protective while heavy occupational activity may paradoxically increase risk.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:36Z","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":"Studie die aantoont dat sport en beroepsmatige lichamelijke activiteit verschillende associaties hebben met cardiovasculair risico. Nuanceert het 'elke beweging is goed'-paradigma.","abstract_original":"OBJECTIVES: We investigate the independent and interacting long-term associations of occupational physical activity (OPA) and sport physical activity (SpPA) with the incidence of coronary heart disease (CHD) and cardiovascular diseases (CVD; CHD plus ischaemic stroke) in North Italian male workers. METHODS: 3574 employed men aged 25-64 years, free of CVD at baseline, recruited in three population-based and one factory-based cohorts, were included in the analysis. The Baecke Questionnaire was used to assess OPA and SpPA in 'minutes per week' of moderate or vigorous PA. We estimated the associations between different domains of PA and the endpoints, adjusting for major CVD risk factors, using Cox models. RESULTS: During a median follow-up of 14 years, 135 and 174 first CHD and CVD events, fatal and non-fatal, occurred. Compared with the intermediate OPA tertile, the HRs for CHD among low and high OPA workers were 1.66 (95% CI 1.06 to 2.59) and 1.18 (0.72 to 1.94), respectively (P value=0.07). Decreasing trends in CHD and CVD rates across increasing levels of SpPA were also found, with an HR for CVD of 0.68 (0.46 to 0.98) for intermediate/recommended SpPA compared with poor SpPA. We also found a statistically significant SpPA-OPA interaction, and the protective effect of SpPA was only found among sedentary workers, for both endpoints. Conversely, high OPA workers with intermediate/recommended SpPA levels had increased CHD and CVD rates compared with the poor SpPA category. CONCLUSIONS: Our results provide further evidence on the health paradox of OPA, with higher CVD rates among workers with intense PA at work. Moreover, the protective effect on CVDs of SpPA is prominent in sedentary workers, but it attenuates and even reverses in moderate and strenuous OPA workers."},{"id":"abb6018ae38e","type":"article","url":"https://hartvaat.nl/2018/06/30/glp-1-glucagon-duale-agonist-bij-obesitas-met-diabetes-type-2-lancet-fase-2/","title":"GLP-1/glucagon duale agonist bij obesitas met diabetes type 2: Lancet fase-2","title_en":"MEDI0382, a GLP-1 and glucagon receptor dual agonist, in obese or overweight patients with type 2 diabetes: a randomised, controlled, double-blind, ascending dose and phase 2a study.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["glp1-agonisten","glp1-semaglutide-cardiovasculair","semaglutide","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30726-8","source_url":"https://doi.org/10.1016/S0140-6736(18)30726-8","authors":["Philip Ambery","Victoria E Parker","Michael Stumvoll","Maximilian G Posch","Tim Heise","Leona Plum-Moerschel","Lan-Feng Tsai","Darren Robertson","Meena Jain","Marcella Petrone","Cristina Rondinone","Boaz Hirshberg","Lutz Jermutus"],"significance":7,"published":"2018-06-30","source_date":"2018-06-30","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This Lancet phase 2 trial of MEDI0382, a dual GLP-1/glucagon receptor agonist, showed clinically meaningful weight loss and glucose improvement in obese patients with type 2 diabetes, exploring a new class of incretin-based combination therapeutics.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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":"Lancet fase-2-trial van MEDI0382, een duale GLP-1 en glucagonreceptor-agonist, bij obese diabetespatiënten. Nieuwe klasse van gewichts- en glucoseverlagende middelen.","abstract_original":"BACKGROUND: Weight loss is often key in the management of obese or overweight patients with type 2 diabetes, yet few treatments for diabetes achieve clinically meaningful weight loss. We aimed to assess the efficacy, tolerability, and safety of treatment with MEDI0382, a balanced glucagon-like peptide-1 and glucagon receptor dual agonist developed to provide glycaemic control and weight loss, in patients with type 2 diabetes. METHODS: This randomised, placebo-controlled, double-blind, combined multiple-ascending dose (MAD) and phase 2a study was done at 11 study sites (hospitals and contract research organisations) in Germany. We enrolled patients aged 18-65 years with controlled type 2 diabetes (glycated haemoglobin A1c [HbA1c] levels of 6·5-8·5% at screening) and a body-mass index between 27 kg/m2 and 40 kg/m2. An interactive web-response system was used to randomly assign patients to receive MEDI0382 or placebo. Patients were randomly assigned 2:1 in cohorts A-C and 3:1 in cohorts D and E in the MAD portion of the study, and 1:1 in the phase 2a portion. Randomisation was done by a contracted third-party operator who was not involved in the clinical operations of the study. The pharmacists, participants, and study site personnel involved in treating and assessing participants were masked to treatment allocation. Patients received once-daily subcutaneous injections of the study drug at doses of no more than 300 μg for 22 days or less in the MAD portion of the study, and a dose of no more than 200 μg for 41 days or less in the phase 2a portion. The two primary endpoints of the phase 2a portion were the change from baseline to day 41 in glucose area under the curve at 0-4 h (AUC0-4 h) after a mixed-meal tolerance test (MMTT), assessed in all participants who received at least one dose of study drug and whose measurements were taken at baseline and day 41, and change from baseline in bodyweight, assessed in the intention-to-treat (ITT) population. Safety analyses were done in all participants who received any study drug analysed according to the treatment they received. This study is registered with ClinicalTrials.gov, number NCT02548585. FINDINGS: Patients were recruited between Dec 9, 2015, and Feb 24, 2017. 61 patients were randomly assigned to the MAD part of the study (42 to MEDI0382 and 19 to placebo). 51 patients were randomly assigned to the phase 2a part, of whom 25 were randomly assigned to MEDI0382 and 26 to placebo. In the phase 2a study, three patients in the MEDI0382 group and one in the placebo group discontinued, all as a result of adverse events. 22 (88%) patients in the MEDI0382 group and 25 (96%) in the placebo group received at least one dose and had measurements taken at baseline and day 41. Glucose AUC0-4 h post MMTT decreased significantly with MEDI0382 versus placebo (least squares [LS] mean -32·78% [90% CI -36·98 to -28·57] vs -10·16% [-14·10 to -6·21], and the mean difference was -22·62% [-28·40 to -16·85]; p<0·0001). In the ITT population, reduction in bodyweight was significantly greater with MEDI0382 than with placebo (LS mean -3·84 kg [90% CI -4·55 to -3·12] vs -1·70 kg [-2·40 to -1·01] and mean difference of 2·14 kg [-3·13 to -1·31]; p=0·0008). The proportion of patients who had a treatment-emergent adverse event (TEAE) was similar between treatment groups (22 [88%] of 25 in the MEDI0382 group vs 23 [88%] of 26 in the placebo group); gastrointestinal disorders (18 [72%] vs 13 [40%]) and decreased appetite (five [20%] vs none) occurred more frequently with MEDI0382 than placebo. No participants in the MEDI0382 group had a grade 3 or worse TEAE (vs two [8%] in the placebo group). INTERPRETATION: MEDI0382 has the potential to deliver clinically meaningful reductions in blood glucose and bodyweight in obese or overweight individuals with type 2 diabetes. FUNDING: MedImmune."},{"id":"539fd2e89a85","type":"article","url":"https://hartvaat.nl/2018/06/21/ibrutinib-plus-rituximab-bij-waldenstrom-nejm-fase-3-trial/","title":"Ibrutinib plus rituximab bij Waldenström: NEJM fase-3-trial","title_en":"Phase 3 Trial of Ibrutinib plus Rituximab in Waldenström's Macroglobulinemia.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1802917","source_url":"https://doi.org/10.1056/NEJMoa1802917","authors":["Meletios A Dimopoulos","Alessandra Tedeschi","Judith Trotman","Ramón García-Sanz","David Macdonald","Veronique Leblond","Beatrice Mahe","Charles Herbaux","Constantine Tam","Lorella Orsucci","M Lia Palomba","Jeffrey V Matous","Chaim Shustik","Efstathios Kastritis","Steven P Treon","Jianling Li","Zeena Salman","Thorsten Graef","Christian Buske"],"significance":6,"published":"2018-06-21","source_date":"2018-06-21","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial of ibrutinib plus rituximab in Waldenström's macroglobulinemia is relevant to cardio-oncology due to the well-documented association between ibrutinib therapy and atrial fibrillation and hypertension.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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 fase-3-trial van ibrutinib plus rituximab bij de ziekte van Waldenström. Cardio-oncologisch relevant vanwege ibrutinib-geassocieerd AF-risico.","abstract_original":"BACKGROUND: Single-agent ibrutinib has shown substantial activity in patients with relapsed Waldenström's macroglobulinemia, a rare form of B-cell lymphoma. We evaluated the effect of adding ibrutinib to rituximab in patients with this disease, both in those who had not received previous treatment and in those with disease recurrence. METHODS: We randomly assigned 150 symptomatic patients to receive ibrutinib plus rituximab or placebo plus rituximab. The primary end point was progression-free survival, as assessed by an independent review committee. Key secondary end points were response rates, sustained hematologic improvement from baseline, and safety. The mutational status of MYD88 and CXCR4 was assessed in bone marrow samples. RESULTS: At 30 months, the progression-free survival rate was 82% with ibrutinib-rituximab versus 28% with placebo-rituximab (hazard ratio for progression or death, 0.20; P<0.001). The benefit in the ibrutinib-rituximab group over that in the placebo-rituximab group was independent of the MYD88 or CXCR4 genotype. The rate of major response was higher with ibrutinib-rituximab than with placebo-rituximab (72% vs. 32%, P<0.001). More patients had sustained increases in hemoglobin level with ibrutinib-rituximab than with placebo-rituximab (73% vs. 41%, P<0.001). The most common adverse events of any grade with ibrutinib-rituximab included infusion-related reactions, diarrhea, arthralgia, and nausea. Events of grade 3 or higher that occurred more frequently with ibrutinib-rituximab than with placebo-rituximab included atrial fibrillation (12% vs. 1%) and hypertension (13% vs. 4%); those that occurred less frequently included infusion reactions (1% vs. 16%) and any grade of IgM flare (8% vs. 47%). The major hemorrhage rate was the same in the two trial groups (4%). CONCLUSIONS: Among patients with Waldenström's macroglobulinemia, the use of ibrutinib-rituximab resulted in significantly higher rates of progression-free survival than the use of placebo-rituximab, both among those who had received no previous treatment and among those with disease recurrence. Atrial fibrillation and hypertension were more common with ibrutinib-rituximab, whereas infusion reactions and IgM flare were more common with placebo-rituximab. (Funded by Pharmacyclics and Janssen Research and Development; ClinicalTrials.gov number, NCT02165397 .)."},{"id":"2d34ad5f225e","type":"article","url":"https://hartvaat.nl/2018/06/21/cpap-en-cardiovasculaire-events-bij-obstructieve-slaapapneu-meta-analyse/","title":"CPAP en cardiovasculaire events bij obstructieve slaapapneu: meta-analyse","title_en":"A meta-analysis of continuous positive airway pressure therapy in prevention of cardiovascular events in patients with obstructive sleep apnoea.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bradycardie","slaapapneu"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx597","source_url":"https://doi.org/10.1093/eurheartj/ehx597","authors":["Safi U Khan","Crystal A Duran","Hammad Rahman","Manidhar Lekkala","Muhammad A Saleem","Edo Kaluski"],"significance":7,"published":"2018-06-21","source_date":"2018-06-21","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This meta-analysis found that CPAP therapy does not significantly reduce major cardiovascular events in patients with obstructive sleep apnea, disappointing expectations that treating nocturnal airway obstruction would translate to cardiovascular protection.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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 naar het effect van CPAP op cardiovasculaire events bij patiënten met obstructieve slaapapneu. Teleurstellend: geen significante reductie ondanks verbetering van de slaapkwaliteit.","abstract_original":"AIMS: To assess whether continuous positive airway pressure (CPAP) therapy reduces major adverse cardiovascular events (MACE) in patients with moderate-to-severe obstructive sleep apnoea (OSA). METHODS AND RESULTS: A total of 235 articles were recovered using MEDLINE, EMBASE and Cochrane library (inception-December 2016) and references contained in the identified articles. Seven randomized controlled trials (RCTs) were selected for final analysis. Analysis of 4268 patients demonstrated non-significant 26% relative risk reduction in MACE with CPAP [risk ratio (RR) 0.74; 95% confidence interval (CI) 0.47-1.17; P = 0.19, I2 = 48%]. A series of sensitivity analyses suggested that increased CPAP usage time yielded significant risk reduction in MACE. and stroke. Subgroup analysis revealed that CPAP adherence time ≥4 hours (h)/night reduced the risk of MACE by 57% (RR 0.43; 95% CI 0.23-0.80; P = 0.01, I2 = 0%). CPAP therapy showed no beneficial effect on myocardial infarction (MI), all-cause mortality, atrial fibrillation/flutter (AF), or heart failure (HF) (P > 0.05). CPAP had positive effect on mood and reduced the daytime sleepiness [Epworth Sleepiness Scale (ESS): mean difference (MD) -2.50, 95% CI - 3.62, -1.39; P < 0.001, I2 = 81%]. CONCLUSION: CPAP therapy might reduce MACE and stroke among subjects with CPAP time exceeding 4 h/night. Additional randomized trials mandating adequate CPAP time adherence are required to confirm this impression."},{"id":"fae846210711","type":"article","url":"https://hartvaat.nl/2018/06/19/cardioprotectieve-therapieen-en-area-at-risk-bij-gereperfuseerd-stemi-cmr-analys/","title":"Cardioprotectieve therapieën en area at risk bij gereperfuseerd STEMI: CMR-analyse","title_en":"Impact of Cardioprotective Therapies on the Edema-Based Area at Risk by CMR in Reperfused STEMI.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiac-mri","farmaco-economie","gedilateerde-cardiomyopathie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.04.016","source_url":"https://doi.org/10.1016/j.jacc.2018.04.016","authors":["Heerajnarain Bulluck","Mervyn H H Chan","Valeria Paradies","Jennifer A Bryant","Sauri Hernández-Reséndiz","Hector A Cabrera-Fuentes","Timothy J Watson","Mark Y Chan","Jack W Tan","Derek J Hausenloy"],"significance":5,"published":"2018-06-19","source_date":"2018-06-19","image":"","kennis":[],"congress":"","summary_en":"This CMR study assessed the impact of cardioprotective therapies on the edema-based area at risk in reperfused STEMI, evaluating whether the salvageable myocardium is affected by various protective interventions.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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 de impact van cardioprotectieve therapieën op het oedeem-gebaseerde area at risk bij gereperfuseerd STEMI middels cardiac MRI.","abstract_original":""},{"id":"a062c0b42c2f","type":"article","url":"https://hartvaat.nl/2018/06/14/langetermijnuitkomsten-bij-angina-zonder-obstructief-coronairlijden-systematisch/","title":"Langetermijnuitkomsten bij angina zonder obstructief coronairlijden: systematische review","title_en":"Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","stabiel-coronairlijden","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy185","source_url":"https://doi.org/10.1093/eurheartj/ehy185","authors":["Francesco Radico","Marco Zimarino","Fabio Fulgenzi","Fabrizio Ricci","Marta Di Nicola","Lasse Jespersen","Su Min Chang","Karin H Humphries","Mario Marzilli","Raffaele De Caterina"],"significance":6,"published":"2018-06-14","source_date":"2018-06-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This systematic review characterized the long-term clinical outcomes of patients with angina but without obstructive coronary artery disease, showing that this common presentation is not entirely benign and carries meaningful cardiovascular risk.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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 naar determinanten van langetermijnuitkomsten bij patiënten met angina maar zonder obstructief coronairlijden. Onderkende entiteit met relevante prognose.","abstract_original":"AIMS: The long-term prognosis of angina in patients without obstructive coronary artery disease (CAD) is uncertain. To assess the incidence of long-term adverse outcomes in such patients. METHODS AND RESULTS: We searched PubMed, Cochrane Library, the Embase database, and the Clinical Trials Registry for studies published in English until January 2017, assessing the composite primary outcome of all-cause death and non-fatal myocardial infarction using random-effects models to estimate pooled incidences. We identified 54 studies, reporting outcomes in overall 35 039 patients (mean age 56, male/female ratio 0.51, 99 770 person-years) with angina and no obstructive CAD. After a median follow-up of 5 years (interquartile range 3-7 years), the pooled incidence of the primary outcome was 0.98/100 person-years [95% confidence interval (CI) 0.77-1.19%], with considerable heterogeneity among studies (I2 = 91%, P < 0.001). The primary outcome was associated with prevalent dyslipidaemia (P = 0.016), diabetes (P = 0.035), and hypertension (P = 0.016). Studies enrolling patients with less-than-obstructive CAD showed a higher incidence of the primary outcome (1.32/100 person-years, 95% CI 1.02-1.62) compared with studies including only patients with 'entirely normal' coronary arteries (0.52/100 person-years, 95% CI 0.34-0.79, respectively; P < 0.01). The incidence of the primary outcome did not differ significantly between studies enrolling only patients with documented myocardial ischaemia and those studies enrolling patients regardless of presence of ischaemia. However, ischaemia documented by non-invasive imaging techniques was associated with a higher incidence of events (P = 0.02). Overall, these patients, however, suffered from a high incidence of recurrent hospitalization. CONCLUSION: Angina without obstructive CAD has a heterogeneous prognosis. A main determinant of major adverse events is the presence of 'some' coronary atherosclerosis, with unequivocal myocardial ischaemia being associated with worse clinical outcomes. Patients' quality of life is also worsened by the high incidence of hospitalization, angina recurrence, and repeated coronary angiography."},{"id":"13772fcd7077","type":"article","url":"https://hartvaat.nl/2018/06/12/sglt2-remmers-en-cardiovasculaire-events-de-cvd-real-2-real-world-studie/","title":"SGLT2-remmers en cardiovasculaire events: de CVD-REAL 2 real-world studie","title_en":"Cardiovascular Events Associated With SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL 2 Study.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.03.009","source_url":"https://doi.org/10.1016/j.jacc.2018.03.009","authors":["Mikhail Kosiborod","Carolyn S P Lam","Shun Kohsaka","Dae Jung Kim","Avraham Karasik","Jonathan Shaw","Navdeep Tangri","Su-Yen Goh","Marcus Thuresson","Hungta Chen","Filip Surmont","Niklas Hammar","Peter Fenici"],"significance":7,"published":"2018-06-12","source_date":"2018-06-12","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The CVD-REAL 2 study provided real-world evidence from 6 countries confirming that SGLT2 inhibitor use is associated with lower cardiovascular events and mortality compared with other glucose-lowering drugs in type 2 diabetes, extending the trial evidence to routine clinical practice.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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":"CVD-REAL 2 studie die real-world data uit 6 landen verzamelde over SGLT2-remmers en cardiovasculaire events bij diabetes. Bevestigt de EMPA-REG en CANVAS bevindingen in de praktijk.","abstract_original":"BACKGROUND: Randomized trials demonstrated a lower risk of cardiovascular (CV) events with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) in patients with type 2 diabetes (T2D) at high CV risk. Prior real-world data suggested similar SGLT-2i effects in T2D patients with a broader risk profile, but these studies focused on heart failure and death and were limited to the United States and Europe. OBJECTIVES: The purpose of this study was to examine a broad range of CV outcomes in patients initiated on SGLT-2i versus other glucose-lowering drugs (oGLDs) across 6 countries in the Asia Pacific, the Middle East, and North American regions. METHODS: New users of SGLT-2i and oGLDs were identified via claims, medical records, and national registries in South Korea, Japan, Singapore, Israel, Australia, and Canada. Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching. Hazard ratios (HRs) for death, hospitalization for heart failure (HHF), death or HHF, MI, and stroke were assessed by country and pooled using weighted meta-analysis. RESULTS: After propensity-matching, there were 235,064 episodes of treatment initiation in each group; ∼27% had established CV disease. Patient characteristics were well-balanced between groups. Dapagliflozin, empagliflozin, ipragliflozin, canagliflozin, tofogliflozin, and luseogliflozin accounted for 75%, 9%, 8%, 4%, 3%, and 1% of exposure time in the SGLT-2i group, respectively. Use of SGLT-2i versus oGLDs was associated with a lower risk of death (HR: 0.51; 95% confidence interval [CI]: 0.37 to 0.70; p < 0.001), HHF (HR: 0.64; 95% CI: 0.50 to 0.82; p = 0.001), death or HHF (HR: 0.60; 95% CI: 0.47 to 0.76; p < 0.001), MI (HR: 0.81; 95% CI: 0.74 to 0.88; p < 0.001), and stroke (HR: 0.68; 95% CI: 0.55 to 0.84; p < 0.001). Results were directionally consistent across both countries and patient subgroups, including those with and without CV disease. CONCLUSIONS: In this large, international study of patients with T2D from the Asia Pacific, the Middle East, and North America, initiation of SGLT-2i was associated with a lower risk of CV events across a broad range of outcomes and patient characteristics. (Comparative Effectiveness of Cardiovascular Outcomes in New Users of SGLT-2 Inhibitors [CVD-REAL]; NCT02993614)."},{"id":"966093b38adf","type":"article","url":"https://hartvaat.nl/2018/06/09/dabigatran-bij-myocardschade-na-niet-cardiale-chirurgie-lancet-manage-trial/","title":"Dabigatran bij myocardschade na niet-cardiale chirurgie: Lancet MANAGE-trial","title_en":"Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["iaso-dcm"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30832-8","source_url":"https://doi.org/10.1016/S0140-6736(18)30832-8","authors":["P J Devereaux","Emmanuelle Duceppe","Gordon Guyatt","Vikas Tandon","Reitze Rodseth","Bruce M Biccard","Denis Xavier","Wojciech Szczeklik","Christian S Meyhoff","Jessica Vincent","Maria Grazia Franzosi","Sadeesh K Srinathan","Jason Erb","Patrick Magloire","John Neary","Mangala Rao","Prashant V Rahate","Navneet K Chaudhry","Bongani Mayosi","Miriam de Nadal","Pilar Paniagua Iglesias","Otavio Berwanger","Juan Carlos Villar","Fernando Botto","John W Eikelboom","Daniel I Sessler","Clive Kearon","Shirley Pettit","Mukul Sharma","Stuart J Connolly","Shrikant I Bangdiwala","Purnima Rao-Melacini","Andreas Hoeft","Salim Yusuf"],"significance":8,"published":"2018-06-09","source_date":"2018-06-09","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The MANAGE trial showed that low-dose dabigatran reduced the composite of vascular events in patients with myocardial injury after non-cardiac surgery (MINS), providing the first randomized evidence for anticoagulation therapy in this common but undertreated perioperative complication.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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":"Lancet MANAGE gerandomiseerde trial die dabigatran onderzocht bij patiënten met myocardschade na niet-cardiale chirurgie. Eerste trial die perioperatieve anticoagulatie bij troponinestijging onderzocht.","abstract_original":"BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. METHODS: In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries. Eligible patients were aged at least 45 years, had undergone non-cardiac surgery, and were within 35 days of MINS. Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally twice daily or matched placebo for a maximum of 2 years or until termination of the trial and, using a partial 2-by-2 factorial design, patients not taking a proton-pump inhibitor were also randomly assigned (1:1) to omeprazole 20 mg once daily, for which results will be reported elsewhere, or matched placebo to measure its effect on major upper gastrointestinal complications. Research personnel randomised patients through a central 24 h computerised randomisation system using block randomisation, stratified by centre. Patients, health-care providers, data collectors, and outcome adjudicators were masked to treatment allocation. The primary efficacy outcome was the occurrence of a major vascular complication, a composite of vascular mortality and non-fatal myocardial infarction, non-haemorrhagic stroke, peripheral arterial thrombosis, amputation, and symptomatic venous thromboembolism. The primary safety outcome was a composite of life-threatening, major, and critical organ bleeding. Analyses were done according to the intention-to-treat principle. This trial is registered with ClinicalTrials.gov, number NCT01661101. FINDINGS: Between Jan 10, 2013, and July 17, 2017, we randomly assigned 1754 patients to receive dabigatran (n=877) or placebo (n=877); 556 patients were also randomised in the omeprazole partial factorial component. Study drug was permanently discontinued in 401 (46%) of 877 patients allocated to dabigatran and 380 (43%) of 877 patients allocated to placebo. The composite primary efficacy outcome occurred in fewer patients randomised to dabigatran than placebo (97 [11%] of 877 patients assigned to dabigatran vs 133 [15%] of 877 patients assigned to placebo; hazard ratio [HR] 0·72, 95% CI 0·55-0·93; p=0·0115). The primary safety composite outcome occurred in 29 patients (3%) randomised to dabigatran and 31 patients (4%) randomised to placebo (HR 0·92, 95% CI 0·55-1·53; p=0·76). INTERPRETATION: Among patients who had MINS, dabigatran 110 mg twice daily lowered the risk of major vascular complications, with no significant increase in major bleeding. Patients with MINS have a poor prognosis; dabigatran 110 mg twice daily has the potential to help many of the 8 million adults globally who have MINS to reduce their risk of a major vascular complication [corrected]. FUNDING: Boehringer Ingelheim and Canadian Institutes of Health Research."},{"id":"df1113cec2e8","type":"article","url":"https://hartvaat.nl/2018/06/09/endovasculaire-echografie-renale-denervatie-lancet-radiance-htn-solo/","title":"Endovasculaire echografie renale denervatie: Lancet RADIANCE-HTN SOLO","title_en":"Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)31082-1","source_url":"https://doi.org/10.1016/S0140-6736(18)31082-1","authors":["Michel Azizi","Roland E Schmieder","Felix Mahfoud","Michael A Weber","Joost Daemen","Justin Davies","Jan Basile","Ajay J Kirtane","Yale Wang","Melvin D Lobo","Manish Saxena","Lida Feyz","Florian Rader","Philipp Lurz","Jeremy Sayer","Marc Sapoval","Terry Levy","Kintur Sanghvi","Josephine Abraham","Andrew S P Sharp","Naomi D L Fisher","Michael J Bloch","Helen Reeve-Stoffer","Leslie Coleman","Christopher Mullin","Laura Mauri"],"significance":8,"published":"2018-06-09","source_date":"2018-06-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"The RADIANCE-HTN SOLO trial showed that endovascular ultrasound-based renal denervation significantly reduced daytime ambulatory blood pressure compared with a sham procedure in patients with hypertension not receiving antihypertensive medication. The second-generation ultrasound approach demonstrated improved procedural precision.","created":"2026-07-03T10:27:20Z","updated":"2026-07-03T13:26:35Z","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":"Lancet RADIANCE-HTN SOLO trial van ultrageluid-gebaseerde renale denervatie bij hypertensie. Tweede generatie RDN met verbeterd studieontwerp — sham-gecontroleerd.","abstract_original":"BACKGROUND: Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patients with moderate hypertension. We investigated whether an alternative technology using endovascular ultrasound renal denervation reduces ambulatory blood pressure in patients with hypertension in the absence of antihypertensive medications. METHODS: RADIANCE-HTN SOLO was a multicentre, international, single-blind, randomised, sham-controlled trial done at 21 centres in the USA and 18 in Europe. Patients with combined systolic-diastolic hypertension aged 18-75 years were eligible if they had ambulatory blood pressure greater than or equal to 135/85 mm Hg and less than 170/105 mm Hg after a 4-week discontinuation of up to two antihypertensive medications and had suitable renal artery anatomy. Patients were randomised (1:1) to undergo renal denervation with the Paradise system (ReCor Medical, Palo Alto, CA, USA) or a sham procedure consisting of renal angiography only. The randomisation sequence was computer generated and stratified by centres with randomised blocks of four or six and permutation of treatments within each block. Patients and outcome assessors were blinded to randomisation. The primary effectiveness endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Patients were to remain off antihypertensive medications throughout the 2 months of follow-up unless specified blood pressure criteria were exceeded. Major adverse events included all-cause mortality, renal failure, an embolic event with end-organ damage, renal artery or other major vascular complications requiring intervention, or admission to hospital for hypertensive crisis within 30 days and new renal artery stenosis within 6 months. This study is registered with ClinicalTrials.gov, number NCT02649426. FINDINGS: Between March 28, 2016, and Dec 28, 2017, 803 patients were screened for eligibility and 146 were randomised to undergo renal denervation (n=74) or a sham procedure (n=72). The reduction in daytime ambulatory systolic blood pressure was greater with renal denervation (-8·5 mm Hg, SD 9·3) than with the sham procedure (-2·2 mm Hg, SD 10·0; baseline-adjusted difference between groups: -6·3 mm Hg, 95% CI -9·4 to -3·1, p=0·0001). No major adverse events were reported in either group. INTERPRETATION: Compared with a sham procedure, endovascular ultrasound renal denervation reduced ambulatory blood pressure at 2 months in patients with combined systolic-diastolic hypertension in the absence of medications. FUNDING: ReCor Medical."},{"id":"0de66a6708e0","type":"article","url":"https://hartvaat.nl/2018/06/09/renale-denervatie-met-antihypertensiva-lancet-spyral-htn-on-med-6-maandsresultat/","title":"Renale denervatie met antihypertensiva: Lancet SPYRAL HTN-ON MED 6-maandsresultaten","title_en":"Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie","sacubitril-valsartan"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30951-6","source_url":"https://doi.org/10.1016/S0140-6736(18)30951-6","authors":["David E Kandzari","Michael Böhm","Felix Mahfoud","Raymond R Townsend","Michael A Weber","Stuart Pocock","Konstantinos Tsioufis","Dimitrios Tousoulis","James W Choi","Cara East","Sandeep Brar","Sidney A Cohen","Martin Fahy","Garrett Pilcher","Kazuomi Kario"],"significance":8,"published":"2018-06-09","source_date":"2018-06-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"The SPYRAL HTN-ON MED 6-month results demonstrated that renal denervation significantly reduced blood pressure in patients with uncontrolled hypertension who were also receiving antihypertensive medications. The finding confirmed additive blood pressure lowering on top of drug therapy.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:35Z","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":"Lancet SPYRAL HTN-ON MED 6-maandsresultaten van renale denervatie bij ongecontroleerde hypertensie met achtergrondmedicatie. Bevestigt additioneel bloeddrukverlagend effect van RDN.","abstract_original":"BACKGROUND: Previous catheter-based renal denervation studies have reported variable efficacy results. We aimed to evaluate safety and blood pressure response after renal denervation or sham control in patients with uncontrolled hypertension on antihypertensive medications with drug adherence testing. METHODS: In this international, randomised, single-blind, sham-control, proof-of-concept trial, patients with uncontrolled hypertension (aged 20-80 years) were enrolled at 25 centres in the USA, Germany, Japan, UK, Australia, Austria, and Greece. Eligible patients had an office systolic blood pressure of between 150 mm Hg and 180 mm Hg and a diastolic blood pressure of 90 mm Hg or higher; a 24 h ambulatory systolic blood pressure of between 140 mm Hg and 170 mm Hg at second screening; and were on one to three antihypertensive drugs with stable doses for at least 6 weeks. Patients underwent renal angiography and were randomly assigned to undergo renal denervation or sham control. Patients, caregivers, and those assessing blood pressure were masked to randomisation assignments. The primary efficacy endpoint was blood pressure change from baseline (measured at screening visit two), based on ambulatory blood pressure measurements assessed at 6 months, as compared between treatment groups. Drug surveillance was used to assess medication adherence. The primary analysis was done in the intention-to-treat population. Safety events were assessed through 6 months as per major adverse events. This trial is registered with ClinicalTrials.gov, number NCT02439775, and follow-up is ongoing. FINDINGS: Between July 22, 2015, and June 14, 2017, 467 patients were screened and enrolled. This analysis presents results for the first 80 patients randomly assigned to renal denervation (n=38) and sham control (n=42). Office and 24 h ambulatory blood pressure decreased significantly from baseline to 6 months in the renal denervation group (mean baseline-adjusted treatment differences in 24 h systolic blood pressure -7·0 mm Hg, 95% CI -12·0 to -2·1; p=0·0059, 24 h diastolic blood pressure -4·3 mm Hg, -7·8 to -0·8; p=0.0174, office systolic blood pressure -6·6 mm Hg, -12·4 to -0·9; p=0·0250, and office diastolic blood pressure -4·2 mm Hg, -7·7 to -0·7; p=0·0190). The change in blood pressure was significantly greater at 6 months in the renal denervation group than the sham-control group for office systolic blood pressure (difference -6·8 mm Hg, 95% CI -12·5 to -1·1; p=0·0205), 24 h systolic blood pressure (difference -7·4 mm Hg, -12·5 to -2·3; p=0·0051), office diastolic blood pressure (difference -3·5 mm Hg, -7·0 to -0·0; p=0·0478), and 24 h diastolic blood pressure (difference -4·1 mm Hg, -7·8 to -0·4; p=0·0292). Evaluation of hourly changes in 24 h systolic blood pressure and diastolic blood pressure showed blood pressure reduction throughout 24 h for the renal denervation group. 3 month blood pressure reductions were not significantly different between groups. Medication adherence was about 60% and varied for individual patients throughout the study. No major adverse events were recorded in either group. INTERPRETATION: Renal denervation in the main renal arteries and branches significantly reduced blood pressure compared with sham control with no major safety events. Incomplete medication adherence was common. FUNDING: Medtronic."},{"id":"f460337af1b1","type":"article","url":"https://hartvaat.nl/2018/06/05/verlaagde-dosis-prasugrel-versus-standaard-clopidogrel-bij-oudere-acs-patienten/","title":"Verlaagde dosis prasugrel versus standaard clopidogrel bij oudere ACS-patiënten","title_en":"Comparison of Reduced-Dose Prasugrel and Standard-Dose Clopidogrel in Elderly Patients With Acute Coronary Syndromes Undergoing Early Percutaneous Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032180","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032180","authors":["Stefano Savonitto","Luca A Ferri","Luigi Piatti","Daniele Grosseto","Giancarlo Piovaccari","Nuccia Morici","Irene Bossi","Paolo Sganzerla","Giovanni Tortorella","Michele Cacucci","Maurizio Ferrario","Ernesto Murena","Girolamo Sibilio","Stefano Tondi","Anna Toso","Sergio Bongioanni","Amelia Ravera","Elena Corrada","Matteo Mariani","Leonardo Di Ascenzo","A Sonia Petronio","Claudio Cavallini","Giancarlo Vitrella","Renata Rogacka","Roberto Antonicelli","Bruno M Cesana","Leonardo De Luca","Filippo Ottani","Giuseppe De Luca","Federico Piscione","Nadia Moffa","Stefano De Servi"],"significance":7,"published":"2018-06-05","source_date":"2018-06-05","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/cardiometabool/peripartum-cardiomyopathie/"],"congress":"","summary_en":"This comparison of reduced-dose prasugrel with standard clopidogrel in elderly ACS patients undergoing early invasive management showed prasugrel had similar ischemic efficacy but more bleeding, informing antiplatelet selection in the older population.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:34Z","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":"Vergelijking van verlaagde dosis prasugrel met standaard clopidogrel bij oudere (≥75 jaar) ACS-patiënten die vroege invasieve behandeling ondergaan.","abstract_original":"BACKGROUND: Elderly patients are at elevated risk of both ischemic and bleeding complications after an acute coronary syndrome and display higher on-clopidogrel platelet reactivity compared with younger patients. Prasugrel 5 mg provides more predictable platelet inhibition compared with clopidogrel in the elderly, suggesting the possibility of reducing ischemic events without increasing bleeding. METHODS: In a multicenter, randomized, open-label, blinded end point trial, we compared a once-daily maintenance dose of prasugrel 5 mg with the standard clopidogrel 75 mg in patients >74 years of age with acute coronary syndrome undergoing percutaneous coronary intervention. The primary end point was the composite of mortality, myocardial infarction, disabling stroke, and rehospitalization for cardiovascular causes or bleeding within 1 year. The study was designed to demonstrate superiority of prasugrel 5 mg over clopidogrel 75 mg. RESULTS: Enrollment was interrupted, according to prespecified criteria, after a planned interim analysis, when 1443 patients (40% women; mean age, 80 years) had been enrolled with a median follow-up of 12 months, because of futility for efficacy. The primary end point occurred in 121 patients (17%) with prasugrel and 121 (16.6%) with clopidogrel (hazard ratio, 1.007; 95% confidence interval, 0.78-1.30; P=0.955). Definite/probable stent thrombosis rates were 0.7% with prasugrel versus 1.9% with clopidogrel (odds ratio, 0.36; 95% confidence interval, 0.13-1.00; P=0.06). Bleeding Academic Research Consortium types 2 and greater rates were 4.1% with prasugrel versus 2.7% with clopidogrel (odds ratio, 1.52; 95% confidence interval, 0.85-3.16; P=0.18). CONCLUSIONS: The present study in elderly patients with acute coronary syndromes showed no difference in the primary end point between reduced-dose prasugrel and standard-dose clopidogrel. However, the study should be interpreted in light of the premature termination of the trial. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01777503."},{"id":"301772e2906d","type":"article","url":"https://hartvaat.nl/2018/06/01/fgf-23-en-recidiverende-cv-events-na-acs/","title":"FGF-23 en recidiverende CV-events na ACS","title_en":"Association of Fibroblast Growth Factor 23 With Recurrent Cardiovascular Events in Patients After an Acute Coronary Syndrome: A Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.0653","source_url":"https://doi.org/10.1001/jamacardio.2018.0653","authors":["Brian A Bergmark","Jacob A Udell","David A Morrow","Christopher P Cannon","Dylan L Steen","Petr Jarolim","Andrzej Budaj","Christian Hamm","Jianping Guo","KyungAh Im","Julia F Kuder","Eugene Braunwald","Marc S Sabatine","Michelle L O'Donoghue"],"significance":5,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"This study identified FGF-23 as a predictor of recurrent cardiovascular events after ACS, establishing this phosphate-regulating hormone as a novel biomarker linking mineral metabolism to cardiovascular risk.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:34Z","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 analyse naar de associatie van fibroblast growth factor 23 met recidiverende cardiovasculaire events na ACS. FGF-23 als cardiorenal risicobiomarker.","abstract_original":"IMPORTANCE: Elevated fibroblast growth factor 23 (FGF-23) concentrations are associated with myocardial fibrosis and renin-angiotensin system upregulation, potentially providing prognostic information distinct from standard cardiovascular (CV) biomarkers. OBJECTIVE: To evaluate the association of FGF-23 with recurrent CV events in patients after an acute coronary syndrome (ACS). DESIGN, SETTING, AND PARTICIPANTS: C-terminal FGF-23 was measured in plasma samples using an established enzyme-linked immunosorbent assay system for 4947 patients within 30 days of ACS (median, 14 days) and with 1 additional CV risk factor in the Stabilization of Plaques Using Darapladib-Thrombolysis in Myocardial Infarction 52 (SOLID-TIMI 52) trial of the lipoprotein-associated phospholipase A2 inhibitor darapladib vs placebo performed from December 1, 2009, to April 24, 2014 (median follow-up, 2.5 years). Analyses were adjusted for clinical risk factors, renal function, and established cardiorenal biomarkers. This secondary analysis was performed from September 25, 2014, to October 1, 2017. EXPOSURE: The FGF-23 concentration at baseline. MAIN OUTCOMES AND MEASURES: The primary end point for this post hoc analysis was the composite of CV death or hospitalization for heart failure. RESULTS: In this study, baseline FGF-23 concentrations were available for 4947 patients (median age, 64.0 years; interquartile range, 59.0-71.0 years; 1276 [25.8%] female). Patients with higher FGF-23 concentrations were older and more likely female, with a greater proportion of hypertension, diabetes, and previous myocardial infarction. After multivariable adjustment for baseline clinical characteristics and established biomarkers (high-sensitivity troponin I, brain-type natriuretic peptide, and high-sensitivity C-reactive protein), FGF-23 concentration in the top quartile was independently associated with an increased risk of CV death or heart failure hospitalization (adjusted hazard ratio [HR], 2.35; 95% CI, 1.82-3.02; P < .001) and its individual components. Elevated FGF-23 concentration was also associated with an increased risk of all-cause mortality (adjusted HR, 2.27; 95% CI, 1.73-2.97; P < .001) and CV death, myocardial infarction, or stroke (adjusted HR, 1.42; 95% CI, 1.17-1.71; P < .001). When analyses were stratified by patient sex, the association between FGF-23 and CV risk, including CV death or heart failure, appeared to be attenuated in women (adjusted HR, 1.11; 95% CI, 0.70-1.76; P = .67) compared with men (HR, 3.11; 95% CI, 2.29-4.22; P < .001; P < .001 for interaction). CONCLUSIONS AND RELEVANCE: In patients stabilized after ACS, elevated FGF-23 concentrations may be associated with recurrent major CV events and all-cause mortality, providing information independent of established clinical risk factors and cardiorenal biomarkers. A potential sex difference in these findings deserves further study."},{"id":"4630d7149fdf","type":"article","url":"https://hartvaat.nl/2018/06/01/maatschappelijk-werker-palliatieve-zorg-bij-hoogrisico-hf-swap-hf-pilot/","title":"Maatschappelijk werker-palliatieve zorg bij hoogrisico-HF: SWAP-HF pilot","title_en":"Social Worker-Aided Palliative Care Intervention in High-risk Patients With Heart Failure (SWAP-HF): A Pilot Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.0589","source_url":"https://doi.org/10.1001/jamacardio.2018.0589","authors":["Arden E O'Donnell","Kristen G Schaefer","Lynne W Stevenson","Kristen DeVoe","Kayley Walsh","Mandeep R Mehra","Akshay S Desai"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This SWAP-HF pilot trial tested a social worker-led palliative care intervention for high-risk heart failure patients, demonstrating feasibility and preliminary evidence for improved quality of life with early palliative care integration.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:34Z","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 pilot trial van een maatschappelijk werker-geleide palliatieve zorginterventie bij hoogrisico hartfalenpatiënten.","abstract_original":"IMPORTANCE: Palliative care considerations are typically introduced late in the disease trajectory of patients with advanced heart failure (HF), and access to specialty-level palliative care may be limited. OBJECTIVE: To determine if early initiation of goals of care conversations by a palliative care-trained social worker would improve prognostic understanding, elicit advanced care preferences, and influence care plans for high-risk patients discharged after HF hospitalization. DESIGN, SETTING, AND PARTICIPANTS: This prospective, randomized clinical trial of a social worker-led palliative care intervention vs usual care analyzed patients recently hospitalized for management of acute HF who had risk factors for poor prognosis. Analyses were conducted by intention to treat. INTERVENTIONS: Key components of the social worker-led intervention included a structured evaluation of prognostic understanding, end-of-life preferences, symptom burden, and quality of life with routine review by a palliative care physician; communication of this information to treating clinicians; and longitudinal follow-up in the ambulatory setting. MAIN OUTCOMES AND MEASURES: Percentage of patients with physician-level documentation of advanced care preferences and the degree of alignment between patient and cardiologist expectations of prognosis at 6 months. RESULTS: The study population (N = 50) had a mean (SD) age of 72 (11) years and had a mean (SD) left ventricular ejection fraction of 0.33 (13). Of 50 patients, 41 (82%) had been hospitalized more than once for HF management within 12 months of enrollment. At enrollment, treating physicians anticipated death within a year for 32 patients (64%), but 42 patients (84%) predicted their life expectancy to be longer than 5 years. At 6 months, more patients in the intervention group than in the control group had physician-level documentation of advanced care preferences in the electronic health record (17 [65%] vs 8 [33%]; χ2 = 5.1; P = .02). Surviving patients allocated to intervention were also more likely to revise their baseline prognostic assessment in a direction consistent with the physician's assessment (15 [94%] vs 4 [26%]; χ2 = 14.7; P < .001). Among the 31 survivors at 6 months, there was no measured difference between groups in depression, anxiety, or quality-of-life scores. CONCLUSIONS AND RELEVANCE: Patients at high risk for mortality from HF frequently overestimate their life expectancy. Without an adverse impact on quality of life, prognostic understanding and patient-physician communication regarding goals of care may be enhanced by a focused, social worker-led palliative care intervention that begins in the hospital and continues in the outpatient setting. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02805712."},{"id":"7615856bf0fd","type":"article","url":"https://hartvaat.nl/2018/06/01/sacubitril-valsartan-en-fysieke-en-sociale-activiteitsbeperkingen-bij-hf-paradig/","title":"Sacubitril/valsartan en fysieke en sociale activiteitsbeperkingen bij HF: PARADIGM-HF","title_en":"Effects of Sacubitril/Valsartan on Physical and Social Activity Limitations in Patients With Heart Failure: A Secondary Analysis of the PARADIGM-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","sacubitril-valsartan"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.0398","source_url":"https://doi.org/10.1001/jamacardio.2018.0398","authors":["Alvin Chandra","Eldrin F Lewis","Brian L Claggett","Akshay S Desai","Milton Packer","Michael R Zile","Karl Swedberg","Jean L Rouleau","Victor C Shi","Martin P Lefkowitz","Tzvetana Katova","John J V McMurray","Scott D Solomon"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This PARADIGM-HF secondary analysis showed that sacubitril-valsartan significantly improves physical and social activity limitations compared with enalapril in HFrEF, demonstrating patient-centered functional benefits.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:34Z","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 secundaire PARADIGM-HF analyse naar het effect van sacubitril/valsartan op fysieke en sociale activiteitsbeperkingen. Patiëntgerapporteerde uitkomsten.","abstract_original":"IMPORTANCE: Health-related quality of life (HRQL) of patients with heart failure is markedly reduced compared with that in patients with other chronic diseases, demonstrating substantial limitations in physical and social activities. In the Prospective Comparison of ARNI With an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial, sacubitril/valsartan improved overall HRQL compared with enalapril, as determined by the Kansas City Cardiomyopathy Questionnaire (KCCQ). OBJECTIVE: To examine the effects of sacubitril/valsartan on physical and social activities. DESIGN, SETTING, AND PARTICIPANTS: The PARADIGM-HF trial was a randomized, double-blind, active treatment-controlled clinical trial performed from December 8, 2009, to March 31, 2014, in 8399 patients with New York Heart Association class II to IV disease and a left ventricular ejection fraction of 40% or less at 1043 centers in 38 countries. Data analysis was performed from August 1, 2017, to December 25, 2017. INTERVENTIONS: Sacubitril/valsartan, 200 mg twice daily, or enalapril, 10 mg twice daily. MAIN OUTCOMES AND MEASURES: Patients completed HRQL assessments using the KCCQ at randomization, 4-month, 8-month, and annual visits. The effect of sacubitril/valsartan on components of the physical and social limitation sections of the KCCQ at 8 months and longitudinally and related biomarkers and clinical outcomes were studied. RESULTS: At baseline, 7618 of 8399 patients (90.7%) (mean [SD] age, 64 [11] years; 5987 [78.6%] male and 1631 [21.4%] female) completed the initial KCCQ assessment. Patients reported the greatest limitations at baseline in jogging and sexual relationships. Patients receiving sacubitril/valsartan had significantly better adjusted change scores in most physical and social activities at 8 months and during 36 months compared with those receiving enalapril. The largest improvement over enalapril was in household chores (adjusted change score difference, 2.35; 95% CI, 1.19-3.50; P < .001) and sexual relationships (adjusted change score difference, 2.72; 95% CI, 0.97-4.46; P = .002); both persisted through 36 months (overall change score difference, 1.69 [95% CI, 0.78-2.60], P < .001; and 2.36 [95% CI, 1.01-3.71], P = .001, respectively). CONCLUSIONS AND RELEVANCE: In patients with heart failure with reduced ejection fraction, sacubitril/valsartan significantly improved nearly all KCCQ physical and social activities compared with enalapril, with the largest responses in household chores and sexual relationships. In addition to reduced likelihood of cardiovascular death, all-cause mortality, and heart failure hospitalization, sacubitril/valsartan may improve limitations in common activities in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01035255."},{"id":"42bec50776c0","type":"article","url":"https://hartvaat.nl/2018/06/01/intensieve-versus-standaard-bloeddruk-naar-tertielen-in-sprint/","title":"Intensieve versus standaard bloeddruk naar tertielen in SPRINT","title_en":"Impact of Intensive Versus Standard Blood Pressure Management by Tertiles of Blood Pressure in SPRINT (Systolic Blood Pressure Intervention Trial).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10646","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10646","authors":["Brian P Shapiro","Walter T Ambrosius","Joseph L Blackshear","William C Cushman","Paul K Whelton","Suzanne Oparil","Srinivasan Beddhu","Jamie P Dwyer","Lisa H Gren","William J Kostis","Michael Lioudis","Roberto Pisoni","Clive Rosendorff","William E Haley"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This SPRINT analysis stratified the benefit of intensive blood pressure treatment by baseline blood pressure tertiles, showing that patients across all starting pressures benefit from intensive management.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:34Z","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 analyse die het effect van intensieve versus standaard bloeddrukbehandeling onderzocht gestratificeerd naar bloeddruktertielen bij baseline.","abstract_original":"Intensive systolic blood pressure (SBP) control improved outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Our objective was to expand on reported findings by analysis of baseline characteristics, primary outcomes, adverse events, follow-up blood pressure, and medication use differences by baseline SBP (tertile 1 [T1], <132; tertile 2 [T2], 132-145; and tertile 3 [T3], >145 mm Hg). Participants with higher baseline SBP tertile were more often women and older, had higher cardiovascular risk, and lower utilization of antihypertensive medications, statins, and aspirin. Achieved SBP in both treatment arms was slightly higher in T2 and T3 compared with T1 and fewer in the T3 groups achieved SBP targets compared with T1 and T2 groups. The primary composite outcome with intensive versus standard SBP treatment was reduced by 30% in T1, 23% in T2, and 17% in T3 with no evidence of an interaction (P=0.77). Event rates were lower in the intensive arm, and there was no evidence that this benefit differed by SBP tertile. There was no difference in the hazard for serious adverse events in any of the 3 tertiles. Medication utilization differed across the SBP tertiles at baseline with a lesser percentage of diuretics and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker drugs in the higher tertiles-a finding that reversed during the trial. The beneficial effects of intensive SBP lowering were not modified by the level of baseline SBP. Within the parameters of this population, these findings add support for clinicians to treat blood pressure to goal irrespective of baseline SBP."},{"id":"57f4ae96301e","type":"article","url":"https://hartvaat.nl/2018/06/01/amenorroe-duur-bij-start-antihypertensiva-in-de-zwangerschap-chips-secundaire-an/","title":"Amenorroe-duur bij start antihypertensiva in de zwangerschap: CHIPS secundaire analyse","title_en":"Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study).","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10689","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10689","authors":["Anouk Pels","Ben Willem J Mol","Joel Singer","Terry Lee","Peter von Dadelszen","Wessel Ganzevoort","Elizabeth Asztalos","Laura A Magee"],"significance":5,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/"],"congress":"","summary_en":"This CHIPS secondary analysis examined whether gestational age at antihypertensive therapy initiation influences outcomes in chronic hypertension during pregnancy, evaluating the timing of treatment start.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:34Z","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":"CHIPS secundaire analyse naar de invloed van zwangerschapsduur bij start van antihypertensieve therapie op uitkomsten bij chronische hypertensie in de zwangerschap.","abstract_original":"UNLABELLED: For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight <10th centile (Pinteraction=0.005), but more preterm birth (Pinteraction=0.043), and no effect on perinatal death or high-level neonatal care >48 hours (Pinteraction=0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks (Pinteraction=0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. CLINICAL TRIAL REGISTRATION: URL: https://www.isrctn.com. Unique identifier: ISRCTN71416914."},{"id":"76ab68c1abb7","type":"article","url":"https://hartvaat.nl/2018/06/01/interarmbloeddrukverschil-en-beroerte-ipd-meta-analyse/","title":"Interarmbloeddrukverschil en beroerte: IPD meta-analyse","title_en":"Simultaneously Measured Interarm Blood Pressure Difference and Stroke: An Individual Participants Data Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["perifeer-vaatlijden"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.118.10923","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.118.10923","authors":["Hirofumi Tomiyama","Toshiaki Ohkuma","Toshiharu Ninomiya","Chisa Mastumoto","Kazuomi Kario","Satoshi Hoshide","Yoshikuni Kita","Toyoshi Inoguchi","Yasutaka Maeda","Katsuhiko Kohara","Yasuharu Tabara","Motoyuki Nakamura","Takayoshi Ohkubo","Hirotaka Watada","Masanori Munakata","Mitsuru Ohishi","Norihisa Ito","Michinari Nakamura","Tetsuo Shoji","Charalambos Vlachopoulos","Akira Yamashina"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis showed that simultaneously measured interarm blood pressure difference predicts stroke risk, supporting routine bilateral measurement as a simple screening tool for vascular asymmetry.","created":"2026-07-03T10:27:19Z","updated":"2026-07-03T13:26:34Z","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":"Individuele patiëntdata meta-analyse naar het verband tussen simultaan gemeten interarmbloeddrukverschil en beroerterisico. Eenvoudige klinische marker voor vasculair risico.","abstract_original":"We conducted individual participant data meta-analysis to examine the validity of interarm blood pressure difference in simultaneous measurement as a marker to identify subjects with ankle-brachial pressure index <0.90 and to predict future cardiovascular events. We collected individual participant data on 13 317 Japanese subjects from 10 cohorts (general population-based cohorts, cohorts of patients with past history of cardiovascular events, and those with cardiovascular risk factors). Binary logistic regression analysis with adjustments identified interarm blood pressure difference >5 mm Hg as being associated with a significant odds ratio for the presence of ankle-brachial pressure index <0.90 (odds ratio, 2.19; 95% confidence interval, 1.60-3.03; P<0.01). Among 11 726 subjects without a past history of cardiovascular disease, 249 developed stroke during the average follow-up period of 7.4 years. Interarm blood pressure difference >15 mm Hg was associated with a significant Cox stratified adjusted hazard ratio for subsequent stroke (hazard ratio, 2.42; 95% confidence interval, 1.27-4.60; P<0.01). Therefore, interarm blood pressure differences, measured simultaneously in both arms, may be associated with vascular damage in the systemic arterial tree. These differences may be useful for identifying subjects with an ankle-brachial pressure index of <0.90 in the overall study population, and also a reliable predictor of future stroke in subjects without a past history of cardiovascular disease. These findings support the recommendation to measure blood pressure in both arms at the first visit."},{"id":"b58c8e74e13d","type":"article","url":"https://hartvaat.nl/2018/06/01/hemodynamische-effecten-van-levosimendan-bij-gevorderd-stabiel-chronisch-hartfal/","title":"Hemodynamische effecten van levosimendan bij gevorderd stabiel chronisch hartfalen","title_en":"Haemodynamic effects of levosimendan in advanced but stable chronic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12272","source_url":"https://doi.org/10.1002/ehf2.12272","authors":["Emil Najjar","Marcus Stålhberg","Camilla Hage","Erica Ottenblad","Aristomenis Manouras","Ida Haugen Löfman","Lars H Lund"],"significance":5,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"This study characterized the hemodynamic effects of levosimendan in advanced but stable chronic heart failure, evaluating the rationale for intermittent inotropic support in the outpatient advanced HF setting.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 levosimendan bij patiënten met gevorderd maar stabiel chronisch hartfalen. Evaluatie van inotrope ondersteuning bij ambulante patiënten.","abstract_original":"AIMS: Levosimendan improves haemodynamics in acute decompensated heart failure (HF). However, it is increasingly used for repetitive or intermittent infusions in advanced but stable chronic HF, without clear indication, selection criteria, or effect. We tested the hypotheses that (1) levosimendan improves haemodynamics in stable chronic HF and (2) that the response is dependent on baseline clinical and haemodynamic factors. METHODS AND RESULTS: Twenty-three patients [median age 56 (49-64) years, four (17%) women] with stable New York Heart Association (NYHA) III and IV HF received a single 24 h levosimendan infusion. Non-invasive haemodynamics (inert gas re-breathing technique), estimated glomerular filtration rate, and N-terminal pro-brain natriuretic peptide were assessed before and after infusion. Levosimendan had the following effects (median change): a significant increase in cardiac output (+9.8 ± 21.6%; P = 0.026) and decrease in N-terminal pro-brain natriuretic peptide (-28.1 ± 16.3%, P < 0.001), estimated total peripheral resistance (-16.9 ± 18.3%, P = 0.005), and mean arterial pressure (-5.9 ± 8.2%, P = 0.007), but no change in estimated glomerular filtration rate (+0.89 ± 14.0%, P = 0.955). There were no significant associations between baseline clinical and/or haemodynamic factors and the levosimendan effect on cardiac output. CONCLUSIONS: Levosimendan was associated with improved haemodynamics in patients with stable chronic HF, but we could not identify any predictors of the magnitude of haemodynamic response."},{"id":"3eb596ea57c8","type":"article","url":"https://hartvaat.nl/2018/06/01/implementatie-van-sacubitril-valsartan-in-de-klinische-praktijk-inzichten/","title":"Implementatie van sacubitril/valsartan in de klinische praktijk: inzichten","title_en":"Insights into implementation of sacubitril/valsartan into clinical practice.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12258","source_url":"https://doi.org/10.1002/ehf2.12258","authors":["Pieter Martens","Hanne Beliën","Matthias Dupont","Wilfried Mullens"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This practice analysis provided insights into the real-world implementation of sacubitril-valsartan in heart failure clinics, identifying barriers (hypotension, renal concerns) and facilitators for achieving guideline-recommended ARNI uptake.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T13:26:34Z","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":"Praktijkanalyse die inzichten biedt in de implementatie van sacubitril/valsartan in de dagelijkse hartfalenzorg. Barrières en facilitatoren voor adoptie.","abstract_original":"BACKGROUND: Sacubitril/valsartan significantly reduced heart failure hospitalization and mortality in PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With an Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure). However, real-world data from its use are lacking. METHODS AND RESULTS: We retrospectively assessed all baseline and follow-up data of consecutive heart failure patients with reduced ejection fraction receiving therapy with sacubitril/valsartan for Class I recommendation between December 2016 and July 2017. Baseline characteristics and dose titration of sacubitril/valsartan were compared between patients in clinical practice and in PARADIGM-HF. A total of 120 patients (81% male) were switched from angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to sacubitril/valsartan. A total of 20.1% of patients received dose uptitration. Patients were treated with an equipotential dose of renin-angiotensin system blockers before and after uptitration of sacubitril/valsartan (57 ± 29% vs. 53 ± 29% of target dose indicated by European Society of Cardiology guidelines; P = 0.286). However, they received a lower dose of sacubitril/valsartan in comparison with those in the PARADIGM-HF (219 ± 12 vs. 375 ± 75 mg; P < 0.001). In comparison with the patients receiving sacubitril/valsartan in PARADIGM-HF, patients in clinical practice were older and had a higher serum creatinine, higher New York Heart Association functional classification, and lower left ventricular ejection fraction (all P-value <0.05). Even in comparison with patients who experienced dropout during the run-in phase of PARADIGM-HF, real-world patients exhibited baseline characteristics indicative of more disease severity. Patients were at high absolute baseline risk for adverse outcome as illustrated by the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) risk score of 6 (inter-quartile range 3), in comparison with 5 (inter-quartile range 4) in PARADIGM-HF. After initiation of sacubitril/valsartan, New York Heart Association class significantly improved (P < 0.001), but systolic blood pressure dropped more than was reported in PARADIGM-HF (7.1 ± 8.0 vs. 3.2 ± 0.4 mmHg; P < 0.001). CONCLUSIONS: Patients in clinical practice exhibit baseline characteristics associated with more severe disease, which might lead to prescription of lower doses. Nevertheless, patients in clinical practice are at high risk of adverse outcome as illustrated by the EMPHASIS-HF risk score, underscoring the large potential for sacubitril/valsartan therapy to reduce the risk of heart failure hospitalization and all-cause mortality."},{"id":"63b18afa48c0","type":"article","url":"https://hartvaat.nl/2018/06/01/complementactivatie-bij-acuut-hartfalen-na-mi-correlatie-met-ernst/","title":"Complementactivatie bij acuut hartfalen na MI: correlatie met ernst","title_en":"Acute heart failure following myocardial infarction: complement activation correlates with the severity of heart failure in patients developing cardiogenic shock.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12266","source_url":"https://doi.org/10.1002/ehf2.12266","authors":["Hilde L Orrem","Per H Nilsson","Søren E Pischke","Guro Grindheim","Peter Garred","Ingebjørg Seljeflot","Trygve Husebye","Pål Aukrust","Arne Yndestad","Geir Ø Andersen","Andreas Barratt-Due","Tom E Mollnes"],"significance":5,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that complement activation correlates with heart failure severity following acute MI, providing immunological insights into the pathogenesis of post-infarction cardiac dysfunction.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T13:26:33Z","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":"Studie die aantoont dat complementactivatie correleert met de ernst van hartfalen bij patiënten met acuut MI. Immunologische mechanismen bij acuut HF.","abstract_original":"AIMS: Heart failure (HF) is an impending complication to myocardial infarction. We hypothesized that the degree of complement activation reflects severity of HF following acute myocardial infarction. METHODS AND RESULTS: The LEAF trial (LEvosimendan in Acute heart Failure following myocardial infarction) evaluating 61 patients developing HF within 48 h after percutaneous coronary intervention-treated ST-elevation myocardial infarction herein underwent a post hoc analysis. Blood samples were drawn from inclusion to Day 5 and at 42 day follow-up, and biomarkers were measured with enzyme immunoassays. Regional myocardial contractility was measured by echocardiography as wall motion score index (WMSI). The cardiogenic shock group (n = 9) was compared with the non-shock group (n = 52). Controls (n = 44) were age-matched and sex-matched healthy individuals. C4bc, C3bc, C3bBbP, and sC5b-9 were elevated in patients at inclusion compared with controls (P < 0.01). The shock group had higher levels compared with the non-shock group for all activation products except C3bBbP (P < 0.05). At Day 42, all products were higher in the shock group (P < 0.05). In the shock group, sC5b-9 correlated significantly with WMSI at baseline (r = 0.68; P = 0.045) and at Day 42 (r = 0.84; P = 0.036). Peak sC5b-9 level correlated strongly with WMSI at Day 42 (r = 0.98; P = 0.005). Circulating endothelial cell activation markers sICAM-1 and sVCAM-1 were higher in the shock group during the acute phase (P < 0.01), and their peak levels correlated with sC5b-9 peak level in the whole HF population (r = 0.32; P = 0.014 and r = 0.30; P = 0.022, respectively). CONCLUSIONS: Complement activation discriminated cardiogenic shock from non-shock in acute ST-elevation myocardial infarction complicated by HF and correlated with regional contractility and endothelial cell activation, suggesting a pathogenic role of complement in this condition."},{"id":"ef74e21cb07b","type":"article","url":"https://hartvaat.nl/2018/06/01/geindividualiseerd-patiromer-doseringsregime-bij-hf-met-ckd-en-hyperkaliemie/","title":"Geïndividualiseerd patiromer-doseringsregime bij HF met CKD en hyperkaliëmie","title_en":"Evaluation of an individualized dose titration regimen of patiromer to prevent hyperkalaemia in patients with heart failure and chronic kidney disease.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","ijzertekort","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12265","source_url":"https://doi.org/10.1002/ehf2.12265","authors":["Bertram Pitt","David A Bushinsky","Dalane W Kitzman","Frank Ruschitzka","Marco Metra","Gerasimos Filippatos","Patrick Rossignol","Charles Du Mond","Dahlia Garza","Lance Berman","Mitja Lainscak"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"This study evaluated an individualized patiromer dosing regimen for preventing hyperkalemia in heart failure patients with CKD, demonstrating that tailored potassium management enables optimized RAAS inhibitor therapy.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T13:26:33Z","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":"Studie naar een geïndividualiseerd doseringsregime van patiromer ter preventie van hyperkaliëmie bij patiënten met hartfalen en chronische nierziekte.","abstract_original":"AIMS: Hyperkalaemia risk precludes optimal renin-angiotensin-aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a sodium-free, non-absorbed potassium (K+ )-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16.4 g/day) followed by individualized titration in preventing hyperkalaemia and hypokalaemia when initiating spironolactone. METHODS AND RESULTS: This open-label 8-week study enrolled 63 patients with CKD, serum K+ 4.3-5.1 mEq/L, and chronic HF, who, based on investigator opinion, should receive spironolactone. Eligible patients started spironolactone 25 mg/day and patiromer 16.8 g/day (divided into two doses), with patiromer titrated to maintain serum K+ 4.0-5.1 mEq/L. Mean (standard deviation) serum K+ was 4.78 (0.51) mEq/L at baseline; weekly values were 4.48-4.70 mEq/L during treatment. Serum K+ of 3.5-5.5 mEq/L at the end of study treatment (primary endpoint) was achieved by 57 (90.5%) patients; 53 (84.1%) had serum K+ 4.0-5.1 mEq/L. One patient (1.6%) developed hypokalaemia, and two patients (3.2%) developed hypomagnesaemia. Spironolactone was increased to 50 mg/day in all patients; 43 (68%) patients required one or more patiromer dose titration. Adverse events (AEs) occurred in 36 (57.1%) patients, with a low rate of discontinuations [four (6.3%) patients]. The most common AE was mild to moderate abdominal discomfort [four (6.3%) patients]. CONCLUSIONS: In this open-label study, patiromer 16.8 g/day followed by individualized titration maintained serum K+ within the target range in the majority of patients with HF and CKD, all of whom were uptitrated to spironolactone 50 mg/day, patiromer was well tolerated, with a low incidence of hyperkalaemia, hypokalaemia, and hypomagnesaemia."},{"id":"614726e07bf6","type":"article","url":"https://hartvaat.nl/2018/06/01/ivabradine-bij-hartfalen-door-chagas-ziekte-shift-post-hoc-analyse/","title":"Ivabradine bij hartfalen door Chagas-ziekte: SHIFT post-hoc analyse","title_en":"Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","iaso-dcm"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12240","source_url":"https://doi.org/10.1002/ehf2.12240","authors":["Edimar Alcides Bocchi","Salvador Rassi","Guilherme Veiga Guimarães"],"significance":5,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"This SHIFT post-hoc analysis confirmed the safety and efficacy of ivabradine in heart failure due to Chagas cardiomyopathy, extending the evidence for heart rate reduction to this specific tropical cardiomyopathy.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 SHIFT-trial naar de veiligheid en werkzaamheid van ivabradine bij Chagas-cardiomyopathie. Uitbreiding naar een tropische etiologie.","abstract_original":"AIMS: The SHIFT trial showed that ivabradine reduced heart rate (HR) and the risk of cardiovascular outcomes. Concerns remain over the efficacy and safety of ivabradine on heart failure (HF) due to Chagas disease (ChD). We therefore conducted a post hoc analysis of the SHIFT trial to investigate the effect of ivabradine in these patients. METHODS AND RESULTS: SHIFT was a randomized, double-blind, placebo-controlled trial in symptomatic systolic stable HF, HR ≥ 70 b.p.m., and in sinus rhythm. The ChD HF subgroup included 38 patients, 20 on ivabradine, and 18 on placebo. The ChD HF subgroup showed high prevalence of bundle branch right block and, compared with the overall SHIFT population, lower systolic blood pressure; higher use of diuretics, cardiac glycosides, and antialdosterone agents; and lower use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker or target daily dose of beta-blocker. ChD HF presented a poor prognosis (all-cause mortality at 2 years was ~60%). The mean twice-daily dose of ivabradine was 6.26 ± 1.15 mg and placebo 6.43 ± 1.55 mg. Ivabradine reduced HR from 77.9 ± 3.8 to 62.3 ± 10.1 b.p.m. (P = 0.005) and improved functional class (P = 0.02). A trend towards reduction in all-cause death was observed in ivabradine arm vs. placebo (P = 0.07). Ivabradine was not associated with serious bradycardia, atrioventricular block, hypotension, or syncope. CONCLUSIONS: ChD HF is an advanced form of HF with poor prognosis. Ivabradine was effective in reducing HR in these patients and improving functional class. Although our results are based on a very limited sample and should be interpreted with caution, they suggest that ivabradine may have a favourable benefit-risk profile in ChD HF patients."},{"id":"995a920f3a10","type":"article","url":"https://hartvaat.nl/2018/06/01/preventie-van-atriumfibrilleren-beoordeling-van-huidig-bewijs/","title":"Preventie van atriumfibrilleren: beoordeling van huidig bewijs","title_en":"Atrial fibrillation prevention: an appraisal of current evidence.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["hartrevalidatie","primaire-preventie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311546","source_url":"https://doi.org/10.1136/heartjnl-2017-311546","authors":["Giuseppe Boriani","Marco Proietti"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"This comprehensive review evaluated the evidence for AF prevention, covering lifestyle modifications (weight loss, exercise, alcohol reduction), pharmacological upstream therapy, and structural interventions for reducing AF incidence.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 die het beschikbare bewijs voor AF-preventie evalueert. Overzicht van leefstijlinterventies, farmacologische en interventionele strategieën.","abstract_original":"Atrial fibrillation (AF), which is the most diagnosed arrhythmia, is becoming a significant issue for health policy-makers. In particular, more and more attention is being devoted to AF prevention. Indeed, several studies recently published point out how targeted interventions could be useful in reducing the risk of AF occurrence (or recurrence). In this review, we briefly summarised the role of the major risk factors associated with the incidence of AF, as well as the effectiveness of interventions aimed at controlling these risk factors. Several general risk factors, such as alcohol consumption, physical activity, smoking habit, as well as specific cardiovascular risk factors as diabetes mellitus, hypertension and obesity have a relevant impact in determining the occurrence of AF, along with a strong clinical evidence of a dose-effect response mechanism for most of the factors examined. Specific interventions aimed at controlling risk factors have been showed to clearly reduce the risk of AF in several cohorts. Even more importantly, integrated programmes aimed at controlling for multiple risk factors would be more efficient in terms of reducing risk of AF, in particular whena stricter control is observed. AF prevention requires a series of initiatives focused on the many risk factors that we reviewed, as well as a more integrated approach, which should involve many stakeholders at different levels. In this light and also considering the constantly changing epidemiology, AF prevention may constitute a future 'win-win' strategy for all the stakeholders."},{"id":"9b3d17be7457","type":"article","url":"https://hartvaat.nl/2018/06/01/systematische-review-voor-de-2017-acc-aha-hypertensierichtlijn-hypertension-edit/","title":"Systematische review voor de 2017 ACC/AHA hypertensierichtlijn (Hypertension-editie)","title_en":"Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYP.0000000000000067","source_url":"https://doi.org/10.1161/HYP.0000000000000067","authors":["David M Reboussin","Norrina B Allen","Michael E Griswold","Eliseo Guallar","Yuling Hong","Daniel T Lackland","Edgar Pete R Miller","Tamar Polonsky","Angela M Thompson-Paul","Suma Vupputuri"],"significance":8,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"Hypertension journal publication of the systematic review underlying the 2017 ACC/AHA blood pressure guideline, covering the evidence base for revised definitions, treatment thresholds, and management strategies.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Hypertension-publicatie van de systematische review onderliggend aan de 2017 ACC/AHA hypertensierichtlijn.","abstract_original":"OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS: Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (ie, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome."},{"id":"567c27bee262","type":"article","url":"https://hartvaat.nl/2018/06/01/gwas-van-pr-interval-bij-hispanic-latino-s-nieuw-locus-bij-id2/","title":"GWAS van PR-interval bij Hispanic/Latino's: nieuw locus bij ID2","title_en":"Genome-wide association study of PR interval in Hispanics/Latinos identifies novel locus at ID2.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312045","source_url":"https://doi.org/10.1136/heartjnl-2017-312045","authors":["Amanda A Seyerle","Henry J Lin","Stephanie M Gogarten","Adrienne Stilp","Raul Méndez Giráldez","Elsayed Soliman","Antoine Baldassari","Mariaelisa Graff","Susan Heckbert","Kathleen F Kerr","Charles Kooperberg","Carlos Rodriguez","Xiuqing Guo","Jie Yao","Nona Sotoodehnia","Kent D Taylor","Eric A Whitsel","Jerome I Rotter","Cathy C Laurie","Christy L Avery"],"significance":4,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":[],"congress":"","summary_en":"The first genome-wide association study of PR interval in Hispanic/Latino populations identified a novel genetic locus at ID2 associated with atrial and atrioventricular nodal conduction, addressing an underrepresented group in cardiac genetics research.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T13:26:33Z","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":"Genoomwijde associatiestudie die een nieuw genetisch locus identificeerde bij ID2 dat het PR-interval beïnvloedt in Hispanische/Latino populaties.","abstract_original":"OBJECTIVE: PR interval (PR) is a heritable electrocardiographic measure of atrial and atrioventricular nodal conduction. Changes in PR duration may be associated with atrial fibrillation, heart failure and all-cause mortality. Hispanic/Latino populations have high burdens of cardiovascular morbidity and mortality, are highly admixed and represent exceptional opportunities for novel locus identification. However, they remain chronically understudied. We present the first genome-wide association study (GWAS) of PR in 14 756 participants of Hispanic/Latino ancestry from three studies. METHODS: Study-specific summary results of the association between 1000 Genomes Phase 1 imputed single-nucleotide polymorphisms (SNPs) and PR assumed an additive genetic model and were adjusted for global ancestry, study centre/region and clinical covariates. Results were combined using fixed-effects, inverse variance weighted meta-analysis. Sequential conditional analyses were used to identify independent signals. Replication of novel loci was performed in populations of Asian, African and European descent. ENCODE and RoadMap data were used to annotate results. RESULTS: We identified a novel genome-wide association (P<5×10-8) with PR at ID2 (rs6730558), which replicated in Asian and European populations (P<0.017). Additionally, we generalised 10 previously identified PR loci to Hispanics/Latinos. Bioinformatics annotation provided evidence for regulatory function in cardiac tissue. Further, for six loci that generalised, the Hispanic/Latino index SNP was genome-wide significant and identical to (or in high linkage disequilibrium with) the previously identified GWAS lead SNP. CONCLUSIONS: Our results suggest that genetic determinants of PR are consistent across race/ethnicity, but extending studies to admixed populations can identify novel associations, underscoring the importance of conducting genetic studies in diverse populations."},{"id":"78f4e83becb3","type":"article","url":"https://hartvaat.nl/2018/05/19/des-versus-bms-in-veneuze-bypass-grafts-lancet-dubbelblinde-trial/","title":"DES versus BMS in veneuze bypass grafts: Lancet dubbelblinde trial","title_en":"Drug-eluting stents versus bare-metal stents in saphenous vein grafts: a double-blind, randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["newton-cabg"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30801-8","source_url":"https://doi.org/10.1016/S0140-6736(18)30801-8","authors":["Emmanouil S Brilakis","Robert Edson","Deepak L Bhatt","Steven Goldman","David R Holmes","Sunil V Rao","Kendrick Shunk","Bavana V Rangan","Kreton Mavromatis","Kodangudi Ramanathan","Anthony A Bavry","Santiago Garcia","Faisal Latif","Ehrin Armstrong","Hani Jneid","Todd A Conner","Todd Wagner","Judit Karacsonyi","Lauren Uyeda","Beverly Ventura","Aaron Alsleben","Ying Lu","Mei-Chiung Shih","Subhash Banerjee"],"significance":7,"published":"2018-05-19","source_date":"2018-05-19","image":"","kennis":[],"congress":"","summary_en":"This Lancet double-blind trial compared drug-eluting with bare-metal stents specifically in saphenous vein grafts, providing unique evidence for stent selection in the bypass graft setting where the lesion biology differs from native coronary disease.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T13:26:33Z","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":"Lancet dubbelblinde gerandomiseerde trial die DES vergeleek met BMS specifiek in safeneuze bypass grafts. Uniek bewijs voor stentkeuze in venegrafts.","abstract_original":"BACKGROUND: Few studies have examined the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure compared with bare-metal stents (BMS) in patients undergoing stenting of de-novo SVG lesions. We assessed the risks and benefits of the use of DES versus BMS in de-novo SVG lesions. METHODS: Patients were recruited to our double-blind, randomised controlled trial from 25 US Department of Veterans Affairs centres. Eligible participants were aged at least 18 years and had at least one significant de-novo SVG lesion (50-99% stenosis of a 2·25-4·5 mm diameter SVG) requiring percutaneous coronary intervention with intent to use embolic protection devices. Enrolled patients were randomly assigned, in a 1:1 ratio, by phone randomisation system to receive a DES or BMS. Randomisation was stratified by presence or absence of diabetes and number of target SVG lesions requiring percutaneous coronary intervention (one or two or more) within each participating site by use of an adaptive scheme intended to balance the two stent type groups on marginal totals for the stratification factors. Patients, referring physicians, study coordinators, and outcome assessors were masked to group allocation. The primary endpoint was the 12-month incidence of target vessel failure, defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularisation. The DIVA trial is registered with ClinicalTrials.gov, number NCT01121224. FINDINGS: Between Jan 1, 2012, and Dec 31, 2015, 599 patients were randomly assigned to the stent groups, and the data for 597 patients were used. The patients' mean age was 68·6 (SD 7·6) years, and 595 (>99%) patients were men. The two stent groups were similar for most baseline characteristics. At 12 months, the incidence of target vessel failure was 17% (51 of 292) in the DES group versus 19% (58 of 305) in the BMS group (adjusted hazard ratio 0·92, 95% CI 0·63-1·34, p=0·70). Between-group differences in the components of the primary endpoint, serious adverse events, or stent thrombosis were not significant. Enrolment was stopped before the revised target sample size of 762 patients was reached. INTERPRETATION: In patients undergoing stenting of de-novo SVG lesions, no significant differences in outcomes between those receiving DES and BMS during 12 months of follow-up were found. The study results have important economic implications in countries with high DES prices such as the USA, because they suggest that the lower-cost BMS can be used in SVG lesions without compromising either safety or efficacy. FUNDING: US Department of Veterans Affairs Cooperative Studies Program."},{"id":"ecadf213a69e","type":"article","url":"https://hartvaat.nl/2018/05/15/liraglutide-bij-diabetes-type-2-met-polyvasculaire-ziekte-leader-analyse/","title":"Liraglutide bij diabetes type 2 met polyvasculaire ziekte: LEADER-analyse","title_en":"Effect of Liraglutide on Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Polyvascular Disease: Results of the LEADER Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-type-2"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.033898","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.033898","authors":["Subodh Verma","Deepak L Bhatt","Stephen C Bain","John B Buse","Johannes F E Mann","Steven P Marso","Michael A Nauck","Neil R Poulter","Richard E Pratley","Bernard Zinman","Marie M Michelsen","Tea Monk Fries","Søren Rasmussen","Lawrence A Leiter"],"significance":7,"published":"2018-05-15","source_date":"2018-05-15","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This LEADER subanalysis in patients with polyvascular disease showed that liraglutide reduces cardiovascular events even in the highest-risk diabetic patients with multiple vascular territories affected, supporting GLP-1 agonist use across the cardiovascular risk spectrum.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T13:26:33Z","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":"LEADER subanalyse bij patiënten met polyvasculaire ziekte — de hoogste risicogroep. Liraglutide vermindert CV-events ook bij uitgebreid vaatlijden.","abstract_original":""},{"id":"5110b9eb6f68","type":"article","url":"https://hartvaat.nl/2018/05/15/trombocytenaantal-beinvloedt-werkzaamheid-van-foliumzuur-bij-cva-preventie/","title":"Trombocytenaantal beïnvloedt werkzaamheid van foliumzuur bij CVA-preventie","title_en":"Platelet Count Affects Efficacy of Folic Acid in Preventing First Stroke.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.02.072","source_url":"https://doi.org/10.1016/j.jacc.2018.02.072","authors":["Xiangyi Kong","Xiao Huang","Min Zhao","Benjamin Xu","Richard Xu","Yun Song","Yaren Yu","Wenbin Yang","Jingping Zhang","Lishun Liu","Yan Zhang","Genfu Tang","Binyan Wang","Fan Fan Hou","Ping Li","Xiaoshu Cheng","Shuiping Zhao","Xiaobin Wang","Xianhui Qin","Jianping Li","Yong Huo"],"significance":5,"published":"2018-05-15","source_date":"2018-05-15","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This study showed that platelet count modifies the efficacy of folic acid in preventing first stroke in hypertensive patients, informing personalized approaches to cerebrovascular prevention.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T13:26:33Z","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":"Studie die aantoont dat het trombocytenaantal de werkzaamheid van foliumzuur bij primaire CVA-preventie beïnvloedt. Gepersonaliseerde preventie.","abstract_original":"BACKGROUND: The role of platelets and important effect modifiers on the risk of first stroke is unknown. OBJECTIVES: This study examined whether low platelet count (PLT) and elevated total homocysteine (tHcy) levels jointly increase the risk of first stroke, and, if so, whether folic acid treatment is particularly effective in stroke prevention in such a setting. METHODS: A total of 10,789 Chinese hypertensive adults (mean age 59.5 years; 38% male, with no history of stroke and myocardial infarction) were analyzed from the China Stroke Primary Prevention Trial, where participants were randomly assigned to daily treatments of 10 mg enalapril and 0.8 mg folic acid (n = 5,408) or 10 mg enalapril alone (n = 5,381). The primary endpoint was first stroke. RESULTS: During 4.2 years of follow-up, a total of 371 first strokes occurred. In the enalapril-alone group, the lowest rate of first stroke (3.3%) was found in patients with high PLT (quartiles 2 to 4) and low tHcy (<15 μmol/l); and the highest rate (5.6%) was in patients with low PLT (quartile 1) and high tHcy (≥15 μmol/l) levels. Following folic acid treatment, the high-risk group had a 73% reduction in stroke (hazard ratio: 0.27; 95% confidence interval: 0.11 to 0.64; p = 0.003), whereas there was no significant effect among the low-risk group. CONCLUSIONS: Among Chinese hypertensive adults, the subgroup with low PLT and high tHcy had the highest risk of first stroke, and this risk was reduced by 73% with folic acid treatment. If confirmed, PLT and tHcy could serve as biomarkers to identify high-risk individuals who would particularly benefit from folic acid treatment. (China Stroke Primary Prevention Trial [CSPPT]; NCT00794885)."},{"id":"3e5f99237583","type":"article","url":"https://hartvaat.nl/2018/05/15/systematische-review-voor-de-2017-acc-aha-hypertensierichtlijn/","title":"Systematische review voor de 2017 ACC/AHA hypertensierichtlijn","title_en":"Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.11.004","source_url":"https://doi.org/10.1016/j.jacc.2017.11.004","authors":["David M Reboussin","Norrina B Allen","Michael E Griswold","Eliseo Guallar","Yuling Hong","Daniel T Lackland","Edgar Pete R Miller","Tamar Polonsky","Angela M Thompson-Paul","Suma Vupputuri"],"significance":8,"published":"2018-05-15","source_date":"2018-05-15","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/","https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/"],"congress":"","summary_en":"This systematic review provided the evidence foundation for the 2017 ACC/AHA hypertension guideline, addressing questions about self-monitored blood pressure, ambulatory monitoring, treatment thresholds, and target goals that shaped the updated recommendations.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 evidence base leverde voor de 2017 ACC/AHA-hypertensierichtlijn. Onderbouwt de nieuwe definities en behandeldrempels.","abstract_original":"OBJECTIVE: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? METHODS: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. RESULTS: Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome."},{"id":"26af0e8d5734","type":"article","url":"https://hartvaat.nl/2018/05/14/dubbele-versus-triple-antitrombotische-therapie-bij-af-na-pci-meta-analyse/","title":"Dubbele versus triple antitrombotische therapie bij AF na PCI: meta-analyse","title_en":"Safety and efficacy of dual vs. triple antithrombotic therapy in patients with atrial fibrillation following percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy162","source_url":"https://doi.org/10.1093/eurheartj/ehy162","authors":["Harsh B Golwala","Christopher P Cannon","Ph Gabriel Steg","Gheorghe Doros","Arman Qamar","Stephen G Ellis","Jonas Oldgren","Jurrien M Ten Berg","Takeshi Kimura","Stefan H Hohnloser","Gregory Y H Lip","Deepak L Bhatt"],"significance":8,"published":"2018-05-14","source_date":"2018-05-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This systematic meta-analysis confirmed that dual antithrombotic therapy (DOAC plus P2Y12 inhibitor, without aspirin) reduces bleeding compared with triple therapy in AF patients after PCI, with similar ischemic event rates. The analysis supported the paradigm shift toward aspirin-free regimens.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T13:26:32Z","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":"Systematische meta-analyse die duale versus triple antitrombotische therapie vergeleek bij AF-patiënten na PCI. Bevestigt het gunstigere veiligheidsprofiel van duale therapie.","abstract_original":"AIMS: Of patients with atrial fibrillation (AF), approximately 10% undergo percutaneous coronary intervention (PCI). We studied the safety and efficacy of dual vs. triple antithrombotic therapy (DAT vs. TAT) in this population. METHODS AND RESULTS: A systematic review and meta-analysis was conducted using PubMed, Embase, EBSCO, Cochrane database of systematic reviews, Web of Science, and relevant meeting abstracts for Phase 3, randomized trials that compared DAT vs. TAT in patients with AF following PCI. Four trials including 5317 patients were included, of whom 3039 (57%) received DAT. Compared with the TAT arm, Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding showed a reduction by 47% in the DAT arm [4.3% vs. 9.0%; hazard ratio (HR) 0.53, 95% credible interval (CrI) 0.36-0.85, I2 = 42.9%]. In addition, there was no difference in the trial-defined major adverse cardiac events (MACE) (10.4% vs. 10.0%, HR 0.85, 95% CrI 0.48-1.29, I2 = 58.4%), or in individual outcomes of all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, or stroke between the two arms. CONCLUSION: Compared with TAT, DAT shows a reduction in TIMI major or minor bleeding by 47% with comparable outcomes of MACE. Our findings support the concept that DAT may be a better option than TAT in many patients with AF following PCI."},{"id":"7509083a2d76","type":"article","url":"https://hartvaat.nl/2018/05/08/vasopressine-plus-catecholamines-en-af-bij-distributieve-shock-jama-meta-analyse/","title":"Vasopressine plus catecholamines en AF bij distributieve shock: JAMA meta-analyse","title_en":"Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock: A Systematic Review and Meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.4528","source_url":"https://doi.org/10.1001/jama.2018.4528","authors":["William F McIntyre","Kevin J Um","Waleed Alhazzani","Alexandra P Lengyel","Ludhmila Hajjar","Anthony C Gordon","François Lamontagne","Jeff S Healey","Richard P Whitlock","Emilie P Belley-Côté"],"significance":6,"published":"2018-05-08","source_date":"2018-05-08","image":"","kennis":[],"congress":"","summary_en":"This JAMA meta-analysis showed that adding vasopressin to catecholamine vasopressors in distributive shock is associated with reduced atrial fibrillation incidence, identifying a potential antiarrhythmic benefit of dual vasopressor strategy.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T13:26:32Z","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 meta-analyse naar de associatie van vasopressine-toevoeging aan catecholamines met AF-incidentie bij distributieve shock.","abstract_original":"IMPORTANCE: Vasopressin is an alternative to catecholamine vasopressors for patients with distributive shock-a condition due to excessive vasodilation, most frequently from severe infection. Blood pressure support with a noncatecholamine vasopressor may reduce stimulation of adrenergic receptors and decrease myocardial oxygen demand. Atrial fibrillation is common with catecholamines and is associated with adverse events, including mortality and increased length of stay (LOS). OBJECTIVES: To determine whether treatment with vasopressin + catecholamine vasopressors compared with catecholamine vasopressors alone was associated with reductions in the risk of adverse events. DATA SOURCES: MEDLINE, EMBASE, and CENTRAL were searched from inception to February 2018. Experts were asked and meta-registries searched to identify ongoing trials. STUDY SELECTION: Pairs of reviewers identified randomized clinical trials comparing vasopressin in combination with catecholamine vasopressors to catecholamines alone for patients with distributive shock. DATA EXTRACTION AND SYNTHESIS: Two reviewers abstracted data independently. A random-effects model was used to combine data. MAIN OUTCOMES AND MEASURES: The primary outcome was atrial fibrillation. Other outcomes included mortality, requirement for renal replacement therapy (RRT), myocardial injury, ventricular arrhythmia, stroke, and LOS in the intensive care unit and hospital. Measures of association are reported as risk ratios (RRs) for clinical outcomes and mean differences for LOS. RESULTS: Twenty-three randomized clinical trials were identified (3088 patients; mean age, 61.1 years [14.2]; women, 45.3%). High-quality evidence supported a lower risk of atrial fibrillation associated with vasopressin treatment (RR, 0.77 [95% CI, 0.67 to 0.88]; risk difference [RD], -0.06 [95% CI, -0.13 to 0.01]). For mortality, the overall RR estimate was 0.89 (95% CI, 0.82 to 0.97; RD, -0.04 [95% CI, -0.07 to 0.00]); however, when limited to trials at low risk of bias, the RR estimate was 0.96 (95% CI, 0.84 to 1.11). The overall RR estimate for RRT was 0.74 (95% CI, 0.51 to 1.08; RD, -0.07 [95% CI, -0.12 to -0.01]). However, in an analysis limited to trials at low risk of bias, RR was 0.70 (95% CI, 0.53 to 0.92, P for interaction = .77). There were no significant differences in the pooled risks for other outcomes. CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, the addition of vasopressin to catecholamine vasopressors compared with catecholamines alone was associated with a lower risk of atrial fibrillation. Findings for secondary outcomes varied."},{"id":"8eb6299dc17f","type":"article","url":"https://hartvaat.nl/2018/05/08/hoog-versus-laaggedoseerd-pitavastatine-bij-stabiel-coronairlijden-real-cad/","title":"Hoog- versus laaggedoseerd pitavastatine bij stabiel coronairlijden: REAL-CAD","title_en":"High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["stabiel-coronairlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032615","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032615","authors":["Isao Taguchi","Satoshi Iimuro","Hiroshi Iwata","Hiroaki Takashima","Mitsuru Abe","Eisuke Amiya","Takanori Ogawa","Yukio Ozaki","Ichiro Sakuma","Yoshihisa Nakagawa","Kiyoshi Hibi","Takafumi Hiro","Yoshihiro Fukumoto","Seiji Hokimoto","Katsumi Miyauchi","Tsutomu Yamazaki","Hiroshi Ito","Yutaka Otsuji","Kazuo Kimura","Jun Takahashi","Atsushi Hirayama","Hiroyoshi Yokoi","Kazuo Kitagawa","Takao Urabe","Yasushi Okada","Yasuo Terayama","Kazunori Toyoda","Takehiko Nagao","Masayasu Matsumoto","Yasuo Ohashi","Tetsuji Kaneko","Retsu Fujita","Hiroshi Ohtsu","Hisao Ogawa","Hiroyuki Daida","Hiroaki Shimokawa","Yasushi Saito","Takeshi Kimura","Teruo Inoue","Masunori Matsuzaki","Ryozo Nagai"],"significance":7,"published":"2018-05-08","source_date":"2018-05-08","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/statines-overzicht/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The REAL-CAD superiority trial showed that high-dose pitavastatin reduces cardiovascular events compared with low-dose in Japanese patients with stable coronary disease, confirming the 'more is better' principle for statin therapy in an Asian population.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T13:26:32Z","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":"Japanse REAL-CAD superioriteitstrial die hoog- versus laaggedoseerd pitavastatine vergeleek bij stabiel coronairlijden. Bevestigt dosisafhankelijk voordeel van statines.","abstract_original":"BACKGROUND: Current guidelines call for high-intensity statin therapy in patients with cardiovascular disease on the basis of several previous \"more versus less statins\" trials. However, no clear evidence for more versus less statins has been established in an Asian population. METHODS: In this prospective, multicenter, randomized, open-label, blinded end point study, 13 054 Japanese patients with stable coronary artery disease who achieved low-density lipoprotein cholesterol (LDL-C) <120 mg/dL during a run-in period (pitavastatin 1 mg/d) were randomized in a 1-to-1 fashion to high-dose (pitavastatin 4 mg/d; n=6526) or low-dose (pitavastatin 1 mg/d; n=6528) statin therapy. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization. The secondary composite end point was a composite of the primary end point and clinically indicated coronary revascularization excluding target-lesion revascularization at sites of prior percutaneous coronary intervention. RESULTS: The mean age of the study population was 68 years, and 83% were male. The mean LDL-C level before enrollment was 93 mg/dL with 91% of patients taking statins. The baseline LDL-C level after the run-in period on pitavastatin 1 mg/d was 87.7 and 88.1 mg/dL in the high-dose and low-dose groups, respectively. During the entire course of follow-up, LDL-C in the high-dose group was lower by 14.7 mg/dL than in the low-dose group (P<0.001). With a median follow-up of 3.9 years, high-dose as compared with low-dose pitavastatin significantly reduced the risk of the primary end point (266 patients [4.3%] and 334 patients [5.4%]; hazard ratio, 0.81; 95% confidence interval, 0.69-0.95; P=0.01) and the risk of the secondary composite end point (489 patients [7.9%] and 600 patients [9.7%]; hazard ratio, 0.83; 95% confidence interval, 0.73-0.93; P=0.002). High-dose pitavastatin also significantly reduced the risks of several other secondary end points such as all-cause death, myocardial infarction, and clinically indicated coronary revascularization. The results for the primary and the secondary composite end points were consistent across several prespecified subgroups, including the low (<95 mg/dL) baseline LDL-C subgroup. Serious adverse event rates were low in both groups. CONCLUSIONS: High-dose (4 mg/d) compared with low-dose (1 mg/d) pitavastatin therapy significantly reduced cardiovascular events in Japanese patients with stable coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01042730."},{"id":"03847b439209","type":"article","url":"https://hartvaat.nl/2018/05/08/spontane-coronaire-arterie-dissectie-aha-scientific-statement/","title":"Spontane coronaire arterie dissectie: AHA scientific statement","title_en":"Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["spontane-coronairdissectie"],"journal":"Circulation","doi":"10.1161/CIR.0000000000000564","source_url":"https://doi.org/10.1161/CIR.0000000000000564","authors":["Sharonne N Hayes","Esther S H Kim","Jacqueline Saw","David Adlam","Cynthia Arslanian-Engoren","Katherine E Economy","Santhi K Ganesh","Rajiv Gulati","Mark E Lindsay","Jennifer H Mieres","Sahar Naderi","Svati Shah","David E Thaler","Marysia S Tweet","Malissa J Wood"],"significance":8,"published":"2018-05-08","source_date":"2018-05-08","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/spontane-coronaire-arterie-dissectie/"],"congress":"","summary_en":"This AHA scientific statement provided the first comprehensive review of spontaneous coronary artery dissection (SCAD), covering epidemiology, pathophysiology, diagnosis, and management of this increasingly recognized cause of acute coronary syndrome, particularly in young women.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T13:26:32Z","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":"AHA scientific statement over de huidige kennis van spontane coronaire arterie dissectie (SCAD). Eerste uitgebreide overzicht van deze steeds vaker herkende oorzaak van acuut MI bij jonge vrouwen.","abstract_original":"Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented."},{"id":"9024fe1f31d5","type":"article","url":"https://hartvaat.nl/2018/05/08/nierfunctieverslechtering-bij-acuut-hartfalen-met-agressieve-diurese-geen-tubula/","title":"Nierfunctieverslechtering bij acuut hartfalen met agressieve diurese: geen tubulaire schade","title_en":"Worsening Renal Function in Patients With Acute Heart Failure Undergoing Aggressive Diuresis Is Not Associated With Tubular Injury.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030112","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030112","authors":["Tariq Ahmad","Keyanna Jackson","Veena S Rao","W H Wilson Tang","Meredith A Brisco-Bacik","Horng H Chen","G Michael Felker","Adrian F Hernandez","Christopher M O'Connor","Venkata S Sabbisetti","Joseph V Bonventre","F Perry Wilson","Steven G Coca","Jeffrey M Testani"],"significance":7,"published":"2018-05-08","source_date":"2018-05-08","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"This study demonstrated that worsening renal function during aggressive diuresis for acute heart failure does not reflect tubular injury and is not associated with adverse outcomes. The finding supports pursuing effective decongestion despite transient creatinine rises.","created":"2026-07-03T10:27:17Z","updated":"2026-07-03T13:26:32Z","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 nierfunctieverslechtering bij acuut hartfalen tijdens agressieve diurese niet geassocieerd is met tubulaire nierschade. Geruststellend voor het agressieve diureticabeleid.","abstract_original":"BACKGROUND: Worsening renal function (WRF) in the setting of aggressive diuresis for acute heart failure treatment may reflect renal tubular injury or simply indicate a hemodynamic or functional change in glomerular filtration. Well-validated tubular injury biomarkers, N-acetyl-β-d-glucosaminidase, neutrophil gelatinase-associated lipocalin, and kidney injury molecule 1, are now available that can quantify the degree of renal tubular injury. The ROSE-AHF trial (Renal Optimization Strategies Evaluation-Acute Heart Failure) provides an experimental platform for the study of mechanisms of WRF during aggressive diuresis for acute heart failure because the ROSE-AHF protocol dictated high-dose loop diuretic therapy in all patients. We sought to determine whether tubular injury biomarkers are associated with WRF in the setting of aggressive diuresis and its association with prognosis. METHODS: Patients in the multicenter ROSE-AHF trial with baseline and 72-hour urine tubular injury biomarkers were analyzed (n=283). WRF was defined as a ≥20% decrease in glomerular filtration rate estimated with cystatin C. RESULTS: Consistent with protocol-driven aggressive dosing of loop diuretics, participants received a median 560 mg IV furosemide equivalents (interquartile range, 300-815 mg), which induced a urine output of 8425 mL (interquartile range, 6341-10 528 mL) over the 72-hour intervention period. Levels of N-acetyl-β-d-glucosaminidase and kidney injury molecule 1 did not change with aggressive diuresis (both P>0.59), whereas levels of neutrophil gelatinase-associated lipocalin decreased slightly (-8.7 ng/mg; interquartile range, -169 to 35 ng/mg; P<0.001). WRF occurred in 21.2% of the population and was not associated with an increase in any marker of renal tubular injury: neutrophil gelatinase-associated lipocalin (P=0.21), N-acetyl-β-d-glucosaminidase (P=0.46), or kidney injury molecule 1 (P=0.22). Increases in neutrophil gelatinase-associated lipocalin, N-acetyl-β-d-glucosaminidase, and kidney injury molecule 1 were paradoxically associated with improved survival (adjusted hazard ratio, 0.80 per 10 percentile increase; 95% confidence interval, 0.69-0.91; P=0.001). CONCLUSIONS: Kidney tubular injury does not appear to have an association with WRF in the context of aggressive diuresis of patients with acute heart failure. These findings reinforce the notion that the small to moderate deteriorations in renal function commonly encountered with aggressive diuresis are dissimilar from traditional causes of acute kidney injury."},{"id":"5a2045f24f1a","type":"article","url":"https://hartvaat.nl/2018/05/07/esc-eapci-taskforce-rapport-over-bioresorbeerbare-scaffolds-executive-summary/","title":"ESC-EAPCI taskforce-rapport over bioresorbeerbare scaffolds: executive summary","title_en":"Report of an ESC-EAPCI Task Force on the evaluation and use of bioresorbable scaffolds for percutaneous coronary intervention: executive summary.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx488","source_url":"https://doi.org/10.1093/eurheartj/ehx488","authors":["Robert A Byrne","Giulio G Stefanini","Davide Capodanno","Yoshinobu Onuma","Andreas Baumbach","Javier Escaned","Michael Haude","Stefan James","Michael Joner","Peter Jüni","Adnan Kastrati","Semih Oktay","William Wijns","Patrick W Serruys","Stephan Windecker"],"significance":7,"published":"2018-05-07","source_date":"2018-05-07","image":"","kennis":[],"congress":"","summary_en":"This ESC-EAPCI Task Force report provided an official position statement on bioresorbable scaffolds following the accumulating safety concerns, recommending restricted use and providing guidance for managing patients with implanted devices.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T13:26:32Z","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":"ESC-EAPCI taskforce evaluatierapport over het gebruik van bioresorbeerbare scaffolds voor PCI. Officiele positiebepaling na de veiligheidssignalen.","abstract_original":"A previous Task Force of the European Society of Cardiology (ESC) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) provided a report on recommendations for the non-clinical and clinical evaluation of coronary stents. Following dialogue with the European Commission, the Task Force was asked to prepare an additional report on the class of devices known as bioresorbable scaffolds (BRS). Five BRS have CE-mark approval for use in Europe. Only one device-the Absorb bioresorbable vascular scaffold-has published randomized clinical trial data and this data show inferior outcomes to conventional drug-eluting stents (DES) at 2-3 years. For this reason, at present BRS should not be preferred to conventional DES in clinical practice. The Task Force recommends that new BRS devices should undergo systematic non-clinical testing according to standardized criteria prior to evaluation in clinical studies. A clinical evaluation plan should include data from a medium sized, randomized trial against DES powered for a surrogate end point of clinical efficacy. Manufacturers of successful devices receive CE-mark approval for use and must have an approved plan for a large-scale randomized clinical trial with planned long-term follow-up."},{"id":"daf7bd89f52e","type":"article","url":"https://hartvaat.nl/2018/05/01/farmacogenomisch-gestuurd-antiplaatjestherapie-bij-acs-pharmclo-trial/","title":"Farmacogenomisch gestuurd antiplaatjestherapie bij ACS: PHARMCLO-trial","title_en":"Pharmacogenomic Approach to Selecting Antiplatelet Therapy in Patients With Acute Coronary Syndromes: The PHARMCLO Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.02.029","source_url":"https://doi.org/10.1016/j.jacc.2018.02.029","authors":["Francesca Maria Notarangelo","Giuseppe Maglietta","Paola Bevilacqua","Marco Cereda","Piera Angelica Merlini","Giovanni Quinto Villani","Paolo Moruzzi","Giampiero Patrizi","Guidantonio Malagoli Tagliazucchi","Antonio Crocamo","Angela Guidorossi","Filippo Pigazzani","Elisa Nicosia","Giorgia Paoli","Marco Bianchessi","Mario Angelo Comelli","Caterina Caminiti","Diego Ardissino"],"significance":7,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/"],"congress":"","summary_en":"The PHARMCLO trial of pharmacogenomic-guided antiplatelet selection in ACS was among the first to show that genotype-directed therapy reduces ischemic events, pioneering the application of pharmacogenomics in acute coronary care.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T13:26:32Z","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":"PHARMCLO gerandomiseerde trial naar farmacogenomisch gestuurd antiplaatjesbeleid bij ACS. Pionierswerk in genetica-geleide therapiekeuze voor P2Y12-remmers.","abstract_original":"BACKGROUND: Although clopidogrel is still frequently used in patients with acute coronary syndromes (ACS), its efficacy is hampered by interpatient response variability caused by genetic polymorphisms associated with clopidogrel's metabolism. OBJECTIVES: The goal of this study was to evaluate whether selecting antiplatelet therapy (clopidogrel, prasugrel, or ticagrelor) on the basis of a patient's genetic and clinical characteristics leads to better clinical outcomes compared with the standard of care, which bases the selection on clinical characteristics alone. METHODS: Patients hospitalized for ACS were randomly assigned to standard of care or the pharmacogenomic arm, which included the genotyping of ABCB1, CYP2C19*2, and CYP2C19*17 using an ST Q3 system that provides data within 70 min at each patient's bedside. The patients were followed up for 12 ± 1 month for the primary composite endpoint of cardiovascular death and the first occurrence of nonfatal myocardial infarction, nonfatal stroke, and major bleeding defined according to Bleeding Academic Research Consortium type 3 to 5 criteria. RESULTS: After enrolling 888 patients, the study was prematurely stopped. Clopidogrel was used more frequently in the standard-of-care arm (50.7% vs. 43.3%), ticagrelor in the pharmacogenomic arm (42.6% vs. 32.7%; p = 0.02), and prasugrel was equally used in both arms. The primary endpoint occurred in 71 patients (15.9%) in the pharmacogenomic arm and in 114 (25.9%) in the standard-of-care arm (hazard ratio: 0.58; 95% confidence interval: 0.43 to 0.78; p < 0.001). CONCLUSIONS: A personalized approach to selecting antiplatelet therapy for patients with ACS may reduce ischemic and bleeding events. (Pharmacogenetics of Clopidogrel in Patients With Acute Coronary Syndromes [PHARMCLO]; NCT03347435)."},{"id":"d6167a836e1d","type":"article","url":"https://hartvaat.nl/2018/05/01/ticagrelor-versus-clopidogrel-na-fibrinolyse-bij-stemi-jama-cardiology-gerandomi/","title":"Ticagrelor versus clopidogrel na fibrinolyse bij STEMI: JAMA Cardiology gerandomiseerde trial","title_en":"Ticagrelor vs Clopidogrel After Fibrinolytic Therapy in Patients With ST-Elevation Myocardial Infarction: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aperitif-trial","trombocytenaggregatieremmers"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.0612","source_url":"https://doi.org/10.1001/jamacardio.2018.0612","authors":["Otavio Berwanger","Jose C Nicolau","Antonio C Carvalho","Lixin Jiang","Shaun G Goodman","Stephen J Nicholls","Alexander Parkhomenko","Oleg Averkov","Carlos Tajer","Germán Malaga","Jose F K Saraiva","Francisco A Fonseca","Fábio A De Luca","Helio P Guimaraes","Pedro G M de Barros E Silva","Lucas P Damiani","Denise M Paisani","Camila M R Lasagno","Carolina T Candido","Nanci Valeis","Diogo D F Moia","Leopoldo S Piegas","Christopher B Granger","Harvey D White","Renato D Lopes"],"significance":7,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized trial comparing ticagrelor with clopidogrel after fibrinolytic therapy in STEMI assessed whether the more potent P2Y12 inhibitor is safe in the post-fibrinolysis setting, a population excluded from the original PLATO trial.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T13:26:32Z","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 gerandomiseerde trial die ticagrelor vergeleek met clopidogrel na fibrinolyse bij STEMI. Relevant voor de P2Y12-remmerkeuze in de farmaco-invasieve strategie.","abstract_original":"IMPORTANCE: The bleeding safety of ticagrelor in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy remains uncertain. OBJECTIVE: To evaluate the short-term safety of ticagrelor when compared with clopidogrel in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy. DESIGN, SETTING AND PARTICIPANTS: We conducted a multicenter, randomized, open-label with blinded end point adjudication trial that enrolled 3799 patients (younger than 75 years) with ST-segment elevation myocardial infarction receiving fibrinolytic therapy in 152 sites from 10 countries from November 2015 through November 2017. The prespecified upper boundary for noninferiority for bleeding was an absolute margin of 1.0%. INTERVENTIONS: Patients were randomized to ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300-mg to 600-mg loading dose, 75 mg daily thereafter). Patients were randomized with a median of 11.4 hours after fibrinolysis, and 90% were pretreated with clopidogrel. MAIN OUTCOMES AND MEASURES: The primary outcome was thrombolysis in myocardial infarction (TIMI) major bleeding through 30 days. RESULTS: The mean (SD) age was 58.0 (9.5) years, 2928 of 3799 patients (77.1%) were men, and 2177 of 3799 patients (57.3%) were white. At 30 days, TIMI major bleeding had occurred in 14 of 1913 patients (0.73%) receiving ticagrelor and in 13 of 1886 patients (0.69%) receiving clopidogrel (absolute difference, 0.04%; 95% CI, -0.49% to 0.58%; P < .001 for noninferiority). Major bleeding defined by the Platelet Inhibition and Patient Outcomes criteria and by the Bleeding Academic Research Consortium types 3 to 5 bleeding occurred in 23 patients (1.20%) in the ticagrelor group and in 26 patients (1.38%) in the clopidogrel group (absolute difference, -0.18%; 95% CI, -0.89% to 0.54; P = .001 for noninferiority). The rates of fatal (0.16% vs 0.11%; P = .67) and intracranial bleeding (0.42% vs 0.37%; P = .82) were similar between the ticagrelor and clopidogrel groups, respectively. Minor and minimal bleeding were more common with ticagrelor than with clopidogrel. The composite of death from vascular causes, myocardial infarction, or stroke occurred in 76 patients (4.0%) treated with ticagrelor and in 82 patients (4.3%) receiving clopidogrel (hazard ratio, 0.91; 95% CI, 0.67-1.25; P = .57). CONCLUSIONS AND RELEVANCE: In patients younger than 75 years with ST-segment elevation myocardial infarction, delayed administration of ticagrelor after fibrinolytic therapy was noninferior to clopidogrel for TIMI major bleeding at 30 days. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02298088."},{"id":"476adb55c12b","type":"article","url":"https://hartvaat.nl/2018/05/01/risicostratificatie-met-geintegreerde-devicediagnostiek-bij-hartfalen/","title":"Risicostratificatie met geïntegreerde devicediagnostiek bij hartfalen","title_en":"Risk stratification of cardiovascular and heart failure hospitalizations using integrated device diagnostics in patients with a cardiac resynchronization therapy defibrillator.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","hartkatheterisatie","harttransplantatie","hfpef","hfref","klepprothese","laminopathie","myocardinfarct","nt-probnp","step-hfpef","vericiguat","vrouwen"],"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/eux206","source_url":"https://doi.org/10.1093/europace/eux206","authors":["Haran Burri","Antoine da Costa","Aurelio Quesada","Renato Pietro Ricci","Stefano Favale","Nicolas Clementy","Gabriele Boscolo","Federico Segura Villalobos","Lorenza Mangoni di S Stefano","Vinod Sharma","Giuseppe Boriani"],"significance":5,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated integrated CRT-D device diagnostics for risk stratification of cardiovascular hospitalizations, testing whether automated multi-parameter algorithms can provide actionable early warning of clinical deterioration.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T18:38:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 geïntegreerde devicediagnostiek voor risicostratificatie van cardiovasculaire en hartfalen-hospitalisaties.","abstract_original":"AIMS: Cardiac resynchronization therapy defibrillators (CRT-D) are able to monitor various parameters that may be combined by an automatic algorithm to provide a heart failure risk status (HFRS). We sought to validate the HFRS for stratifying patient risk, evaluate its association with heart failure (HF) symptoms, and investigate its utility for triage of automatic alerts. METHODS AND RESULTS: Data from 722 patients included in the MORE-CARE trial were analysed in a post hoc analysis. A high HFRS was associated with a significantly increased risk of admission over the next 30 days with a relative risk for cardiovascular hospitalization (CVH) of 4.5 (95% CI: 3.1-6.6, P < 0.001), of HF hospitalization of 6.3 (95% CI: 3.9-10.2, P < 0.001) and of non-HF related CVH of 3.5 (95% CI: 2.0-6.9, P < 0.001). The negative predictive value of low or medium HFRS for these admissions was ≥98%. A high HFRS was associated with an increased risk of HF symptoms. Of all the automatic remote monitoring alerts generated during the study, only 10% had a high HFRS. CONCLUSION: The HFRS is able to risk-stratify CRT-D patients, which is potentially useful for managing automatic remote monitoring alerts, by focusing attention on the minority of high-risk patients. CLINICAL TRIAL REGISTRATION: The trial was registered at www.clinicaltrials.gov under number NCT00885677."},{"id":"06b9dd4da8e1","type":"article","url":"https://hartvaat.nl/2018/05/01/crt-voordeel-bij-concordant-versus-discordant-linksbundeltakblok-esc-hf-pilot/","title":"CRT-voordeel bij concordant versus discordant linksbundeltakblok: ESC-HF pilot","title_en":"The prognostic benefit of cardiac resynchronization therapy is greater in concordant vs. discordant left bundle branch block in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT).","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/euw446","source_url":"https://doi.org/10.1093/europace/euw446","authors":["Luigi Padeletti","Alberto Aimo","Bella Vishenvsky","Arielle Schwartz","Scott McNitt","Paul J Wang","Arthur J Moss","Michele Emdin","Wojciech Zareba"],"significance":6,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/","https://hartvaat.nl/kennis/diagnostiek/high-sensitivity-troponine/"],"congress":"","summary_en":"This analysis showed that the prognostic benefit of CRT is significantly greater in patients with concordant versus discordant left bundle branch block, refining the ECG criteria for optimal CRT candidate selection.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T13:26:31Z","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 die aantoont dat het prognostische voordeel van CRT groter is bij concordant versus discordant LBTB. Verfijnt de CRT-indicatiestelling op ECG-morfologie.","abstract_original":"AIMS: Discordant and concordant left bundle branch block (dLBBB/cLBBB) are characterized by negative or positive T waves, respectively, in lateral leads. We assessed if the two morphologies are associated with different clinical status and prognosis in patients with heart failure (HF) and current indication to Cardiac Resynchronization Therapy (CRT)/CRT-Defibrillator (CRT-D). METHODS AND RESULTS: Baseline electrocardiograms of 1270 patients with LBBB in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy cohort were analysed to identify dLBBB and cLBBB. The two groups were compared with respect to baseline clinical characteristics, primary endpoint (HF event or death), and secondary endpoint (ventricular tachycardia, ventricular fibrillation, or death) over a 3.5-year period, and benefit of CRT-D over implantable cardioverter defibrillator (ICD). dLBBB was identified in 909 (72%) patients, and cLBBB in 361 (28%). Patients with dLBBB were older, had more severe symptoms and systolic dysfunction, as well as higher brain natriuretic peptide. CRT-D was superior to ICD in patients with both LBBB morphologies. The occurrence of the primary outcome was significantly more frequent in patients with dLBBB than in those with cLBBB, both in the entire cohort (P = 0.005), and in the CRT-D arm (P = 0.002). There was a trend towards more frequent occurrence of the secondary endpoint in patients with dLBBB than in those with cLBBB, but statistical significance was not reached in the whole population or in the subgroup undergoing CRT-D. Among patients receiving CRT-D, dLBBB was an independent predictor of the primary endpoint. CONCLUSION: dLBBB morphology is associated with more severe HF clinical status and worse prognosis, even in patients receiving CRT-D, compared with cLBBB morphology."},{"id":"6ab86a06faaf","type":"article","url":"https://hartvaat.nl/2018/05/01/bloeddruk-voor-conceptie-en-reproductieve-uitkomsten/","title":"Bloeddruk vóór conceptie en reproductieve uitkomsten","title_en":"Preconception Blood Pressure Levels and Reproductive Outcomes in a Prospective Cohort of Women Attempting Pregnancy.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["bloeddrukbehandeling","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10705","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10705","authors":["Carrie J Nobles","Pauline Mendola","Sunni L Mumford","Ashley I Naimi","Edwina H Yeung","Keewan Kim","Hyojun Park","Brian Wilcox","Robert M Silver","Neil J Perkins","Lindsey Sjaarda","Enrique F Schisterman"],"significance":5,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This prospective study showed that elevated preconception blood pressure is associated with adverse reproductive outcomes, establishing blood pressure as a modifiable factor for fertility and pregnancy health.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve studie naar het verband tussen preconceptionele bloeddruk en reproductieve uitkomsten. Relevant voor preconceptiezorg en cardiovasculaire risicostratificatie.","abstract_original":"UNLABELLED: Elevated blood pressure in young adulthood is an early risk marker for cardiovascular disease. Despite a strong biological rationale, little research has evaluated whether incremental increases in preconception blood pressure have early consequences for reproductive health. We evaluated preconception blood pressure and fecundability, pregnancy loss, and live birth in the EAGeR trial (Effects of Aspirin on Gestational and Reproduction; 2007-2011), a randomized clinical trial of aspirin and reproductive outcomes among 1228 women attempting pregnancy with a history of pregnancy loss. Systolic and diastolic blood pressure were measured during preconception in the first observed menstrual cycle and in early pregnancy and used to derive mean arterial pressure. Fecundability was assessed as number of menstrual cycles until pregnancy, determined through human chorionic gonadotropin testing. Pregnancy loss included both human chorionic gonadotropin-detected and clinical losses. Analyses adjusted for treatment assignment, age, body mass index, race, marital status, smoking, parity, and time since last loss. Mean preconception systolic and diastolic blood pressure were 111.6 mm Hg (SD, 12.1) and 72.5 (SD, 9.4) mm Hg. Risk of pregnancy loss increased 18% per 10 mm Hg increase in diastolic blood pressure (95% confidence interval, 1.03-1.36) and 17% per 10 mm Hg increase in mean arterial pressure (95% confidence interval, 1.02-1.35) in adjusted analyses. Findings were similar for early pregnancy blood pressure. Preconception blood pressure was not related to fecundability or live birth in adjusted analyses. Findings suggest that preconception blood pressure among healthy women is associated with pregnancy loss, and lifestyle interventions targeting blood pressure among young women may favorably impact reproductive health. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00467363."},{"id":"5ad0e3ba9be3","type":"article","url":"https://hartvaat.nl/2018/05/01/verlaging-van-diastolische-druk-bij-patienten-met-en-zonder-cardiovasculaire-zie/","title":"Verlaging van diastolische druk bij patiënten met en zonder cardiovasculaire ziekte: SPRINT","title_en":"Effect of Lowering Diastolic Pressure in Patients With and Without Cardiovascular Disease: Analysis of the SPRINT (Systolic Blood Pressure Intervention Trial).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["ouderen","stride-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10177","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10177","authors":["Nadia A Khan","Simon W Rabkin","Yinshan Zhao","Finlay A McAlister","Julie E Park","Meijiao Guan","Sammy Chan","Karin H Humphries"],"significance":6,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/"],"congress":"","summary_en":"This SPRINT analysis evaluated the effect of diastolic blood pressure lowering in patients with and without cardiovascular disease, providing data on the J-curve concern for diastolic hypotension during intensive systolic treatment.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T13:26:31Z","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":"SPRINT analyse naar het effect van diastolische bloeddrukverlaging bij patiënten met en zonder bestaande cardiovasculaire ziekte. J-curvedebat voor diastolische druk.","abstract_original":"Systolic and diastolic blood pressure thresholds, below which cardiovascular events increase, are widely debated. Using data from the SPRINT (Systolic Blood Pressure Intervention Trial), we evaluated the relation between systolic and diastolic pressure and cardiovascular events among 1519 participants with or 7574 without prior cardiovascular disease. Using Cox regression, we examined the composite risk of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or cardiovascular death, and follow-up systolic and diastolic pressure were analyzed as time-dependent covariates for a median of 3.1 years. Models were adjusted for age, sex, baseline systolic pressure, body mass index, 10-year Framingham risk score, and estimated glomerular filtration rate. A J-shaped relationship with diastolic pressure was observed in both treatment arms in patients with or without cardiovascular disease (P nonlinearity≤0.002). When diastolic pressure fell <55 mm Hg, the hazards were at least 25% higher relative to 70 mm Hg (P=0.29). The hazard ratios (95% CI) of diastolic pressure <55 mm Hg versus 55 to 90 mm Hg were 1.68 (1.16-2.43), P value 0.006 and 1.52 (0.99-2.34), P value 0.06 in patients without and with prior cardiovascular disease, respectively. After adjusting for follow-up diastolic pressure, follow-up systolic pressure was not associated with the outcome in those without prior cardiovascular disease (P=0.64). In those with cardiovascular disease, adjusting for diastolic pressure, follow-up systolic pressure was associated with the risk in the intensive arm (hazard ratio per 10 mm Hg decrease, 0.86; 95% CI, 0.75-0.99; P interaction=0.02). Although the observed J-shaped relationship may be because of reverse causality in the SPRINT population, we advise caution in aggressively lowering diastolic pressure."},{"id":"1d41c45cd9d9","type":"article","url":"https://hartvaat.nl/2018/05/01/natriuminname-en-bloeddruk-varieren-met-energie-inname-dash-secundaire-analyse/","title":"Natriuminname en bloeddruk variëren met energie-inname: DASH secundaire analyse","title_en":"Relationship of Sodium Intake and Blood Pressure Varies With Energy Intake: Secondary Analysis of the DASH (Dietary Approaches to Stop Hypertension)-Sodium Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10602","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10602","authors":["Maureen A Murtaugh","Jeannette M Beasley","Lawrence J Appel","Patricia M Guenther","Molly McFadden","Tom Greene","Janet A Tooze"],"significance":5,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":[],"congress":"","summary_en":"This DASH secondary analysis showed that the relationship between sodium intake and blood pressure varies with total energy intake, suggesting that sodium density (mg/kcal) may be a more relevant metric than absolute sodium consumption.","created":"2026-07-03T10:27:16Z","updated":"2026-07-03T13:26:31Z","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":"DASH secundaire analyse die aantoont dat het verband tussen natrium en bloeddruk varieert met de totale energie-inname. Nuanceert de zoutaanbeveling.","abstract_original":"Dietary Na recommendations are expressed as absolute amounts (mg/d) rather than as Na density (mg/kcal). Our objective was to determine whether the strength of the relationship of Na intake with blood pressure (BP) varied with energy intake. The DASH (Dietary Approaches to Stop Hypertension)-Sodium trial was a randomized feeding trial comparing 2 diets (DASH and control) and 3 levels of Na density. Participants with pre- or stage 1 hypertension consumed diets for 30 days in random order; energy intake was controlled to maintain body weight. This secondary analysis of 379 non-Hispanic black and white participants used mixed-effects models to assess the association of Na and energy intakes with BP. The relationships between absolute Na and both systolic and diastolic BP varied with energy intake. BP rose more steeply with increasing Na at lower energy intake than at higher energy intake (P interaction<0.001). On the control diet with 2300 mg Na, both systolic and diastolic BP were higher (3.0 mm Hg; 95% confidence interval, 0.2-5.8; and 2.7 mm Hg; 95% confidence interval, 1.0-4.5, respectively) among those with lower energy intake (higher Na density) than among those with higher energy intake (lower Na density). The association of Na with systolic BP was stronger at lower levels of energy intake in both blacks and whites (P<0.001). The association of Na and diastolic BP varied with energy intake only among blacks (P=0.001). Sodium density should be considered as a metric for expressing dietary Na recommendations."},{"id":"225c4cc734cc","type":"article","url":"https://hartvaat.nl/2018/05/01/bloeddrukmeting-in-sprint-methodologische-overwegingen/","title":"Bloeddrukmeting in SPRINT: methodologische overwegingen","title_en":"Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10479","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10479","authors":["Karen C Johnson","Paul K Whelton","William C Cushman","Jeffrey A Cutler","Gregory W Evans","Joni K Snyder","Walter T Ambrosius","Srinivasan Beddhu","Alfred K Cheung","Lawrence J Fine","Cora E Lewis","Mahboob Rahman","David M Reboussin","Michael V Rocco","Suzanne Oparil","Jackson T Wright"],"significance":7,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/nierziekte/albumine-creatinine-ratio/"],"congress":"","summary_en":"This analysis of blood pressure measurement methodology in SPRINT clarified the automated office blood pressure technique used, addressing concerns about how SPRINT blood pressure readings translate to standard clinical office measurements.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:31Z","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 bloeddrukmeetmethodologie in SPRINT. Essentieel voor de interpretatie van SPRINT-resultaten in de klinische praktijk waar meetmethoden verschillen.","abstract_original":"UNLABELLED: Recent publications have stated that the blood pressure (BP) measurement technique used in SPRINT (Systolic Blood Pressure Intervention Trial) was unattended. However, the SPRINT protocol does not address the issue of attendance. A survey was conducted immediately after SPRINT closeout visits were completed to inquire whether BP measurements were usually attended or unattended by staff. There were 4082 participants at 38 sites that measured BP after leaving the participant alone the entire time (always alone), 2247 at 25 sites that had personnel in the room the entire time (never alone), 1746 at 19 sites that left the participant alone only during the rest period (alone for rest), and 570 at 6 sites that left the participant alone only during the BP readings (alone for BP measurement). Similar systolic and diastolic BPs within randomized groups were noted during follow-up at the majority of visits in all 4 measurement categories. In the always alone and never alone categories, the intensive group had a similarly reduced risk for the primary outcome compared with the standard group (hazard ratio, 0.62; 95% confidence interval, 0.51-0.76 and hazard ratio, 0.64; 95% confidence interval, 0.46-0.91, respectively; pairwise interaction P value, 0.88); risk was not significantly reduced for the intensive group in the smaller alone-for-rest and the alone-for-BP-measurement categories. Similar BP levels and cardiovascular disease risk reduction were observed in the intensive group in SPRINT participants whether the measurement technique used was primarily attended or unattended. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062."},{"id":"6fa98340f8a2","type":"article","url":"https://hartvaat.nl/2018/05/01/klinische-score-verbetert-risicostratificatie-bij-stressechocardiografie/","title":"Klinische score verbetert risicostratificatie bij stressechocardiografie","title_en":"Simple six-item clinical score improves risk prediction capability of stress echocardiography.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","bradycardie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312122","source_url":"https://doi.org/10.1136/heartjnl-2017-312122","authors":["Lauro Cortigiani","Clara Carpeggiani","Rosa Sicari","Claudio Michelassi","Francesco Bovenzi","Eugenio Picano"],"significance":5,"published":"2018-05-01","source_date":"2018-05-01","image":"","kennis":[],"congress":"","summary_en":"This study developed a simple 6-item clinical score that improves risk prediction beyond wall motion abnormalities during stress echocardiography, enhancing the prognostic yield of this common cardiac imaging test.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:31Z","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 een eenvoudige 6-punts klinische score ontwikkelde die de risicostratificatie bij stressechocardiografie verbetert.","abstract_original":"OBJECTIVES: To assess the value of a simple score integrating non-ischaemia-related variables in expanding the wall motion abnormalities risk power during stress echocardiography (SE). METHODS: Study includes 14 279 patients who underwent SE for evaluation of coronary artery disease. All-cause death was the end point. Patients were randomly divided into the modelling and validation group of equal size. In the modelling group, multivariate analysis was conducted using clinical, rest and SE data, and a score was obtained from the number of non-ischaemia-related independent prognostic predictors. The score prognostic capability was compared in both groups. RESULTS: During a median follow-up of 31 months, 1230 patients died: 622 (9%) in the modelling and 608 (9%) in the validation group (p=0.68). Independent predictors of mortality were ischaemia at SE (HR 1.77, 95% CI 1.49 to 2.12; p<0.0001) and six other parameters: age>65 years, wall motion at rest, diabetes, left bundle branch block, anti-ischaemic therapy and male sex. Risk score resulted prognostically effective in the modelling and validation groups, both with and without inducible ischaemia subset. When risk score was included in the multivariate analysis, besides ischaemia at SE it was the only independent predictor of mortality in the modelling (HR 1.70, 95% CI 1.60 to 1.82; p<0.0001), in the validation (HR 1.77, 95% CI 1.65 to 1.90; p<0.0001) and in the overall group (HR 1.73, 95% CI 1.66 to 1.82; p<0.0001). CONCLUSIONS: Simple clinical variables may be able to optimise SE risk stratification."},{"id":"c098dd2d2e12","type":"article","url":"https://hartvaat.nl/2018/04/28/liberale-versus-conservatieve-zuurstoftherapie-bij-acuut-zieke-volwassenen-lance/","title":"Liberale versus conservatieve zuurstoftherapie bij acuut zieke volwassenen: Lancet IOTA meta-analyse","title_en":"Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30479-3","source_url":"https://doi.org/10.1016/S0140-6736(18)30479-3","authors":["Derek K Chu","Lisa H-Y Kim","Paul J Young","Nima Zamiri","Saleh A Almenawer","Roman Jaeschke","Wojciech Szczeklik","Holger J Schünemann","John D Neary","Waleed Alhazzani"],"significance":9,"published":"2018-04-28","source_date":"2018-04-28","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The IOTA systematic review demonstrated that liberal supplemental oxygen therapy increases mortality in acutely ill adults across a range of conditions. This paradigm-shifting analysis led to conservative oxygen targets becoming standard practice in acute care.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:31Z","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":"Lancet IOTA systematische review die aantoonde dat liberale zuurstoftherapie bij acuut zieke patiënten de mortaliteit verhoogt. Paradigmaverschuiving in zuurstofbeleid.","abstract_original":"BACKGROUND: Supplemental oxygen is often administered liberally to acutely ill adults, but the credibility of the evidence for this practice is unclear. We systematically reviewed the efficacy and safety of liberal versus conservative oxygen therapy in acutely ill adults. METHODS: In the Improving Oxygen Therapy in Acute-illness (IOTA) systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, HealthSTAR, LILACS, PapersFirst, and the WHO International Clinical Trials Registry from inception to Oct 25, 2017, for randomised controlled trials comparing liberal and conservative oxygen therapy in acutely ill adults (aged ≥18 years). Studies limited to patients with chronic respiratory diseases or psychiatric disease, patients on extracorporeal life support, or patients treated with hyperbaric oxygen therapy or elective surgery were excluded. We screened studies and extracted summary estimates independently and in duplicate. We also extracted individual patient-level data from survival curves. The main outcomes were mortality (in-hospital, at 30 days, and at longest follow-up) and morbidity (disability at longest follow-up, risk of hospital-acquired pneumonia, any hospital-acquired infection, and length of hospital stay) assessed by random-effects meta-analyses. We assessed quality of evidence using the grading of recommendations assessment, development, and evaluation approach. This study is registered with PROSPERO, number CRD42017065697. FINDINGS: 25 randomised controlled trials enrolled 16 037 patients with sepsis, critical illness, stroke, trauma, myocardial infarction, or cardiac arrest, and patients who had emergency surgery. Compared with a conservative oxygen strategy, a liberal oxygen strategy (median baseline saturation of peripheral oxygen [SpO2] across trials, 96% [range 94-99%, IQR 96-98]) increased mortality in-hospital (relative risk [RR] 1·21, 95% CI 1·03-1·43, I2=0%, high quality), at 30 days (RR 1·14, 95% CI 1·01-1·29, I2=0%, high quality), and at longest follow-up (RR 1·10, 95% CI 1·00-1·20, I2=0%, high quality). Morbidity outcomes were similar between groups. Findings were robust to trial sequential, subgroup, and sensitivity analyses. INTERPRETATION: In acutely ill adults, high-quality evidence shows that liberal oxygen therapy increases mortality without improving other patient-important outcomes. Supplemental oxygen might become unfavourable above an SpO2 range of 94-96%. These results support the conservative administration of oxygen therapy. FUNDING: None."},{"id":"ceb66c4b893f","type":"article","url":"https://hartvaat.nl/2018/04/24/hoge-versus-lage-bloeddrukstreefwaarden-tijdens-cardiopulmonale-bypass-en-cerebr/","title":"Hoge versus lage bloeddrukstreefwaarden tijdens cardiopulmonale bypass en cerebraal letsel","title_en":"High-Target Versus Low-Target Blood Pressure Management During Cardiopulmonary Bypass to Prevent Cerebral Injury in Cardiac Surgery Patients: A Randomized Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["coronaire-bypass"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030308","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030308","authors":["Anne G Vedel","Frederik Holmgaard","Lars S Rasmussen","Annika Langkilde","Olaf B Paulson","Theis Lange","Carsten Thomsen","Peter Skov Olsen","Hanne Berg Ravn","Jens C Nilsson"],"significance":6,"published":"2018-04-24","source_date":"2018-04-24","image":"","kennis":["https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"This randomized trial compared high versus low blood pressure targets during cardiopulmonary bypass for prevention of cerebral injury in cardiac surgery, addressing the optimal hemodynamic management during on-pump procedures.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:31Z","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":"Gerandomiseerde trial naar optimale bloeddrukstreefwaarden tijdens cardiopulmonale bypass voor preventie van cerebraal letsel bij hartchirurgie.","abstract_original":"BACKGROUND: Cerebral injury is an important complication after cardiac surgery with the use of cardiopulmonary bypass. The rate of overt stroke after cardiac surgery is 1% to 2%, whereas silent strokes, detected by diffusion-weighted magnetic resonance imaging, are found in up to 50% of patients. It is unclear whether a higher versus a lower blood pressure during cardiopulmonary bypass reduces cerebral infarction in these patients. METHODS: In a patient- and assessor-blinded randomized trial, we allocated patients to a higher (70-80 mm Hg) or lower (40-50 mm Hg) target for mean arterial pressure by the titration of norepinephrine during cardiopulmonary bypass. Pump flow was fixed at 2.4 L·min-1·m-2. The primary outcome was the total volume of new ischemic cerebral lesions (summed in millimeters cubed), expressed as the difference between diffusion-weighted imaging conducted preoperatively and again postoperatively between days 3 and 6. Secondary outcomes included diffusion-weighted imaging-evaluated total number of new ischemic lesions. RESULTS: Among the 197 enrolled patients, mean (SD) age was 65.0 (10.7) years in the low-target group (n=99) and 69.4 (8.9) years in the high-target group (n=98). Procedural risk scores were comparable between groups. Overall, diffusion-weighted imaging revealed new cerebral lesions in 52.8% of patients in the low-target group versus 55.7% in the high-target group (P=0.76). The primary outcome of volume of new cerebral lesions was comparable between groups, 25 mm3 (interquartile range, 0-118 mm3; range, 0-25 261 mm3) in the low-target group versus 29 mm3 (interquartile range, 0-143 mm3; range, 0-22 116 mm3) in the high-target group (median difference estimate, 0; 95% confidence interval, -25 to 0.028; P=0.99), as was the secondary outcome of number of new lesions (1 [interquartile range, 0-2; range, 0-24] versus 1 [interquartile range, 0-2; range, 0-29] respectively; median difference estimate, 0; 95% confidence interval, 0-0; P=0.71). No significant difference was observed in frequency of severe adverse events. CONCLUSIONS: Among patients undergoing on-pump cardiac surgery, targeting a higher versus a lower mean arterial pressure during cardiopulmonary bypass did not seem to affect the volume or number of new cerebral infarcts. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02185885."},{"id":"fcf8a64f9c5f","type":"article","url":"https://hartvaat.nl/2018/04/21/2018-ehra-praktische-gids-voor-doac-gebruik-bij-af/","title":"2018 EHRA praktische gids voor DOAC-gebruik bij AF","title_en":"The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy136","source_url":"https://doi.org/10.1093/eurheartj/ehy136","authors":["Jan Steffel","Peter Verhamme","Tatjana S Potpara","Pierre Albaladejo","Matthias Antz","Lien Desteghe","Karl Georg Haeusler","Jonas Oldgren","Holger Reinecke","Vanessa Roldan-Schilling","Nigel Rowell","Peter Sinnaeve","Ronan Collins","A John Camm","Hein Heidbüchel"],"significance":9,"published":"2018-04-21","source_date":"2018-04-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"","summary_en":"The 2018 EHRA Practical Guide updated recommendations for DOAC use in atrial fibrillation, covering dosing, drug interactions, perioperative management, and special populations. The document serves as the primary clinical reference for day-to-day DOAC prescribing decisions in AF.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:30Z","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":"Geactualiseerde EHRA praktische gids voor het gebruik van DOAC's bij patiënten met AF. Standaarddocument voor DOAC-dosering, monitoring en bijzondere situaties.","abstract_original":"The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain. The European Heart Rhythm Association (EHRA) set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group identified 20 topics of concrete clinical scenarios for which practical answers were formulated, based on available evidence. The 20 topics are as follows i.e., (1) Eligibility for NOACs; (2) Practical start-up and follow-up scheme for patients on NOACs; (3) Ensuring adherence to prescribed oral anticoagulant intake; (4) Switching between anticoagulant regimens; (5) Pharmacokinetics and drug-drug interactions of NOACs; (6) NOACs in patients with chronic kidney or advanced liver disease; (7) How to measure the anticoagulant effect of NOACs; (8) NOAC plasma level measurement: rare indications, precautions, and potential pitfalls; (9) How to deal with dosing errors; (10) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a potential risk of bleeding; (11) Management of bleeding under NOAC therapy; (12) Patients undergoing a planned invasive procedure, surgery or ablation; (13) Patients requiring an urgent surgical intervention; (14) Patients with AF and coronary artery disease; (15) Avoiding confusion with NOAC dosing across indications; (16) Cardioversion in a NOAC-treated patient; (17) AF patients presenting with acute stroke while on NOACs; (18) NOACs in special situations; (19) Anticoagulation in AF patients with a malignancy; and (20) Optimizing dose adjustments of VKA. Additional information and downloads of the text and anticoagulation cards in different languages can be found on an EHRA website (www.NOACforAF.eu)."},{"id":"d1d446bcf174","type":"article","url":"https://hartvaat.nl/2018/04/21/subklinisch-device-gedetecteerd-af-en-cva-risico-meta-analyse/","title":"Subklinisch device-gedetecteerd AF en CVA-risico: meta-analyse","title_en":"Subclinical device-detected atrial fibrillation and stroke risk: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx731","source_url":"https://doi.org/10.1093/eurheartj/ehx731","authors":["Rajiv Mahajan","Tharani Perera","Adrian D Elliott","Darragh J Twomey","Sharath Kumar","Dian A Munwar","Kashif B Khokhar","Anand Thiyagarajah","Melissa E Middeldorp","Chrishan J Nalliah","Jeroen M L Hendriks","Jonathan M Kalman","Dennis H Lau","Prashanthan Sanders"],"significance":7,"published":"2018-04-21","source_date":"2018-04-21","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis quantified the stroke risk associated with subclinical device-detected atrial fibrillation, finding a significantly elevated but lower absolute risk than clinical AF. The analysis informed the debate about anticoagulation for subclinical AF that was tested in NOAH-AFNET 6 and ARTESIA.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:30Z","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":"Systematische review en meta-analyse die het verband kwantificeerde tussen subklinisch door device gedetecteerd AF en het risico op beroerte. Relevant voor het antistollingsdilemma.","abstract_original":"AIMS: To determine stroke risk in subclinical atrial fibrillation (AF) and temporal association between subclinical AF and stroke. METHODS AND RESULTS: Pubmed/Embase was searched for studies reporting stroke in subclinical AF in patients with cardiac implantable electronic devices (CIEDs). After exclusions, 11 studies were analysed. Of these seven studies reported prevalence of subclinical AF, two studies reported association between subclinical and clinical AF, seven studies reported stroke risk in subclinical AF, and five studies reported temporal relationship between subclinical AF and stroke. Subclinical AF was noted after CIEDs implant in 35% [interquartile range (IQR) 34-42] of unselected patients with pacing indication over 1-2.5 years. The definition and cut-off duration (for stroke risk) of subclinical AF varied across studies. Subclinical AF was strongly associated with clinical AF (OR 5.7, 95% CI 4.0-8.0, P < 0.001, I2 = 0%). The annual stroke rate in patients with subclinical AF > defined cut-off duration was 1.89/100 person-year (95% CI 1.02-3.52) with 2.4-fold (95% CI 1.8-3.3, P < 0.001, I2 = 0%) increased risk of stroke as compared to patients with subclinical AF < cut-off duration (absolute risk was 0.93/100 person-year). Three studies provided mean CHADS2 score. In these studies, with mean CHADS2 score of 2.1 ± 0.1, subclinical AF was associated with annual stroke rate of 2.76/100 person-years (95% CI 1.46-5.23). After excluding patients without AF, only 17% strokes occurred in presence of ongoing AF. Subclinical AF was noted in 29% [IQR 8-57] within 30 days preceding stroke. CONCLUSION: Subclinical AF strongly predicts clinical AF and is associated with elevated absolute stroke risk albeit lower than risk described for clinical AF."},{"id":"032bd3ce8a1f","type":"article","url":"https://hartvaat.nl/2018/04/21/telemonitoring-verbetert-doac-therapietrouw-bij-af/","title":"Telemonitoring verbetert DOAC-therapietrouw bij AF","title_en":"Telemonitoring-based feedback improves adherence to non-vitamin K antagonist oral anticoagulants intake in patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx762","source_url":"https://doi.org/10.1093/eurheartj/ehx762","authors":["Lien Desteghe","Johan Vijgen","Pieter Koopman","Dagmara Dilling-Boer","Joris Schurmans","Paul Dendale","Hein Heidbuchel"],"significance":6,"published":"2018-04-21","source_date":"2018-04-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This study showed that telemonitoring-based feedback improves DOAC adherence in AF patients, demonstrating that digital monitoring and patient engagement tools can address the common problem of medication non-compliance.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:30Z","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 telemonitoring met feedback de therapietrouw aan DOAC's verbetert bij AF-patiënten. Digitale interventie voor betere anticoagulatie.","abstract_original":"AIMS: To evaluate the effect of telemonitoring on adherence to non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients. METHODS AND RESULTS: A randomized, single-blind, crossover, controlled trial in 48 AF patients on once or twice daily (OD or BID) NOAC. The Medication Event Monitoring System tracked NOAC intake during three phases of 3 months each: daily telemonitoring, telemonitoring with immediate telephone feedback in case of intake errors, and an observation phase without daily transmissions. Unprotected days were defined as ≥ 3 or ≥ 1 consecutively missed doses for a BID or OD NOAC, respectively, or excess dose intake. Cost-effectiveness was calculated based on anticipated stroke reduction derived from patients' risk profile and measured intake. Persistence over the entire study was 98%. Telemonitoring-only already led to very high taking and regimen adherence (97.4% respectively 93.8%). Nevertheless, direct feedback further improved both to 99.0% and 96.8%, respectively (P < 0.001 respectively P = 0.002). Observation without daily monitoring resulted in a significant waning of taking adherence (94.3%; P = 0.049). Taking adherence was significantly higher for OD compared to BID NOAC, although unprotected days were similar. Feedback intervention had an incremental cost of €344 289 to prevent one stroke, but this could be as low as €15 488 in high-risk patients with low adherence and optimized technology. CONCLUSION: Telemonitoring resulted in high NOAC adherence due to the notion of being watched, as evidenced by the rapid decline during the observation period. Feedback further optimized adherence. Telemonitoring with or without feedback may be a cost-effective approach in high-risk patients deemed poorly adherent."},{"id":"3e57ebeda7c0","type":"article","url":"https://hartvaat.nl/2018/04/21/pvi-met-versus-zonder-antiaritmica-bij-recidiverend-af-powder-af/","title":"PVI met versus zonder antiaritmica bij recidiverend AF: POWDER-AF","title_en":"PulmOnary vein isolation With vs. without continued antiarrhythmic Drug trEatment in subjects with Recurrent Atrial Fibrillation (POWDER AF): results from a multicentre randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx666","source_url":"https://doi.org/10.1093/eurheartj/ehx666","authors":["Mattias Duytschaever","Anthony Demolder","Thomas Phlips","Andrea Sarkozy","Milad El Haddad","Philippe Taghji","Sebastien Knecht","Rene Tavernier","Yves Vandekerckhove","Tom De Potter"],"significance":6,"published":"2018-04-21","source_date":"2018-04-21","image":"","kennis":[],"congress":"","summary_en":"The POWDER-AF trial investigated whether continuing antiarrhythmic drugs after successful pulmonary vein isolation provides additional benefit over ablation alone, addressing the routine use of post-ablation antiarrhythmic therapy.","created":"2026-07-03T10:27:15Z","updated":"2026-07-03T13:26:30Z","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":"POWDER-AF gerandomiseerde trial naar PVI met versus zonder aanvullende antiaritmische therapie bij recidiverend AF.","abstract_original":"AIMS: Catheter ablation is indicated in patients with symptomatic paroxysmal atrial fibrillation (AF) resistant to antiarrhythmic drug therapy (ADT). We investigated whether continued use of previously ineffective ADT beyond the post-ablation blanking period reduces recurrence of atrial tachyarrhythmia within the 1st year after ablation. METHODS AND RESULTS: This was a multicentre, randomized controlled study in patients undergoing contact force-guided pulmonary vein isolation (PVI) for paroxysmal AF in whom previously ineffective ADT was continued during a blanking period of 3 months. If free of AF at the end of the blanking period, patients were randomly assigned in the ratio of 1:1 to continue ADT (ADT ON group, n = 77) or discontinue ADT (ADT OFF group, n = 76). Patients were followed up until 1 year after PVI, with clinical visits, Holter monitoring, and quality-of-life (QOL) questionnaires at 6 and 12 months post-procedure. Analysis of the primary endpoint (any documented atrial tachyarrhythmia lasting >30 s) was performed according to the modified intention-to-treat principle. Secondary endpoints included repeat ablation, unscheduled visits, and QOL score. Baseline clinical characteristics and initial ablation procedure characteristics were comparable between both groups. Three patients were lost to follow-up in each arm. The primary endpoint was observed in 2 of 74 (2.7%) patients in the ADT ON group vs. 16 of 73 (21.9%) patients in the ADT OFF group (P < 0.001). The ADT ON group had a lower rate of repeat ablation [1.4% vs. 19.2%, hazard ratio (HR) = 0.053; 95% confidence interval (CI) 0.007-0.399; P < 0.01) and less unscheduled arrhythmia-related health care visits (2.7% vs. 20.5%, HR = 0.055, 95% CI 0.007-0.410; P < 0.01). Quality-of-life scores were similar in both groups. CONCLUSION: In patients free of AF at the end of 3 months of post-ablation blanking period, continued use of previously ineffective ADT significantly reduces the recurrence of atrial tachyarrhythmia in the 1st year after PVI."},{"id":"ccab5614f5ad","type":"article","url":"https://hartvaat.nl/2018/04/17/sglt2-remmers-glp-1-agonisten-en-dpp-4-remmers-vergelijkende-cardiovasculaire-me/","title":"SGLT2-remmers, GLP-1-agonisten en DPP-4-remmers: vergelijkende cardiovasculaire meta-analyse","title_en":"Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine","cardio-renaal-metabool","cardiorenal-behandelstrategie","cetp-remmers","diabetes-en-hart","diabetes-type-2","empagliflozine","ezetimibe","fidelity","figaro-dkd","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","microbioom","obesitas","obicetrapib","orforglipron","semaglutide","sglt2-remmers","tirzepatide"],"journal":"JAMA","doi":"10.1001/jama.2018.3024","source_url":"https://doi.org/10.1001/jama.2018.3024","authors":["Sean L Zheng","Alistair J Roddick","Rochan Aghar-Jaffar","Matthew J Shun-Shin","Darrel Francis","Nick Oliver","Karim Meeran"],"significance":9,"published":"2018-04-17","source_date":"2018-04-17","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This JAMA comparative meta-analysis showed that SGLT2 inhibitors and GLP-1 receptor agonists both reduce cardiovascular death, MI, and stroke compared with DPP-4 inhibitors in patients with type 2 diabetes. The analysis distinguished the distinct cardiovascular benefit profiles of each drug class and established their clinical superiority.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T13:26:30Z","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 vergelijkende meta-analyse van drie glucoseverlagende klassen op cardiovasculaire uitkomsten. SGLT2-remmers en GLP-1-agonisten superieur aan DPP-4-remmers voor CV-preventie.","abstract_original":"IMPORTANCE: The comparative clinical efficacy of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors for treatment of type 2 diabetes is unknown. OBJECTIVE: To compare the efficacies of SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors on mortality and cardiovascular end points using network meta-analysis. DATA SOURCES: MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, and published meta-analyses from inception through October 11, 2017. STUDY SELECTION: Randomized clinical trials enrolling participants with type 2 diabetes and a follow-up of at least 12 weeks were included, for which SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors were compared with either each other or placebo or no treatment. DATA EXTRACTION AND SYNTHESIS: Data were screened by 1 investigator and extracted in duplicate by 2 investigators. A Bayesian hierarchical network meta-analysis was performed. MAIN OUTCOMES AND MEASURES: The primary outcome: all-cause mortality; secondary outcomes: cardiovascular (CV) mortality, heart failure (HF) events, myocardial infarction (MI), unstable angina, and stroke; safety end points: adverse events and hypoglycemia. RESULTS: This network meta-analysis of 236 trials randomizing 176 310 participants found SGLT-2 inhibitors (absolute risk difference [RD], -1.0%; hazard ratio [HR], 0.80 [95% credible interval {CrI}, 0.71 to 0.89]) and GLP-1 agonists (absolute RD, -0.6%; HR, 0.88 [95% CrI, 0.81 to 0.94]) were associated with significantly lower all-cause mortality than the control groups. SGLT-2 inhibitors (absolute RD, -0.9%; HR, 0.78 [95% CrI, 0.68 to 0.90]) and GLP-1 agonists (absolute RD, -0.5%; HR, 0.86 [95% CrI, 0.77 to 0.96]) were associated with lower mortality than were DPP-4 inhibitors. DPP-4 inhibitors were not significantly associated with lower all-cause mortality (absolute RD, 0.1%; HR, 1.02 [95% CrI, 0.94 to 1.11]) than were the control groups. SGLT-2 inhibitors (absolute RD, -0.8%; HR, 0.79 [95% CrI, 0.69 to 0.91]) and GLP-1 agonists (absolute RD, -0.5%; HR, 0.85 [95% CrI, 0.77 to 0.94]) were significantly associated with lower CV mortality than were the control groups. SGLT-2 inhibitors were significantly associated with lower rates of HF events (absolute RD, -1.1%; HR, 0.62 [95% CrI, 0.54 to 0.72]) and MI (absolute RD, -0.6%; HR, 0.86 [95% CrI, 0.77 to 0.97]) than were the control groups. GLP-1 agonists were associated with a higher risk of adverse events leading to trial withdrawal than were SGLT-2 inhibitors (absolute RD, 5.8%; HR, 1.80 [95% CrI, 1.44 to 2.25]) and DPP-4 inhibitors (absolute RD, 3.1%; HR, 1.93 [95% CrI, 1.59 to 2.35]). CONCLUSIONS AND RELEVANCE: In this network meta-analysis, the use of SGLT-2 inhibitors or GLP-1 agonists was associated with lower mortality than DPP-4 inhibitors or placebo or no treatment. Use of DPP-4 inhibitors was not associated with lower mortality than placebo or no treatment."},{"id":"d8977ba2d1e5","type":"article","url":"https://hartvaat.nl/2018/04/17/uitgangs-ldl-en-mortaliteitsreductie-na-ldl-verlaging-jama-meta-analyse/","title":"Uitgangs-LDL en mortaliteitsreductie na LDL-verlaging: JAMA meta-analyse","title_en":"Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C Lowering: A Systematic Review and Meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe"],"journal":"JAMA","doi":"10.1001/jama.2018.2525","source_url":"https://doi.org/10.1001/jama.2018.2525","authors":["Eliano P Navarese","Jennifer G Robinson","Mariusz Kowalewski","Michalina Kolodziejczak","Felicita Andreotti","Kevin Bliden","Udaya Tantry","Jacek Kubica","Paolo Raggi","Paul A Gurbel"],"significance":8,"published":"2018-04-17","source_date":"2018-04-17","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This JAMA systematic review found that the absolute reduction in cardiovascular mortality from LDL-lowering therapy is proportional to the baseline LDL level, while total mortality benefit is seen primarily in patients with higher baseline LDL. The analysis informed risk-based treatment decisions.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T13:26:30Z","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 systematische review die het verband onderzocht tussen uitgangs-LDL en totale en cardiovasculaire mortaliteitsreductie na LDL-verlaging. Kwantificeert het absolute voordeel per uitgangsrisico.","abstract_original":"IMPORTANCE: Effects on specific fatal and nonfatal end points appear to vary for low-density lipoprotein cholesterol (LDL-C)-lowering drug trials. OBJECTIVE: To evaluate whether baseline LDL-C level is associated with total and cardiovascular mortality risk reductions. DATA SOURCESAND STUDY SELECTION: Electronic databases (Cochrane, MEDLINE, EMBASE, TCTMD, ClinicalTrials.gov, major congress proceedings) were searched through February 2, 2018, to identify randomized clinical trials of statins, ezetimibe, and PCSK9-inhibiting monoclonal antibodies. DATA EXTRACTION AND SYNTHESIS: Two investigators abstracted data and appraised risks of bias. Intervention groups were categorized as \"more intensive\" (more potent pharmacologic intervention) or \"less intensive\" (less potent, placebo, or control group). MAIN OUTCOMES AND MEASURES: The coprimary end points were total mortality and cardiovascular mortality. Random-effects meta-regression and meta-analyses evaluated associations between baseline LDL-C level and reductions in mortality end points and secondary end points including major adverse cardiac events (MACE). RESULTS: In 34 trials, 136 299 patients received more intensive and 133 989 received less intensive LDL-C lowering. All-cause mortality was lower for more vs less intensive therapy (7.08% vs 7.70%; rate ratio [RR], 0.92 [95% CI, 0.88 to 0.96]), but varied by baseline LDL-C level. Meta-regression showed more intensive LDL-C lowering was associated with greater reductions in all-cause mortality with higher baseline LDL-C levels (change in RRs per 40-mg/dL increase in baseline LDL-C, 0.91 [95% CI, 0.86 to 0.96]; P = .001; absolute risk difference [ARD], -1.05 incident cases per 1000 person-years [95% CI, -1.59 to -0.51]), but only when baseline LDL-C levels were 100 mg/dL or greater (P < .001 for interaction) in a meta-analysis. Cardiovascular mortality was lower for more vs less intensive therapy (3.48% vs 4.07%; RR, 0.84 [95% CI, 0.79 to 0.89]) but varied by baseline LDL-C level. Meta-regression showed more intensive LDL-C lowering was associated with a greater reduction in cardiovascular mortality with higher baseline LDL-C levels (change in RRs per 40-mg/dL increase in baseline LDL-C, 0.86 [95% CI, 0.80 to 0.94]; P < .001; ARD, -1.0 incident cases per 1000 person-years [95% CI, -1.51 to -0.45]), but only when baseline LDL-C levels were 100 mg/dL or greater (P < .001 for interaction) in a meta-analysis. Trials with baseline LDL-C levels of 160 mg/dL or greater had the greatest reduction in all-cause mortality (RR, 0.72 [95% CI, 0.62 to 0.84]; P < .001; 4.3 fewer deaths per 1000 person-years) in a meta-analysis. More intensive LDL-C lowering was also associated with progressively greater risk reductions with higher baseline LDL-C level for myocardial infarction, revascularization, and MACE. CONCLUSIONS AND RELEVANCE: In these meta-analyses and meta-regressions, more intensive compared with less intensive LDL-C lowering was associated with a greater reduction in risk of total and cardiovascular mortality in trials of patients with higher baseline LDL-C levels. This association was not present when baseline LDL-C level was less than 100 mg/dL, suggesting that the greatest benefit from LDL-C-lowering therapy may occur for patients with higher baseline LDL-C levels."},{"id":"45b651122f52","type":"article","url":"https://hartvaat.nl/2018/04/17/cardiovasculair-risico-en-relatief-voordeel-van-intensieve-hypertensiebehandelin/","title":"Cardiovasculair risico en relatief voordeel van intensieve hypertensiebehandeling","title_en":"Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","bloeddrukbehandeling","cardio-renaal-metabool","cardiogene-shock","cardiorenal-behandelstrategie","diabetes-en-hart","diabetes-type-2","endotheel","farmaco-economie","fractional-flow-reserve","gepersonaliseerde-geneeskunde","hartrevalidatie","hypertrofische-cardiomyopathie","inflammatie","menopauze","microbioom","myocardinfarct","obesitas","ouderen","ramipril","resistente-hypertensie","richtlijnen-esc","roken","secundaire-preventie","slaapapneu","voeding-hart","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.01.074","source_url":"https://doi.org/10.1016/j.jacc.2018.01.074","authors":["Robert A Phillips","Jiaqiong Xu","Leif E Peterson","Ryan M Arnold","Joseph A Diamond","Adam E Schussheim"],"significance":7,"published":"2018-04-17","source_date":"2018-04-17","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/brugada-syndroom/"],"congress":"","summary_en":"This analysis from SPRINT examined how baseline cardiovascular risk modifies the absolute benefit and harm of intensive blood pressure treatment, demonstrating that higher-risk patients gain more absolute benefit while maintaining a favorable risk-benefit ratio.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 impact van cardiovasculair uitgangsrisico op het relatieve voordeel en de schade van intensieve hypertensiebehandeling. Risicostratificatie voor het SPRINT-paradigma.","abstract_original":"BACKGROUND: The lower rate of primary outcome events in the intensive treatment group in SPRINT (Systolic Pressure Intervention Trial) was associated with increased clinically significant serious adverse events (SAEs). In 2017, the American College of Cardiology/American Heart Association issued risk-based blood pressure treatment guidelines. The authors hypothesized that stratification of the SPRINT population by degree of future cardiovascular disease (CVD) risk might identify a group which could benefit the most from intensive treatment. OBJECTIVES: This study investigated the effect of baseline 10-year CVD risk on primary outcome events and all-cause SAEs in SPRINT. METHODS: Stratifying by quartiles of baseline 10-year CVD risk, Cox proportional hazards models were used to examine the associations of treatment group with the primary outcome events and SAEs. Using multiplicative Poisson regression, a predictive model was developed to determine the benefit-to-harm ratio as a function of CVD risk. RESULTS: Within each quartile, there was a lower rate of primary outcome events in the intensive treatment group, with no differences in all-cause SAEs. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38. The number needed to harm for all-cause SAEs increased from 62 to 250. The predictive model demonstrated significantly increasing benefit-to-harm ratios (± SE) of 0.50 ± 0.15, 0.78 ± 0.26, 2.13 ± 0.73, and 4.80 ± 1.86, for the first, second, third, and fourth quartile, respectively (p for trend <0.001). All possible pairwise comparisons of between-quartile mean values of benefit-to-harm ratios were significantly different (p < 0.001). CONCLUSIONS: In SPRINT, those with lower baseline CVD risk had more harm than benefit from intensive treatment, whereas those with higher risk had more benefit. With the 2017 American College of Cardiology/American Heart Association blood pressure treatment guidelines, this analysis may help providers and patients make decisions regarding the intensity of blood pressure treatment."},{"id":"e2f66e735950","type":"article","url":"https://hartvaat.nl/2018/04/17/nt-probnp-geleide-therapie-bij-acuut-gedecompenseerd-hartfalen-prima-ii/","title":"NT-proBNP-geleide therapie bij acuut gedecompenseerd hartfalen: PRIMA II","title_en":"NT-proBNP (N-Terminal pro-B-Type Natriuretic Peptide)-Guided Therapy in Acute Decompensated Heart Failure: PRIMA II Randomized Controlled Trial (Can NT-ProBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","empagliflozine","emperor-trials","nt-probnp"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.029882","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.029882","authors":["Susan Stienen","Khibar Salah","Arno H Moons","Adrianus L Bakx","Petra van Pol","R A Mikael Kortz","João Pedro Ferreira","Irene Marques","Jutta M Schroeder-Tanka","Jan T Keijer","Antoni Bayés-Genis","Jan G P Tijssen","Yigal M Pinto","Wouter E Kok"],"significance":7,"published":"2018-04-17","source_date":"2018-04-17","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"The PRIMA II trial showed that NT-proBNP-guided therapy in acute decompensated heart failure did not improve outcomes compared with clinically guided management, adding to the evidence against routine biomarker-guided treatment titration in acute HF.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PRIMA II gerandomiseerde trial naar NT-proBNP-geleide therapie bij acuut gedecompenseerd hartfalen. Geen voordeel van biomarker-geleide intensivering in de acute fase.","abstract_original":"BACKGROUND: The concept of natriuretic peptide guidance has been extensively studied in patients with chronic heart failure (HF), with only limited success. The effect of NT-proBNP (N-terminal probrain natriuretic peptide)-guided therapy in patients with acute decompensated HF using a relative NT-proBNP target has not been investigated. This study aimed to assess whether NT-proBNP-guided therapy of patients with acute decompensated HF using a relative NT-proBNP target would lead to improved outcomes compared with conventional therapy. METHODS: We conducted a prospective randomized controlled trial to study the impact of in-hospital guidance for acute decompensated HF treatment by a predefined NT-proBNP target (>30% reduction from admission to discharge) versus conventional treatment. Patients with acute decompensated HF with NT-proBNP levels >1700 ng/L were eligible. After achieving clinical stability, 405 patients were randomized to either NT-proBNP-guided or conventional treatment (1:1). The primary end point was dual: a composite of all-cause mortality and HF readmissions in 180 days and the number of days alive out of the hospital in 180 days. Secondary end points were all-cause mortality within 180 days, HF readmissions within 180 days, and a composite of all-cause mortality and HF readmissions within 90 days. RESULTS: Significantly more patients in the NT-proBNP-guided therapy group were discharged with an NT-proBNP reduction of >30% (80% versus 64%, P=0.001). Nonetheless, NT-proBNP-guided therapy did not significantly improve the combined event rate for all-cause mortality and HF readmissions (hazard ratio, 0.96; 95% confidence interval, 0.72-1.37; P=0.99) or the median number of days alive outside of the hospital (178 versus 179 days for NT-proBNP versus conventional patients, P=0.39). Guided therapy also did not significantly improve any of the secondary end points. CONCLUSIONS: The PRIMA II trial (Can NT-ProBNP-Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?) demonstrates that the guidance of HF therapy to reach an NT-proBNP reduction of >30% after clinical stabilization did not improve 6-month outcomes. CLINICAL TRIAL REGISTRATION: URL: http://www.trialregister.nl. Unique identifier: NTR3279."},{"id":"55707ac58973","type":"article","url":"https://hartvaat.nl/2018/04/14/sildenafil-bij-persisterende-pulmonale-hypertensie-na-klepchirurgie/","title":"Sildenafil bij persisterende pulmonale hypertensie na klepchirurgie","title_en":"Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["pulmonale-hypertensie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx700","source_url":"https://doi.org/10.1093/eurheartj/ehx700","authors":["Javier Bermejo","Raquel Yotti","Rocío García-Orta","Pedro L Sánchez-Fernández","Mario Castaño","Javier Segovia-Cubero","Pilar Escribano-Subías","José Alberto San Román","Xavier Borrás","Angel Alonso-Gómez","Javier Botas","María G Crespo-Leiro","Sonia Velasco","Antoni Bayés-Genís","Amador López","Roberto Muñoz-Aguilera","Eduardo de Teresa","José R González-Juanatey","Arturo Evangelista","Teresa Mombiela","Ana González-Mansilla","Jaime Elízaga","Javier Martín-Moreiras","José M González-Santos","Eduardo Moreno-Escobar","Francisco Fernández-Avilés"],"significance":6,"published":"2018-04-14","source_date":"2018-04-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/rechtsventrikelfalen/"],"congress":"","summary_en":"This multicenter study evaluated sildenafil for persistent pulmonary hypertension after corrected valvular heart disease, testing phosphodiesterase-5 inhibition for residual PH in the post-surgical setting.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T13:26:29Z","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":"Multicenter studie naar sildenafil bij patiënten met gecorrigeerd kleplijden en persisterende pulmonale hypertensie. Onderzoekt farmacologische reductie van residuele PH.","abstract_original":"AIMS: We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). METHODS AND RESULTS: The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22-0.67; P < 0.001]. The Kaplan-Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0-4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups. CONCLUSION: Treatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided. The trial is registered with ClinicalTrials.gov, number NCT00862043."},{"id":"294a2b6c0282","type":"article","url":"https://hartvaat.nl/2018/04/12/heartmate-3-2-jaarsresultaten-bij-gevorderd-hartfalen-nejm-momentum-3/","title":"HeartMate 3 2-jaarsresultaten bij gevorderd hartfalen: NEJM MOMENTUM 3","title_en":"Two-Year Outcomes with a Magnetically Levitated Cardiac Pump in Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1800866","source_url":"https://doi.org/10.1056/NEJMoa1800866","authors":["Mandeep R Mehra","Daniel J Goldstein","Nir Uriel","Joseph C Cleveland","Melana Yuzefpolskaya","Christopher Salerno","Mary N Walsh","Carmelo A Milano","Chetan B Patel","Gregory A Ewald","Akinobu Itoh","David Dean","Arun Krishnamoorthy","William G Cotts","Antone J Tatooles","Ulrich P Jorde","Brian A Bruckner","Jerry D Estep","Valluvan Jeevanandam","Gabriel Sayer","Douglas Horstmanshof","James W Long","Sanjeev Gulati","Eric R Skipper","John B O'Connell","Gerald Heatley","Poornima Sood","Yoshifumi Naka"],"significance":9,"published":"2018-04-12","source_date":"2018-04-12","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/"],"congress":"","summary_en":"The 2-year MOMENTUM 3 results confirmed the sustained superiority of the HeartMate 3 magnetically levitated LVAD over the HeartMate II, with significantly fewer adverse events including pump thrombosis, stroke, and bleeding. The data cemented HeartMate 3 as the standard of care in mechanical circulatory support.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T13:26:29Z","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":"NEJM 2-jaarsresultaten van MOMENTUM 3 die de superioriteit van de HeartMate 3 LVAD bevestigen. Significant minder heropnames en pomptrombose dan eerdere generaties.","abstract_original":"BACKGROUND: In an early analysis of this trial, use of a magnetically levitated centrifugal continuous-flow circulatory pump was found to improve clinical outcomes, as compared with a mechanical-bearing axial continuous-flow pump, at 6 months in patients with advanced heart failure. METHODS: In a randomized noninferiority and superiority trial, we compared the centrifugal-flow pump with the axial-flow pump in patients with advanced heart failure, irrespective of the intended goal of support (bridge to transplantation or destination therapy). The composite primary end point was survival at 2 years free of disabling stroke (with disabling stroke indicated by a modified Rankin score of >3; scores range from 0 to 6, with higher scores indicating more severe disability) or survival free of reoperation to replace or remove a malfunctioning device. The noninferiority margin for the risk difference (centrifugal-flow pump group minus axial-flow pump group) was -10 percentage points. RESULTS: Of 366 patients, 190 were assigned to the centrifugal-flow pump group and 176 to the axial-flow pump group. In the intention-to-treat population, the primary end point occurred in 151 patients (79.5%) in the centrifugal-flow pump group, as compared with 106 (60.2%) in the axial-flow pump group (absolute difference, 19.2 percentage points; 95% lower confidence boundary, 9.8 percentage points [P<0.001 for noninferiority]; hazard ratio, 0.46; 95% confidence interval [CI], 0.31 to 0.69 [P<0.001 for superiority]). Reoperation for pump malfunction was less frequent in the centrifugal-flow pump group than in the axial-flow pump group (3 patients [1.6%] vs. 30 patients [17.0%]; hazard ratio, 0.08; 95% CI, 0.03 to 0.27; P<0.001). The rates of death and disabling stroke were similar in the two groups, but the overall rate of stroke was lower in the centrifugal-flow pump group than in the axial-flow pump group (10.1% vs. 19.2%; hazard ratio, 0.47; 95% CI, 0.27 to 0.84, P=0.02). CONCLUSIONS: In patients with advanced heart failure, a fully magnetically levitated centrifugal-flow pump was superior to a mechanical-bearing axial-flow pump with regard to survival free of disabling stroke or reoperation to replace or remove a malfunctioning device. (Funded by Abbott; MOMENTUM 3 ClinicalTrials.gov number, NCT02224755 .)."},{"id":"bf1760a044cb","type":"article","url":"https://hartvaat.nl/2018/04/10/geen-verband-tussen-hartfalen-en-kankerincidentie/","title":"Geen verband tussen hartfalen en kankerincidentie","title_en":"Lack of Association Between Heart Failure and Incident Cancer.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.01.069","source_url":"https://doi.org/10.1016/j.jacc.2018.01.069","authors":["Senthil Selvaraj","Deepak L Bhatt","Brian Claggett","Luc Djoussé","Sanjiv J Shah","Jiaying Chen","Tasnim F Imran","Saadia Qazi","Howard D Sesso","J Michael Gaziano","Deborah Schrag"],"significance":5,"published":"2018-04-10","source_date":"2018-04-10","image":"","kennis":[],"congress":"","summary_en":"This study found no association between heart failure and incident cancer risk, providing reassurance against the proposed link between HF and malignancy that had raised concerns in observational studies.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T13:26:29Z","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 die geen associatie aantoonde tussen hartfalen en het optreden van kanker. Geruststellend voor de onco-cardiologische discussie.","abstract_original":"BACKGROUND: Several recent studies have suggested an increased cancer risk among patients with heart failure (HF). However, these studies are constrained by limited size and follow-up, lack of comprehensive data on other health attributes, and adjudicated cancer outcomes. OBJECTIVES: This study sought to determine whether HF is associated with cancer incidence and cancer-specific mortality. METHODS: The study assembled a cohort from the Physicians' Health Studies I and II, 2 randomized controlled trials of aspirin and vitamin supplements conducted from 1982 to 1995 and from 1997 to 2011, respectively, that included annual health evaluations and determination of cancer and HF diagnoses. In the primary analysis, the study excluded participants with cancer or HF at baseline and performed multivariable-adjusted Cox models to determine the relationship between HF and cancer, modeling HF as a time-varying exposure. In a complementary analysis, the study used the landmark method and identified cancer-free participants at 70 years of age, distinguishing between those with and without HF, and likewise performed Cox regression. Sensitivity analyses were performed at 65, 75, and 80 years of age. RESULTS: Among 28,341 Physicians' Health Study participants, 1,420 developed HF. A total of 7,363 cancers developed during a median follow-up time of 19.9 years (25th to 75th percentile: 11.0 to 26.8 years). HF was not associated with cancer incidence in crude (hazard ratio: 0.92; 95% confidence interval: 0.80 to 1.08) or multivariable-adjusted analysis (hazard ratio: 1.05; 95% confidence interval: 0.86 to 1.29). No association was found between HF and site-specific cancer incidence or cancer-specific mortality after multivariable adjustment. Results were similar when using the landmark method at all landmark ages. CONCLUSIONS: HF is not associated with an increased risk of cancer among male physicians."},{"id":"de8d4e737382","type":"article","url":"https://hartvaat.nl/2018/04/10/sedentaire-veroudering-omkeren-op-middelbare-leeftijd-gerandomiseerde-trial-voor/","title":"Sedentaire veroudering omkeren op middelbare leeftijd: gerandomiseerde trial voor HF-preventie","title_en":"Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial: Implications For Heart Failure Prevention.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["finearts-hf","hartrevalidatie","primaire-preventie","select-trial","step-hfpef","stride-trial","summit-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030617","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030617","authors":["Erin J Howden","Satyam Sarma","Justin S Lawley","Mildred Opondo","William Cornwell","Douglas Stoller","Marcus A Urey","Beverley Adams-Huet","Benjamin D Levine"],"significance":8,"published":"2018-04-10","source_date":"2018-04-10","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that a 2-year intensive exercise program in sedentary middle-aged adults reversed the cardiac stiffening associated with aging, with implications for preventing HFpEF. The study demonstrated a modifiable window for cardiovascular fitness intervention.","created":"2026-07-03T10:27:14Z","updated":"2026-07-03T13:26:29Z","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":"Gerandomiseerde trial die aantoonde dat een 2-jarig intensief trainingsprogramma op middelbare leeftijd de cardiale effecten van sedentaire veroudering kan omkeren. Implicaties voor HF-preventie.","abstract_original":"BACKGROUND: Poor fitness in middle age is a risk factor for heart failure, particularly heart failure with a preserved ejection fraction. The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness, a consequence of sedentary aging. In a prospective, parallel group, randomized controlled trial, we examined the effect of 2 years of supervised high-intensity exercise training on LV stiffness. METHODS: Sixty-one (48% male) healthy, sedentary, middle-aged participants (53±5 years) were randomly assigned to either 2 years of exercise training (n=34) or attention control (control; n=27). Right heart catheterization and 3-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (Vo2max) was measured to quantify changes in fitness. RESULTS: Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88±11%. Vo2max increased by 18% (exercise training: pre 29.0±4.8 to post 34.4±6.4; control: pre 29.5±5.3 to post 28.7±5.4, group×time P<0.001) and LV stiffness was reduced (right/downward shift in the end-diastolic pressure-volume relationships; preexercise training stiffness constant 0.072±0.037 to postexercise training 0.051±0.0268, P=0.0018), whereas there was no change in controls (group×time P<0.001; pre stiffness constant 0.0635±0.026 to post 0.062±0.031, P=0.83). Exercise increased LV end-diastolic volume (group×time P<0.001), whereas pulmonary capillary wedge pressure was unchanged, providing greater stroke volume for any given filling pressure (loading×group×time P=0.007). CONCLUSIONS: In previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness. Regular exercise training may provide protection against the future risk of heart failure with a preserved ejection fraction by preventing the increase in cardiac stiffness attributable to sedentary aging. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02039154."},{"id":"366e23e51b6d","type":"article","url":"https://hartvaat.nl/2018/04/10/ezetimibe-bij-diabetes-versus-zonder-diabetes-improve-it-subanalyse/","title":"Ezetimibe bij diabetes versus zonder diabetes: IMPROVE-IT-subanalyse","title_en":"Benefit of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes and Safety in Patients With Versus Without Diabetes Mellitus: Results From IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial).","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","ezetimibe","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030950","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030950","authors":["Robert P Giugliano","Christopher P Cannon","Michael A Blazing","José C Nicolau","Ramón Corbalán","Jindřich Špinar","Jeong-Gun Park","Jennifer A White","Erin A Bohula","Eugene Braunwald"],"significance":7,"published":"2018-04-10","source_date":"2018-04-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This IMPROVE-IT subanalysis showed that the cardiovascular benefit of adding ezetimibe to statin therapy after ACS is greater in patients with diabetes than without, supporting more aggressive LDL lowering in the diabetic ACS population.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:29Z","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":"IMPROVE-IT subanalyse naar het voordeel van ezetimibe-toevoeging bij diabetespatiënten versus niet-diabetespatiënten na ACS. Diabetes als risicoversterker.","abstract_original":"BACKGROUND: Ezetimibe, when added to simvastatin, reduces cardiovascular events after acute coronary syndrome. We explored outcomes stratified by diabetes mellitus (DM). METHODS: In IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), 18 144 patients after acute coronary syndrome with low-density lipoprotein cholesterol 50 to 125 mg/dL were randomized to 40 mg ezetimibe/simvastatin (E/S) or 40 mg placebo/simvastatin. The primary composite end point was cardiovascular death, major coronary events, and stroke. DM was a prespecified subgroup. RESULTS: The 4933 (27%) patients with DM were more often older and female, had had a prior myocardial infarction and revascularization, and presented more frequently with non-ST segment elevation acute coronary syndrome compared with patients without DM (each P<0.001). The median admission low-density lipoprotein cholesterol was lower among patients with DM (89 versus 97 mg/dL, P<0.001). E/S achieved a significantly lower median time-weighted average low-density lipoprotein cholesterol compared with placebo/simvastatin, irrespective of DM (DM: 49 versus 67 mg/dL; no DM: 55 versus 71 mg/dL; both P<0.001). In patients with DM, E/S reduced the 7-year Kaplan-Meier primary end point event rate by 5.5% absolute (hazard ratio, 0.85; 95% confidence interval, 0.78-0.94); in patients without DM, the absolute difference was 0.7% (hazard ratio, 0.98; 95% confidence interval, 0.91-1.04; Pint=0.02). The largest relative reductions in patients with DM were in myocardial infarction (24%) and ischemic stroke (39%). No differences in safety outcomes by treatment were present regardless of DM. When stratified further by age, patients ≥75 years of age had a 20% relative reduction in the primary end point regardless of DM (Pint=0.91), whereas patients <75 years of age with DM had greater benefit than those without (Pint=0.011). When stratified by the TIMI (Thrombolysis in Myocardial Infarction) Risk Score for Secondary Prevention, all patients with DM demonstrated benefit with E/S regardless of risk. In contrast, among patients without DM, those with a high risk score experienced a significant (18%) relative reduction in the composite of cardiovascular death, myocardial infarction, and ischemic stroke with E/S compared with placebo/simvastatin, whereas patients without DM at low or moderate risk demonstrated no benefit with the addition of ezetimibe to simvastatin (Pint =0.034). CONCLUSIONS: In IMPROVE-IT, the benefit of adding ezetimibe to statin was enhanced in patients with DM and in high-risk patients without DM. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00202878."},{"id":"b97450bf6a76","type":"article","url":"https://hartvaat.nl/2018/04/07/statines-en-niet-statine-ldl-verlagers-en-cardiovasculaire-uitkomsten-meta-analy/","title":"Statines en niet-statine LDL-verlagers en cardiovasculaire uitkomsten: meta-analyse","title_en":"Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","niet-statine-therapie","rosuvastatine","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx566","source_url":"https://doi.org/10.1093/eurheartj/ehx566","authors":["Konstantinos C Koskinas","George C M Siontis","Raffaele Piccolo","Dimitris Mavridis","Lorenz Räber","François Mach","Stephan Windecker"],"significance":8,"published":"2018-04-07","source_date":"2018-04-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This meta-analysis comparing statins with non-statin LDL-lowering therapies for secondary prevention confirmed that cardiovascular benefit is proportional to the magnitude of LDL cholesterol reduction regardless of the mechanism of lowering, supporting the treat-to-target approach.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:29Z","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":"Meta-analyse die statines vergeleek met niet-statine LDL-verlagers op cardiovasculaire uitkomsten bij secundaire preventie. Bevestigt dat LDL-verlaging het mechanisme is, ongeacht het middel.","abstract_original":"AIMS: Current evidence on dyslipidaemia management has expanded to novel treatments and very low achieved levels of low-density lipoprotein cholesterol (LDL-C). We sought to compare the clinical impact of more-intensive vs. less-intensive LDL-C lowering by means of statins and currently recommended non-statin medications in secondary prevention. METHODS AND RESULTS: We searched Medline, EMBASE, and Cochrane databases for randomized controlled trials of statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, or bile acid sequestrants with >500 patients followed for ≥1 year. We employed random-effects models using risk ratios (RRs) with 95% confidence intervals (CIs) to compare outcomes. We included 19 trials (15 of statins, 3 of PCSK9 inhibitors, and 1 of ezetimibe) with 152 507 patients randomly assigned to more-intensive (n = 76 678) or less-intensive treatment (n = 75 829). More-intensive treatment was associated with 19% relative risk reduction for the primary outcome, major vascular events (MVEs; RR 0.81, 95% CI 0.77-0.86). Risk reduction was greater across higher baseline levels and greater achieved reductions of LDL-C. The clinical benefit was significant across varying types of more-intensive treatment and was consistent for statins (RR 0.81, 95% CI 0.76-0.86) and non-statin agents (PCSK9 inhibitors and ezetimibe; RR 0.85, 95% CI 0.77-0.94) as active (more-intensive) intervention (P-interaction = 0.38). Each 1.0 mmol/L reduction in LDL-C was associated with 19% relative decrease in MVE. Death, cardiovascular death, myocardial infarction, stroke, and coronary revascularization also favoured more-intensive treatment. CONCLUSION: Reduction of MVE is proportional to the magnitude of LDL-C lowering across a broad spectrum of on-treatment levels in secondary prevention. Statin intensification and add-on treatment with PCSK9 inhibitors or ezetimibe are associated with significant reduction of cardiovascular morbidity in this very high-risk population."},{"id":"0b4561b53993","type":"article","url":"https://hartvaat.nl/2018/04/07/2017-esc-eas-praktische-gids-voor-pcsk9-remming/","title":"2017 ESC/EAS praktische gids voor PCSK9-remming","title_en":"2017 Update of ESC/EAS Task Force on practical clinical guidance for proprotein convertase subtilisin/kexin type 9 inhibition in patients with atherosclerotic cardiovascular disease or in familial hypercholesterolaemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx549","source_url":"https://doi.org/10.1093/eurheartj/ehx549","authors":["Ulf Landmesser","M John Chapman","Jane K Stock","Pierre Amarenco","Jill J F Belch","Jan Borén","Michel Farnier","Brian A Ference","Stephan Gielen","Ian Graham","Diederick E Grobbee","G Kees Hovingh","Thomas F Lüscher","Massimo F Piepoli","Kausik K Ray","Erik S Stroes","Olov Wiklund","Stephan Windecker","Jose Luis Zamorano","Fausto Pinto","Lale Tokgözoglu","Jeroen J Bax","Alberico L Catapano"],"significance":8,"published":"2018-04-07","source_date":"2018-04-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"The 2017 ESC/EAS practical guidance update for PCSK9 inhibitor therapy integrated results from FOURIER and ODYSSEY OUTCOMES to provide clinicians with practical recommendations on patient selection, treatment initiation, and monitoring for PCSK9 inhibitor therapy.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:29Z","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":"Geactualiseerde ESC/EAS praktische gids voor PCSK9-remming in de klinische praktijk. Integreert FOURIER- en ODYSSEY OUTCOMES-resultaten.","abstract_original":""},{"id":"7ec716c085a4","type":"article","url":"https://hartvaat.nl/2018/04/05/bloeddrukverlaging-bij-kappersbezoek-nejm-clustergerandomiseerde-trial/","title":"Bloeddrukverlaging bij kappersbezoek: NEJM clustergerandomiseerde trial","title_en":"A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","summit-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1717250","source_url":"https://doi.org/10.1056/NEJMoa1717250","authors":["Ronald G Victor","Kathleen Lynch","Ning Li","Ciantel Blyler","Eric Muhammad","Joel Handler","Jeffrey Brettler","Mohamad Rashid","Brent Hsu","Davontae Foxx-Drew","Norma Moy","Anthony E Reid","Robert M Elashoff"],"significance":8,"published":"2018-04-05","source_date":"2018-04-05","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This innovative NEJM trial demonstrated that a barber-facilitated, pharmacist-led hypertension intervention in black barbershops substantially reduced blood pressure in black men with uncontrolled hypertension. The community-based approach addressed the persistent disparity in hypertension control among black men.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:29Z","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":"Innovatieve NEJM trial die een kapper-gebaseerde hypertensie-interventie onderzocht bij zwarte mannen. Community-gebaseerde benadering voor een moeilijk bereikbare populatie.","abstract_original":"BACKGROUND: Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. METHODS: We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure at 6 months. RESULTS: At baseline, the mean systolic blood pressure was 152.8 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 6 months, the mean systolic blood pressure fell by 27.0 mm Hg (to 125.8 mm Hg) in the intervention group and by 9.3 mm Hg (to 145.4 mm Hg) in the control group; the mean reduction was 21.6 mm Hg greater with the intervention (95% confidence interval, 14.7 to 28.4; P<0.001). A blood-pressure level of less than 130/80 mm Hg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group (P<0.001). In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury). CONCLUSIONS: Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618 .)."},{"id":"caa112739231","type":"article","url":"https://hartvaat.nl/2018/04/03/oplaaddosis-atorvastatine-voor-pci-jama-gerandomiseerde-trial/","title":"Oplaaddosis atorvastatine vóór PCI: JAMA gerandomiseerde trial","title_en":"Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous Coronary Intervention on Major Adverse Cardiovascular Events in Acute Coronary Syndrome: The SECURE-PCI Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2018.2444","source_url":"https://doi.org/10.1001/jama.2018.2444","authors":["Otavio Berwanger","Eliana Vieira Santucci","Pedro Gabriel Melo de Barros E Silva","Isabella de Andrade Jesuíno","Lucas Petri Damiani","Lilian Mazza Barbosa","Renato Hideo Nakagawa Santos","Ligia Nasi Laranjeira","Flávia de Mattos Egydio","Juliana Aparecida Borges de Oliveira","Frederico Toledo Campo Dall Orto","Pedro Beraldo de Andrade","Igor Ribeiro de Castro Bienert","Carlos Eduardo Bosso","José Armando Mangione","Carisi Anne Polanczyk","Amanda Guerra de Moraes Rego Sousa","Renato Abdala Karam Kalil","Luciano de Moura Santos","Andrei Carvalho Sposito","Rafael Luiz Rech","Antônio Carlos Sobral Sousa","Felipe Baldissera","Bruno Ramos Nascimento","Roberto Rocha Corrêa Veiga Giraldez","Alexandre Biasi Cavalcanti","Sabrina Bernardez Pereira","Luiz Alberto Mattos","Luciana Vidal Armaganijan","Hélio Penna Guimarães","José Eduardo Moraes Rego Sousa","John Hunter Alexander","Christopher Bull Granger","Renato Delascio Lopes"],"significance":7,"published":"2018-04-03","source_date":"2018-04-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This JAMA trial showed that a loading dose of atorvastatin prior to planned PCI did not reduce major cardiovascular events in patients with ACS, arguing against routine statin loading before coronary intervention.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 een oplaaddosis atorvastatine vóór geplande PCI op cardiovasculaire events. Onderzocht periprocedurale statineloading.","abstract_original":"IMPORTANCE: The effects of loading doses of statins on clinical outcomes in patients with acute coronary syndrome (ACS) and planned invasive management remain uncertain. OBJECTIVE: To determine if periprocedural loading doses of atorvastatin decrease 30-day major adverse cardiovascular events (MACE) in patients with ACS and planned invasive management. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, double-blind, placebo-controlled, randomized clinical trial conducted at 53 sites in Brazil among 4191 patients with ACS evaluated with coronary angiography to proceed with a percutaneous coronary intervention (PCI) if anatomically feasible. Enrollment occurred between April 18, 2012, and October 6, 2017. Final follow-up for 30-day outcomes was on November 6, 2017. INTERVENTIONS: Patients were randomized to receive 2 loading doses of 80 mg of atorvastatin (n = 2087) or matching placebo (n = 2104) before and 24 hours after a planned PCI. All patients received 40 mg of atorvastatin for 30 days starting 24 hours after the second dose of study medication. MAIN OUTCOMES AND MEASURES: The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, stroke, and unplanned coronary revascularization through 30 days. RESULTS: Among the 4191 patients (mean age, 61.8 [SD, 11.5] years; 1085 women [25.9%]) enrolled, 4163 (99.3%) completed 30-day follow-up. A total of 2710 (64.7%) underwent PCI, 333 (8%) underwent coronary artery bypass graft surgery, and 1144 (27.3%) had exclusively medical management. At 30 days, 130 patients in the atorvastatin group (6.2%) and 149 in the placebo group (7.1%) had a MACE (absolute difference, 0.85% [95% CI, -0.70% to 2.41%]; hazard ratio, 0.88; 95% CI, 0.69-1.11; P = .27). No cases of hepatic failure were reported; 3 cases of rhabdomyolysis were reported in the placebo group (0.1%) and 0 in the atorvastatin group. CONCLUSIONS AND RELEVANCE: Among patients with ACS and planned invasive management with PCI, periprocedural loading doses of atorvastatin did not reduce the rate of MACE at 30 days. These findings do not support the routine use of loading doses of atorvastatin among unselected patients with ACS and intended invasive management. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01448642."},{"id":"73673ed80a64","type":"article","url":"https://hartvaat.nl/2018/04/01/2017-acc-aha-richtlijn-voor-hoge-bloeddruk-bij-volwassenen-jama-cardiology-overz/","title":"2017 ACC/AHA-richtlijn voor hoge bloeddruk bij volwassenen: JAMA Cardiology overzicht","title_en":"The 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline for High Blood Pressure in Adults.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2018.0005","source_url":"https://doi.org/10.1001/jamacardio.2018.0005","authors":["Paul K Whelton","Robert M Carey"],"significance":9,"published":"2018-04-01","source_date":"2018-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This JAMA Cardiology overview of the 2017 ACC/AHA hypertension guideline discussed the paradigm shift of redefining hypertension at ≥130/80 mmHg, the implications for patient populations, treatment thresholds, and the integration of SPRINT evidence into clinical practice.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 bespreking van de 2017 ACC/AHA-hypertensierichtlijn die de definitie van hypertensie verlaagde naar ≥130/80 mmHg. Paradigmaverschuiving in de Amerikaanse bloeddrukbehandeling.","abstract_original":""},{"id":"b08f0f9717a4","type":"article","url":"https://hartvaat.nl/2018/04/01/fibrinestoleigenschappen-en-klinische-uitkomsten-na-acs-plato-substudie/","title":"Fibrinestoleigenschappen en klinische uitkomsten na ACS: PLATO-substudie","title_en":"Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["abelacimab","trombose"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehy013","source_url":"https://doi.org/10.1093/eurheartj/ehy013","authors":["Wael Sumaya","Lars Wallentin","Stefan K James","Agneta Siegbahn","Katja Gabrysch","Maria Bertilsson","Anders Himmelmann","Ramzi A Ajjan","Robert F Storey"],"significance":5,"published":"2018-04-01","source_date":"2018-04-01","image":"","kennis":[],"congress":"","summary_en":"This PLATO substudy showed that fibrin clot properties independently predict adverse clinical outcomes after ACS, identifying a novel thrombotic biomarker beyond traditional platelet and coagulation measures.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PLATO substudie die aantoont dat fibrinestoleigenschappen onafhankelijk de klinische uitkomsten voorspellen na ACS. Nieuwe biomarker voor de coagulatietoestand.","abstract_original":"AIMS: To determine whether fibrin clot properties are associated with clinical outcomes following acute coronary syndrome (ACS). METHODS AND RESULTS: Plasma samples were collected at hospital discharge from 4354 ACS patients randomized to clopidogrel or ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. A validated turbidimetric assay was employed to study plasma clot lysis time and maximum turbidity (a measure of clot density). One-year rates of cardiovascular (CV) death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding events were assessed after sample collection. Hazard ratios (HRs) were estimated using Cox proportional hazards models. After adjusting for CV risk factors, each 50% increase in lysis time was associated with CV death/spontaneous MI [HR 1.17, 95% confidence interval (CI) 1.05-1.31; P < 0.01] and CV death alone (HR 1.36, 95% CI 1.17-1.59; P < 0.001). Similarly, each 50% increase in maximum turbidity was associated with increased risk of CV death (HR 1.24, 95% CI 1.03-1.50; P = 0.024). After adjustment for other prognostic biomarkers (leukocyte count, high-sensitivity C-reactive protein, high-sensitivity troponin T, cystatin C, N-terminal pro B-type natriuretic peptide, and growth differentiation factor-15), the association with CV death remained significant for lysis time (HR 1.2, 95% CI 1.01-1.42; P = 0.042) but not for maximum turbidity. These associations were consistent regardless of randomized antiplatelet treatment (all interaction P > 0.05). Neither lysis time nor maximum turbidity was associated with major bleeding events. CONCLUSION: Fibrin clots that are resistant to lysis independently predict adverse outcome in ACS patients. Novel therapies targeting fibrin clot properties might be a new avenue for improving prognosis in patients with ACS."},{"id":"78d06ece811a","type":"article","url":"https://hartvaat.nl/2018/04/01/spironolacton-versus-clonidine-als-vierde-middel-bij-resistente-hypertensie-reho/","title":"Spironolacton versus clonidine als vierde middel bij resistente hypertensie: ReHOT","title_en":"Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment).","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aprocitentan","lorundrostat","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10662","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10662","authors":["Eduardo M Krieger","Luciano F Drager","Dante M A Giorgi","Alexandre C Pereira","José Augusto Soares Barreto-Filho","Armando R Nogueira","José Geraldo Mill","Paulo A Lotufo","Celso Amodeo","Marcelo C Batista","Luiz C Bodanese","Antônio C C Carvalho","Iran Castro","Hilton Chaves","Eduardo A S Costa","Gilson S Feitosa","Roberto J S Franco","Flávio D Fuchs","Armênio C Guimarães","Paulo C Jardim","Carlos A Machado","Maria E Magalhães","Décio Mion","Raimundo M Nascimento","Fernando Nobre","Antônio C Nóbrega","Antônio L P Ribeiro","Carlos R Rodrigues-Sobrinho","Antônio F Sanjuliani","Maria do Carmo B Teixeira","Jose E Krieger"],"significance":7,"published":"2018-04-01","source_date":"2018-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"The ReHOT trial compared spironolactone with clonidine as fourth-line therapy for resistant hypertension, finding that spironolactone achieved better ambulatory blood pressure control. The result supported spironolactone as the preferred add-on agent.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ReHOT gerandomiseerde trial die spironolacton vergeleek met clonidine als vierdelijns antihypertensivum bij resistente hypertensie. Bevestigt de voorkeurspositie van spironolacton.","abstract_original":"UNLABELLED: The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434."},{"id":"20e942630588","type":"article","url":"https://hartvaat.nl/2018/04/01/eenmalig-intraveneus-ijzer-bij-hartfalen-in-zuidoost-azie-practice-asia-hf-pilot/","title":"Eenmalig intraveneus ijzer bij hartfalen in Zuidoost-Azië: PRACTICE-ASIA-HF pilot","title_en":"Single-dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo-controlled study (PRACTICE-ASIA-HF).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["ijzersuppletie","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12250","source_url":"https://doi.org/10.1002/ehf2.12250","authors":["Tee Joo Yeo","Poh Shuan Daniel Yeo","Farid Abdul Hadi","Timothy Cushway","Kim Yee Lee","Fang Fang Yin","Anne Ching","Ruili Li","Seet Yoong Loh","Shir Lynn Lim","Raymond Ching-Chiew Wong","Bee Choo Tai","Arthur Mark Richards","Carolyn S P Lam"],"significance":5,"published":"2018-04-01","source_date":"2018-04-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This pilot randomized trial of single-dose IV iron in Southeast Asian heart failure patients assessed the safety and initial efficacy of iron repletion in a population with high iron deficiency prevalence.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T13:26:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Pilot gerandomiseerde placebogecontroleerde trial naar eenmalig intraveneus ijzer bij hartfalenpatiënten in Zuidoost-Azië. Onderzoekt IV ijzer in een nieuwe populatie.","abstract_original":"AIMS: Iron deficiency is highly prevalent in Southeast Asians with heart failure (HF) and associated with worse outcomes. This trial aimed to assess the effect of intravenous iron in Southeast Asians hospitalized with decompensated HF. METHODS AND RESULTS: Fifty patients hospitalized for acute decompensated HF, regardless of ejection fraction, with iron deficiency (defined as serum ferritin <300 ng/mL if transferrin saturation is <20%) were randomized to receive either one dose of intravenous ferric carboxymaltose (FCM) 1000 mg or placebo (0.9% saline) following HF stabilization and before discharge in two Singapore tertiary centres. The primary endpoint was difference in 6-min walk test (6MWT) distance over 12 weeks, while secondary endpoints were quality of life assessed using validated Kansas City Cardiomyopathy Questionnaire (KCCQ) and Visual Analogue Scale (VAS). Improvement in 6MWT distance at Week 12 was observed in both FCM and placebo groups (from 252 ± 123 to 334 ± 128 m and from 243 ± 67 to 301 ± 83 m, respectively). Unadjusted analysis showed 6MWT distance for FCM exceeded that for placebo, but adjustment for baseline covariates and time attenuated this effect {adjusted mean difference between groups: 0.88 m [95% confidence interval (CI) -30.2 to 32.0, P = 0.956]}. KCCQ overall summary and VAS were similar in both groups [adjusted mean difference: KCCQ -1.48 (95% CI -8.27 to 5.31, P = 0.670) and VAS 0.26 (95% CI -0.33 to 0.86, P = 0.386)]. FCM was well tolerated with no serious treatment-related adverse events. CONCLUSIONS: Intravenous FCM administered pre-discharge in Southeast Asians hospitalized with decompensated HF is clinically feasible. Changes in 6MWT distance should be measured beyond Week 12 to account for background therapy effects."},{"id":"29d0f4e06e77","type":"article","url":"https://hartvaat.nl/2018/04/01/valsartan-en-linkerkamerremodellering-na-mi/","title":"Valsartan en linkerkamerremodellering na MI","title_en":"The impact of a dose of the angiotensin receptor blocker valsartan on post-myocardial infarction ventricular remodelling.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","secundaire-preventie","ventrikelfibrilleren"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12249","source_url":"https://doi.org/10.1002/ehf2.12249","authors":["Kyungil Park","Young-Dae Kim","Ki-Sik Kim","Su-Hoon Lee","Tae-Ho Park","Sang-Gon Lee","Byung-Soo Kim","Seung-Ho Hur","Tae-Hyun Yang","Joo-Hyun Oh","Taek-Jong Hong","Jong-Sun Park","Jin-Yong Hwang","Byungcheon Jeong","Woo-Hyung Bae"],"significance":5,"published":"2018-04-01","source_date":"2018-04-01","image":"","kennis":[],"congress":"","summary_en":"This study examined the impact of valsartan dose on post-MI ventricular remodeling, testing whether achieving higher doses of ARB therapy provides additional structural cardiac benefit beyond lower-dose treatment.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 valsartandosering op post-MI linkerkamerremodellering. Onderzoekt het dosis-responseffect van RAAS-blokkade na een infarct.","abstract_original":"AIMS: Although clinical guidelines advocate the use of the highest tolerated dose of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after acute myocardial infarction (MI), the optimal dosing or the risk-benefit profile of different doses have not been fully identified. METHODS AND RESULTS: In this multicentre trial, 495 Korean patients with acute ST segment elevation MI and subnormal left ventricular (LV) ejection fraction (<50%) were randomly allocated (2:1) to receive maximal tolerated dose of valsartan (titrated up to 320 mg/day, n = 333) or low-dose valsartan (80 mg/day, n = 162) treatment. The primary objective was to assess the changes in echocardiographic parameters of LV remodelling from baseline to 12 months after discharge. After treatment, end-diastolic LV volume (LVEDV) decreased significantly in the low-dose group, but the difference in LVEDV changes was insignificant between the maximal-tolerated-dose and low-dose groups. End-systolic LV volume decreased significantly in both groups, to a similar degree between groups. LV ejection fraction rose significantly in both study groups, to a similar degree. Changes in plasma levels of neurohormones were also comparable between the two groups. Drug-related adverse effects occurred more frequently in the maximal-tolerated-dose group than in the low-dose group (7.96 vs. 0.69%, P < 0.001). CONCLUSIONS: In the present study, treatment with the maximal tolerated dose of valsartan did not exhibit a superior effect on post-MI LV remodelling compared with low-dose treatment and was associated with a greater frequency of adverse effect in Korean patients. Further study with a sufficient number of cases and statistical power is warranted to verify the findings of the present study."},{"id":"019a09031a81","type":"article","url":"https://hartvaat.nl/2018/04/01/sekseverschillen-in-effectiviteit-van-orale-p2y12-remmers-meta-analyse/","title":"Sekseverschillen in effectiviteit van orale P2Y12-remmers: meta-analyse","title_en":"Differences in relative and absolute effectiveness of oral P2Y 12 inhibition in men and women: a meta-analysis and modelling study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-312003","source_url":"https://doi.org/10.1136/heartjnl-2017-312003","authors":["Kuan Ken Lee","Nicky Welton","Anoop S Shah","Philip D Adamson","Sofia Dias","Atul Anand","David E Newby","Nicholas L Mills","David A McAllister"],"significance":6,"published":"2018-04-01","source_date":"2018-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis examined sex differences in the effectiveness of newer P2Y12 inhibitors versus clopidogrel in ACS, evaluating whether women derive equal antiplatelet benefit from potent P2Y12 inhibition.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T13:26:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 sekseverschillen in de relatieve en absolute effectiviteit van orale P2Y12-remmers. Onderzoekt of vrouwen dezelfde voordelen ontvangen.","abstract_original":"OBJECTIVE: To estimate the absolute treatment effects of newer P2Y12 inhibitors (ticagrelor and prasugrel) compared with clopidogrel in men and women with acute coronary syndrome (ACS). METHODS: We searched Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials of oral P2Y12 inhibitors for acute stroke or ACS. Age-specific and sex-specific mortality was obtained for all patients admitted to hospital with myocardial infarction in Scotland from 2006 to 2010 (prior to introduction of prasugrel or ticagrelor). RESULTS: From 9277 articles, nine fulfilled our inclusion criteria. Three trials compared newer P2Y12 inhibitors to clopidogrel in ACS, in which the treatment rate ratio (RR) for major adverse cardiovascular events in men was 0.80 (95% CI 0.69 to 0.93). For the same outcome, across all nine trials, the sex-treatment interaction RR was 1.08 (95% CI 0.98 to 1.19). Combining these estimates yielded a treatment RR in women of 0.86 (95% CI 0.72 to 1.04).17 842 women and 27 818 men were admitted to hospital with myocardial infarction. Mortality was higher for women than men for all-cause (5708, 32.0% vs 5891, 21.2%), cardiovascular (4032, 22.6% vs 4117, 14.8%) and bleeding (193, 1.1% vs 228, 0.8%) deaths.On applying the sex-specific RRs to this population, the absolute risk reduction for mortality at 1 year was similar for women and men for all-cause (2.30% (95% CI -0.92% to 5.22%) vs 2.47% (95% CI 0.62% to 4.10%)), cardiovascular (2.70% (95% CI -0.63% to 5.74%)) vs 2.72% (95% CI 0.92% to 4.35%)) and bleeding (-0.27% (95% CI -1.06% to 0.30%) vs -0.18% (95% CI -0.71% to 0.24%)) deaths. CONCLUSION: Newer P2Y12 inhibitors may be slightly less efficacious in women than men, but the absolute risk reduction is similar in both sexes."},{"id":"41dcbb1e405b","type":"article","url":"https://hartvaat.nl/2018/03/31/6-versus-12-maanden-dapt-na-pci-bij-acs-lancet-netwerkmeta-analyse/","title":"6 versus 12+ maanden DAPT na PCI bij ACS: Lancet netwerkmeta-analyse","title_en":"6-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndrome (SMART-DATE): a randomised, open-label, non-inferiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30493-8","source_url":"https://doi.org/10.1016/S0140-6736(18)30493-8","authors":["Joo-Yong Hahn","Young Bin Song","Ju-Hyeon Oh","Deok-Kyu Cho","Jin Bae Lee","Joon-Hyung Doh","Sang-Hyun Kim","Jin-Ok Jeong","Jang-Ho Bae","Byung-Ok Kim","Jang Hyun Cho","Il-Woo Suh","Doo-Il Kim","Hoon-Ki Park","Jong-Seon Park","Woong Gil Choi","Wang Soo Lee","Jihoon Kim","Ki Hong Choi","Taek Kyu Park","Joo Myung Lee","Jeong Hoon Yang","Jin-Ho Choi","Seung-Hyuk Choi","Hyeon-Cheol Gwon"],"significance":8,"published":"2018-03-31","source_date":"2018-03-31","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This Lancet meta-analysis compared 6-month versus 12-month or longer DAPT after PCI in ACS patients and found that shorter DAPT reduced bleeding without significantly increasing ischemic events. The data supported individualized DAPT duration based on patient-level bleeding and ischemic risk assessment.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T13:26:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 die 6 maanden vergeleek met 12 maanden of langer DAPT na PCI bij ACS-patiënten. Definitief bewijs voor gepersonaliseerde DAPT-duur.","abstract_original":"BACKGROUND: Current guidelines recommend dual antiplatelet therapy (DAPT) of aspirin plus a P2Y12 inhibitor for at least 12 months after implantation of drug-eluting stents (DES) in patients with acute coronary syndrome. However, available data about the optimal duration of DAPT in patients with acute coronary syndrome undergoing percutaneous coronary intervention are scant. We aimed to investigate whether a 6-month duration of DAPT would be non-inferior to the conventional 12-month or longer duration of DAPT in this population. METHODS: We did a randomised, open-label, non-inferiority trial at 31 centres in South Korea. Patients were eligible if they had unstable angina, non-ST-segment elevation myocardial infarction, or ST-segment elevation myocardial infarction, and underwent percutaneous coronary intervention. Enrolled patients were randomly assigned, via a web-based system by computer-generated block randomisation, to either the 6-month DAPT group or to the 12-month or longer DAPT group, with stratification by site, clinical presentation, and diabetes. Assessors were masked to treatment allocation. The primary endpoint was a composite of all-cause death, myocardial infarction, or stroke at 18 months after the index procedure in the intention-to-treat population. Secondary endpoints were the individual components of the primary endpoint; definite or probable stent thrombosis as defined by the Academic Research Consortium; and Bleeding Academic Research Consortium (BARC) type 2-5 bleeding at 18 months after the index procedure. The primary endpoint was also analysed per protocol. This trial is registered with ClinicalTrials.gov, number NCT01701453. FINDINGS: Between Sept 5, 2012, and Dec 31, 2015, we randomly assigned 2712 patients; 1357 to the 6-month DAPT group and 1355 to the 12-month or longer DAPT group. Clopidogrel was used as a P2Y12 inhibitor for DAPT in 1082 (79·7%) patients in the 6-month DAPT group and in 1109 (81·8%) patients in the 12-month or longer DAPT group. The primary endpoint occurred in 63 patients in the 6-month DAPT group and in 56 patients in the 12-month or longer DAPT group (cumulative event rate 4·7% vs 4·2%; absolute risk difference 0·5%; upper limit of one-sided 95% CI 1·8%; pnon-inferiority=0·03 with a predefined non-inferiority margin of 2·0%). Although all-cause mortality did not differ significantly between the 6-month DAPT group and the 12-month or longer DAPT group (35 [2·6%] patients vs 39 [2·9%]; hazard ratio [HR] 0·90 [95% CI 0·57-1·42]; p=0·90) and neither did stroke (11 [0·8%] patients vs 12 [0·9%]; 0·92 [0·41-2·08]; p=0·84), myocardial infarction occurred more frequently in the 6-month DAPT group than in the 12-month or longer DAPT group (24 [1·8%] patients vs ten [0·8%]; 2·41 [1·15-5·05]; p=0·02). 15 (1·1%) patients had stent thrombosis in the 6-month DAPT group compared with ten (0·7%) in the 12-month or longer DAPT group (HR 1·50 [95% CI 0·68-3·35]; p=0·32). The rate of BARC type 2-5 bleeding was 2·7% (35 patients) in the 6-month DAPT group and 3·9% (51 patients) in the 12-month or longer DAPT group (HR 0·69 [95% CI 0·45-1·05]; p=0·09). Results from the per-protocol analysis were similar to those from the intention-to-treat analysis. INTERPRETATION: The increased risk of myocardial infarction with 6-month DAPT and the wide non-inferiority margin prevent us from concluding that short-term DAPT is safe in patients with acute coronary syndrome undergoing percutaneous coronary intervention with current-generation DES. Prolonged DAPT in patients with acute coronary syndrome without excessive risk of bleeding should remain the standard of care. FUNDING: Abbott Vascular Korea, Medtronic Vascular Korea, Biosensors Inc, and Dong-A ST."},{"id":"ad6c58e27141","type":"article","url":"https://hartvaat.nl/2018/03/27/crt-bij-hartfalen-met-smal-qrs-complex/","title":"CRT bij hartfalen met smal QRS-complex","title_en":"Cardiac Resynchronization Therapy in Patients With Heart Failure and Narrow QRS Complexes.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.01.042","source_url":"https://doi.org/10.1016/j.jacc.2018.01.042","authors":["Bhupendar Tayal","John Gorcsan","Jeroen J Bax","Niels Risum","Niels Thue Olsen","Jagmeet P Singh","William T Abraham","Jeffrey S Borer","Kenneth Dickstein","Daniel Gras","Henry Krum","Josep Brugada","Michele Robertson","Ian Ford","Johannes Holzmeister","Frank Ruschitzka","Peter Sogaard"],"significance":6,"published":"2018-03-27","source_date":"2018-03-27","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study confirmed that CRT is not effective in heart failure patients with narrow QRS complexes, reinforcing the guideline requirement for QRS width ≥130 ms as a prerequisite for cardiac resynchronization therapy.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T13:26:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 CRT bij hartfalenpatiënten met smal QRS. Bevestigt dat CRT bij smal QRS niet effectief is — alleen bij breed QRS (≥130 ms) geïndiceerd.","abstract_original":"BACKGROUND: Cross correlation analysis (CCA) using tissue Doppler imaging has been shown to be associated with outcome after cardiac resynchronization therapy (CRT) in patients with heart failure (HF) with wide QRS. However, its significance in patients with narrow QRS treated with CRT is unknown. OBJECTIVES: The aim of the current study was to investigate the association of mechanical activation delay by CCA with study outcome in patients with HF enrolled in the EchoCRT trial. METHODS: Baseline CCA could be performed from tissue Doppler imaging in the apical views in 807 of 809 (99.7%) enrolled patients, and 6-month follow-up could be performed in 610 of 635 (96%) patients with available echocardiograms. Patients with a pre-specified maximal activation delay ≥35 ms were considered to have significant delay. The study outcome was HF hospitalization or death. RESULTS: Of 807 patients, 375 (46%) did not have delayed mechanical activation at baseline by CCA. Patients without delayed mechanical activation who were randomized to CRT-On compared with CRT-Off had an increased risk of poor outcome (hazard ratio: 1.70; 95% confidence interval: 1.13 to 2.55; p = 0.01) with a significant interaction term (p = 0.04) between delayed mechanical activation and device randomization for the endpoint. Among patients with paired baseline and follow-up data with no events before 6-month follow-up (n = 541), new-onset delayed mechanical activation in the CRT-On group showed a significant increase in unfavorable events (hazard ratio: 3.73; 95% confidence interval: 1.15 to 12.14; p = 0.03). CONCLUSIONS: In the EchoCRT population, absence of delayed mechanical activation by CCA was significantly associated with poor outcomes, possibly due to the onset of new delayed mechanical activation with CRT pacing. (Echocardiography Guided Cardiac Resynchronization Therapy [EchoCRT] Trial; NCT00683696)."},{"id":"be6aa7921c51","type":"article","url":"https://hartvaat.nl/2018/03/27/hdl-subspecies-met-apoliproteine-c-iii-en-coronairlijden-vier-cohorten/","title":"HDL-subspecies met apoliproteïne C-III en coronairlijden: vier cohorten","title_en":"High-Density Lipoprotein Subspecies Defined by Presence of Apolipoprotein C-III and Incident Coronary Heart Disease in Four Cohorts.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["cetp-remmers","hdl-cholesterol"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.031276","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.031276","authors":["Majken K Jensen","Sarah A Aroner","Kenneth J Mukamal","Jeremy D Furtado","Wendy S Post","Michael Y Tsai","Anne Tjønneland","Joseph F Polak","Eric B Rimm","Kim Overvad","Robyn L McClelland","Frank M Sacks"],"significance":6,"published":"2018-03-27","source_date":"2018-03-27","image":"","kennis":[],"congress":"","summary_en":"This study distinguished HDL subspecies based on apolipoprotein C-III content and their differential association with coronary heart disease, showing that HDL-associated apoC-III identifies a dysfunctional HDL subpopulation.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T13:26:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 HDL-subspecies onderscheidt op basis van apoC-III-aanwezigheid en hun associatie met coronairlijden. Verfijnt het begrip van HDL-heterogeniteit.","abstract_original":"BACKGROUND: The causal role of high-density lipoprotein (HDL) cholesterol in cardioprotection has been questioned by genetic and randomized studies. Novel measures that relate to HDL function may contribute new information to the prediction of cardiovascular risk. Apolipoprotein C-III (apoC-III) is a key regulator of lipoprotein metabolism. We investigated whether subspecies of HDL defined by apoC-III are associated with coronary heart disease (CHD). METHODS: We used immunoaffinity chromatography to measure the apoA-I concentrations of HDL that contains and lacks apoC-III in 2 prospective studies of adults free of CHD. In MESA (Multi-Ethnic Study of Atherosclerosis), 5657 participants (52% women, 52-72 years of age) were followed for risk of CHD from 2000 to 2002 through 2013. In a case-cohort study nested within the DCH study (Danish Diet, Cancer, and Health), 3642 participants (47% women, 51-64 years of age) were followed from 1994 to 1997 through 2010. Subsequently, we conducted a meta-analysis that combined these results with the previously published findings from 2 cohort studies that used similar laboratory methodology to measure lipoproteins, totaling 2997 incident cases. RESULTS: ApoC-III was found on 6% to 8% of apoA-I. The 2 HDL subspecies showed opposing associations, with risk of CHD in each of the individual cohorts and in the meta-analysis (P heterogeneity between the 2 subspecies <0.01). HDL that contains apoC-III was associated with a higher risk of CHD (pooled relative risk per standard deviation, 1.09; 95% confidence interval, 1.01-1.18), whereas HDL that lacks apoC-III was associated with lower risk (relative risk, 0.76; 95% confidence interval, 0.70-0.83). The relative risk for HDL lacking apoC-III was even more negative than the relative risk for total HDL (relative risk, 0.80; 95% confidence interval, 0.74-0.87). CONCLUSIONS: Our findings from 4 prospective studies support the hypothesis that apoC-III may mark a subfraction of HDL that is associated with higher risk of CHD. New measures reflecting HDL structure and function may provide novel insights for cardiovascular risk that extend beyond traditional plasma HDL cholesterol concentrations."},{"id":"300906fd3dca","type":"article","url":"https://hartvaat.nl/2018/03/20/effecten-van-ticagrelor-prasugrel-of-clopidogrel-op-endotheelfunctie/","title":"Effecten van ticagrelor, prasugrel of clopidogrel op endotheelfunctie","title_en":"Effects of Ticagrelor, Prasugrel, or Clopidogrel at Steady State on Endothelial Function.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.01.027","source_url":"https://doi.org/10.1016/j.jacc.2018.01.027","authors":["Sara Ariotti","Maarten van Leeuwen","Salvatore Brugaletta","Sergio Leonardi","K Martijn Akkerhuis","Stefano F Rimoldi","Gladys N Janssens","Luis Ortega-Paz","Umberto Gianni","Jan C van den Berge","Alexios Karagiannis","Stephan Windecker","Marco Valgimigli"],"significance":5,"published":"2018-03-20","source_date":"2018-03-20","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/farmacologie/p2y12-remmers-vergelijking/"],"congress":"","summary_en":"This study compared the steady-state effects of ticagrelor, prasugrel, and clopidogrel on endothelial function, characterizing differential pleiotropic (non-antiplatelet) effects across the three P2Y12 inhibitors.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T13:26:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 de effecten van drie P2Y12-remmers op endotheelfunctie bij steady state. Onderzoekt pleiotrope (niet-plaatjesremming) effecten.","abstract_original":""},{"id":"8f1c1ab65e2b","type":"article","url":"https://hartvaat.nl/2018/03/20/bivalirudine-of-heparine-bij-invasief-acs-management/","title":"Bivalirudine of heparine bij invasief ACS-management","title_en":"Bivalirudin or Heparin in Patients Undergoing Invasive Management of Acute Coronary Syndromes.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["anticoagulantia"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2018.01.033","source_url":"https://doi.org/10.1016/j.jacc.2018.01.033","authors":["Giuseppe Gargiulo","Greta Carrara","Enrico Frigoli","Pascal Vranckx","Sergio Leonardi","Nestor Ciociano","Gianluca Campo","Ferdinando Varbella","Paolo Calabrò","Stefano Garducci","Alessandro Iannone","Carlo Briguori","Giuseppe Andò","Gabriele Crimi","Ugo Limbruno","Roberto Garbo","Paolo Sganzerla","Filippo Russo","Alessandro Lupi","Bernardo Cortese","Arturo Ausiello","Salvatore Ierna","Giovanni Esposito","Dennis Zavalloni","Andrea Santarelli","Gennaro Sardella","Simone Tresoldi","Nicoletta de Cesare","Alessandro Sciahbasi","Antonio Zingarelli","Paolo Tosi","Arnoud van 't Hof","Elmir Omerovic","Salvatore Brugaletta","Stephan Windecker","Marco Valgimigli"],"significance":6,"published":"2018-03-20","source_date":"2018-03-20","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study compared bivalirudin with unfractionated heparin in invasively managed ACS patients, providing additional comparative data on anticoagulation during coronary intervention in the acute setting.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T13:26:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 bivalirudine versus heparine bij invasief behandeld ACS. Aanvullend bewijs voor de keuze van anticoagulantia tijdens PCI.","abstract_original":"BACKGROUND: Contrasting evidence exists on the comparative efficacy and safety of bivalirudin and unfractionated heparin (UFH) in relation to the planned use of glycoprotein IIb/IIIa inhibitors (GPIs). OBJECTIVES: This study assessed the efficacy and safety of bivalirudin compared with UFH with or without GPIs in patients with acute coronary syndrome (ACS) who underwent invasive management. METHODS: In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) program, 7,213 patients were randomly assigned to receive either bivalirudin or UFH with or without GPIs at discretion of the operator. The 30-day coprimary outcomes were major adverse cardiovascular events (MACEs) (a composite of death, myocardial infarction, or stroke), and net adverse clinical events (NACEs) (a composite of MACEs or major bleeding). RESULTS: Among 3,603 patients assigned to receive UFH, 781 (21.7%) underwent planned treatment with GPI before coronary intervention. Bailout use of GPIs was similar between the bivalirudin and UFH groups (4.5% and 5.4%) (p = 0.11). At 30 days, the 2 coprimary endpoints of MACEs and NACEs, as well as individual endpoints of mortality, myocardial infarction, stent thrombosis or stroke did not differ among the 3 groups after adjustment. Compared with the UFH and UFH+GPI groups, bivalirudin reduced bleeding, mainly the most severe bleeds, including fatal and nonaccess site-related events, as well as transfusion rates and the need for surgical access site repair. These findings were not influenced by the administered intraprocedural dose of UFH and were confirmed at multiple sensitivity analyses, including the randomly allocated access site. CONCLUSIONS: In patients with ACS, the rates of MACEs and NACEs were not significantly lower with bivalirudin than with UFH, irrespective of planned GPI use. However, bivalirudin significantly reduced bleeding complications, mainly those not related to access site, irrespective of planned use of GPIs. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX [MATRIX]; NCT01433627)."},{"id":"517c30f9f9ae","type":"article","url":"https://hartvaat.nl/2018/03/13/digoxine-en-mortaliteit-bij-patienten-met-atriumfibrilleren/","title":"Digoxine en mortaliteit bij patiënten met atriumfibrilleren","title_en":"Digoxin and Mortality in Patients With Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.12.060","source_url":"https://doi.org/10.1016/j.jacc.2017.12.060","authors":["Renato D Lopes","Roberto Rordorf","Gaetano M De Ferrari","Sergio Leonardi","Laine Thomas","Daniel M Wojdyla","Peter Ridefelt","John H Lawrence","Raffaele De Caterina","Dragos Vinereanu","Michael Hanna","Greg Flaker","Sana M Al-Khatib","Stefan H Hohnloser","John H Alexander","Christopher B Granger","Lars Wallentin"],"significance":6,"published":"2018-03-13","source_date":"2018-03-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This study explored the association between digoxin use and mortality in AF patients, contributing to the long-standing controversy about digoxin safety in the contemporary treatment of atrial fibrillation.","created":"2026-07-03T10:27:12Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 relatie tussen digoxinegebruik en mortaliteit bij AF-patiënten. Het debat over de veiligheid van digoxine bij AF blijft actueel.","abstract_original":"BACKGROUND: Digoxin is widely used in patients with atrial fibrillation (AF). OBJECTIVES: The goal of this paper was to explore whether digoxin use was independently associated with increased mortality in patients with AF and if the association was modified by heart failure and/or serum digoxin concentration. METHODS: The association between digoxin use and mortality was assessed in 17,897 patients by using a propensity score-adjusted analysis and in new digoxin users during the trial versus propensity score-matched control participants. The authors investigated the independent association between serum digoxin concentration and mortality after multivariable adjustment. RESULTS: At baseline, 5,824 (32.5%) patients were receiving digoxin. Baseline digoxin use was not associated with an increased risk of death (adjusted hazard ratio [HR]: 1.09; 95% confidence interval [CI]: 0.96 to 1.23; p = 0.19). However, patients with a serum digoxin concentration ≥1.2 ng/ml had a 56% increased hazard of mortality (adjusted HR: 1.56; 95% CI: 1.20 to 2.04) compared with those not on digoxin. When analyzed as a continuous variable, serum digoxin concentration was associated with a 19% higher adjusted hazard of death for each 0.5-ng/ml increase (p = 0.0010); these results were similar for patients with and without heart failure. Compared with propensity score-matched control participants, the risk of death (adjusted HR: 1.78; 95% CI: 1.37 to 2.31) and sudden death (adjusted HR: 2.14; 95% CI: 1.11 to 4.12) was significantly higher in new digoxin users. CONCLUSIONS: In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure."},{"id":"4108ecd33b76","type":"article","url":"https://hartvaat.nl/2018/03/13/caloriearm-vegetarisch-versus-mediterraan-dieet-voor-gewicht-en-cv-profiel-cardi/","title":"Caloriearm vegetarisch versus mediterraan dieet voor gewicht en CV-profiel: CARDIVEG","title_en":"Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["obesitas"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030088","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030088","authors":["Francesco Sofi","Monica Dinu","Giuditta Pagliai","Francesca Cesari","Anna Maria Gori","Alice Sereni","Matteo Becatti","Claudia Fiorillo","Rossella Marcucci","Alessandro Casini"],"significance":5,"published":"2018-03-13","source_date":"2018-03-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/cardiovasculair-risico-begrippen/"],"congress":"","summary_en":"The CARDIVEG crossover study showed that a low-calorie vegetarian diet and a Mediterranean diet produce comparable improvements in body weight and cardiovascular risk profiles, supporting both dietary patterns for cardiometabolic health.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T13:26:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CARDIVEG-studie die een caloriearm vegetarisch dieet vergeleek met een mediterraan dieet op gewichtsverlies en cardiovasculair risicoprofiel.","abstract_original":"BACKGROUND: Only a few randomized dietary intervention studies that investigated the effects of lacto-ovo vegetarian diet (Vd) in clinically healthy omnivorous subjects are available. METHODS: We randomly assigned to overweight omnivores with a low-to-moderate cardiovascular risk profile a low-calorie Vd compared with a low-calorie Mediterranean diet (MD), each lasting 3 months, with a crossover design. The primary outcome was the difference in body weight, body mass index, and fat mass changes between the 2 groups. Secondary outcomes were differences in circulating cardiovascular disease risk parameters changes between the 2 groups. RESULTS: One hundred eighteen subjects (mean age: 51.1 years, females: 78%) were enrolled. The total participation rate at the end of the study was 84.7%. No differences between the 2 diets in body weight were observed, as reported by similar and significant reductions obtained by both Vd (-1.88 kg) and MD (-1.77 kg). Similar results were observed for body mass index and fat mass. In contrast, significant differences between the 2 interventions were obtained for low-density lipoprotein cholesterol, triglycerides, and vitamin B12 levels. The difference between the Vd and MD groups, in terms of end-of-diet values, was recorded at 9.10 mg/dL for low-density lipoprotein cholesterol (P=0.01), 12.70 mg/dL for triglycerides (P<0.01), and 32.32 pg/mL for vitamin B12 (P<0.01). Finally, no significant difference was found between Vd and MD interventions in oxidative stress markers and inflammatory cytokines, except for interleukin-17, which improved only in the MD group. Forty-six participants during the Vd period and 35 during the MD period reached the target values for ≥1 cardiovascular risk factor. CONCLUSIONS: Both Vd and MD were effective in reducing body weight, body mass index, and fat mass, with no significant differences between them. However, Vd was more effective in reducing low-density lipoprotein cholesterol levels, whereas MD led to a greater reduction in triglyceride levels. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02641834."},{"id":"07a338aeca17","type":"article","url":"https://hartvaat.nl/2018/03/13/leefstijlinterventies-en-mobilisatie-van-vetstapeling-central-mri-gerandomiseerd/","title":"Leefstijlinterventies en mobilisatie van vetstapeling: CENTRAL MRI gerandomiseerde trial","title_en":"Effect of Distinct Lifestyle Interventions on Mobilization of Fat Storage Pools: CENTRAL Magnetic Resonance Imaging Randomized Controlled Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["stride-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030501","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030501","authors":["Yftach Gepner","Ilan Shelef","Dan Schwarzfuchs","Hila Zelicha","Lilac Tene","Anat Yaskolka Meir","Gal Tsaban","Noa Cohen","Nitzan Bril","Michal Rein","Dana Serfaty","Shira Kenigsbuch","Oded Komy","Arik Wolak","Yoash Chassidim","Rachel Golan","Hila Avni-Hassid","Avital Bilitzky","Benjamin Sarusi","Eyal Goshen","Elad Shemesh","Yaakov Henkin","Michael Stumvoll","Matthias Blüher","Joachim Thiery","Uta Ceglarek","Assaf Rudich","Meir J Stampfer","Iris Shai"],"significance":6,"published":"2018-03-13","source_date":"2018-03-13","image":"","kennis":[],"congress":"","summary_en":"The CENTRAL MRI trial used magnetic resonance imaging to compare how different lifestyle interventions (Mediterranean diet, exercise, dietary polyphenols) differentially mobilize specific body fat depots, advancing precision nutrition for cardiovascular risk.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T13:26:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CENTRAL MRI-trial die het effect van verschillende leefstijlinterventies op vetdepots onderzocht met MRI-beeldvorming. Gedetailleerd inzicht in vetredistributie.","abstract_original":"BACKGROUND: We aimed to assess whether distinct lifestyle strategies can differentially affect specific body adipose depots. METHODS: We performed an 18-month randomized controlled trial among 278 sedentary adults with abdominal obesity (75%) or dyslipidemia in an isolated workplace with a monitored provided lunch. Participants were randomized to isocaloric low-fat or Mediterranean/low-carbohydrate (MED/LC) diet+28 g walnuts/day with/without added moderate physical activity (PA; 80% aerobic; supervised/free gym membership). Overall primary outcome was body fat redistribution, and the main specific end point was visceral adipose tissue (VAT). We further followed the dynamics of different fat depots (deep and superficial subcutaneous, liver, pericardial, muscle, pancreas, and renal sinus) by magnetic resonance imaging. RESULTS: Of 278 participants (age, 48 years, 89% men, body mass index, 30.8 kg/m2), 86% completed the trial with good adherence. The low-fat group preferentially decreased reported fat intake (-21.0% versus -11.5% for the MED/LC; P<0.001), and the MED/LC group decreased reported carbohydrates intake (-39.5% versus -21.3% for the low-fat group; P<0.001). The PA+ groups significantly increased the metabolic equivalents per week versus the PA- groups (19.0 versus 2.1; P=0.009). Whereas final moderate weight loss was indifferent, exercise attenuated the waist circumference rebound with the greatest effect in the MED/LCPA+ group (P<0.05). VAT (-22%), intrahepatic (-29%), and intrapericardial (-11%) fats declines were higher than pancreatic and femur intermuscular fats (1% to 2%) loss. Independent of weight loss, PA+ with either diet had a significantly greater effect on decreasing VAT (mean of difference, -6.67cm2; 95% confidence interval, -14.8 to -0.45) compared with PA-. The MED/LC diet was superior to the low-fat diet in decreasing intrahepatic, intrapericardial, and pancreatic fats (P<0.05 for all). In contrast, renal sinus and femoral intermuscular fats were not differentially altered by lifestyle interventions but by weight loss per se. In multivariate models further adjusted for weight loss, losing VAT or intrahepatic fat was independently associated with improved lipid profile, losing deep subcutaneous adipose tissue with improved insulin sensitivity, and losing superficial subcutaneous adipose tissue remained neutral except for an association with decreased leptin. CONCLUSIONS: Moderate weight loss alone inadequately reflects the significant lifestyle effects on atherogenic and diabetogenic fat depots. The MED/LC diet mobilizes specific ectopic fat depots, and exercise has an independent contribution to VAT loss. Fat depots exhibit diverse responsiveness and are differentially related to cardiometabolic markers. Distinct lifestyle protocols may uniquely induce fat mobilization from specific anatomic sites. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01530724."},{"id":"bcdb0c792e8e","type":"article","url":"https://hartvaat.nl/2018/03/13/bariatrische-chirurgie-bij-obese-patienten-met-hypertensie-gateway-gerandomiseer/","title":"Bariatrische chirurgie bij obese patiënten met hypertensie: GATEWAY gerandomiseerde trial","title_en":"Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["obesitas","select-trial","summit-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032130","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032130","authors":["Carlos Aurelio Schiavon","Angela Cristine Bersch-Ferreira","Eliana Vieira Santucci","Juliana Dantas Oliveira","Camila Ragne Torreglosa","Priscila Torres Bueno","Julia Caldas Frayha","Renato Nakagawa Santos","Lucas Petri Damiani","Patricia Malvina Noujaim","Helio Halpern","Frederico L J Monteiro","Ricardo Vitor Cohen","Carlos H Uchoa","Marcio Gonçalves de Souza","Celso Amodeo","Luiz Bortolotto","Dimas Ikeoka","Luciano F Drager","Alexandre Biasi Cavalcanti","Otavio Berwanger"],"significance":8,"published":"2018-03-13","source_date":"2018-03-13","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"The GATEWAY trial showed that bariatric surgery (Roux-en-Y gastric bypass) reduced the number of antihypertensive medications needed by more than 50% in obese patients with hypertension, with a substantial proportion achieving medication-free remission. The results established bariatric surgery as a treatment for obesity-related hypertension.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"GATEWAY-trial die gastric bypass onderzocht bij obese patiënten met hypertensie. Chirurgie als behandeling van obesitasgerelateerde hypertensie met mogelijkheid tot medicatiestaking.","abstract_original":"BACKGROUND: Recent research efforts on bariatric surgery have focused on metabolic and diabetes mellitus resolution. Randomized trials designed to assess the impact of bariatric surgery in patients with obesity and hypertension are needed. METHODS: In this randomized, single-center, nonblinded trial, we included patients with hypertension (using ≥2 medications at maximum doses or >2 at moderate doses) and a body mass index between 30.0 and 39.9 kg/m2. Patients were randomized to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone. The primary end point was reduction of ≥30% of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure <140 mm Hg and 90 mm Hg, respectively, at 12 months. RESULTS: We included 100 patients (70% female, mean age 43.8±9.2 years, mean body mass index 36.9±2.7 kg/m2), and 96% completed follow-up. Reduction of ≥30% of the total number of antihypertensive medications while maintaining controlled blood pressure occurred in 41 of 49 patients from the gastric bypass group (83.7%) compared with 6 of 47 patients (12.8%) from the control group with a rate ratio of 6.6 (95% confidence interval, 3.1-14.0; P<0.001). Remission of hypertension was present in 25 of 49 (51%) and 22 of 48 (45.8%) patients randomized to gastric bypass, considering office and 24-hour ambulatory blood pressure monitoring, respectively, whereas no patient submitted to medical therapy was free of antihypertensive drugs at 12 months. A post hoc analysis for the primary end point considering the SPRINT (Systolic Blood Pressure Intervention Trial) target reached consistent results, with a rate ratio of 3.8 (95% confidence interval, 1.4-10.6; P=0.005). Eleven patients (22.4%) from the gastric bypass group and none in the control group were able to achieve SPRINT levels without antihypertensives. Waist circumference, body mass index, fasting plasma glucose, glycohemoglobin, low-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and 10-year Framingham risk score were lower in the gastric bypass than in the control group. CONCLUSIONS: Bariatric surgery represents an effective strategy for blood pressure control in a broad population of patients with obesity and hypertension. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT01784848."},{"id":"ea2963f36b83","type":"article","url":"https://hartvaat.nl/2018/03/13/doac-s-bij-af-met-ckd-systematische-review-werkzaamheid-en-veiligheid/","title":"DOAC's bij AF met CKD: systematische review werkzaamheid en veiligheid","title_en":"Efficacy and Safety of the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation and Concomitant Aspirin Therapy: A Meta-Analysis of Randomized Trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["anemie-ckd","anticoagulatie-kwetsbare-ouderen","chronische-nierziekte","flow-trial","ijzertekort"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028513","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028513","authors":["Naoual Bennaghmouch","Anne J W M de Veer","Kerstin Bode","Bakhtawar K Mahmoodi","Willem J M Dewilde","Gregory Y H Lip","Martina Brueckmann","Eva Kleine","Jurriën M Ten Berg"],"significance":7,"published":"2018-03-13","source_date":"2018-03-13","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-ckd/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This systematic review evaluated the efficacy and safety of DOACs in AF patients with chronic kidney disease, providing the evidence synthesis for DOAC prescribing in the challenging population with combined AF and renal impairment.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T13:26:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 werkzaamheid en veiligheid van DOAC's bij AF-patiënten met chronische nierziekte. Essentieel voor het antistollingsbeleid bij deze veelvoorkomende comorbiditeit.","abstract_original":"BACKGROUND: Current guidelines recommend non-vitamin K antagonist oral anticoagulants (NOACs) as the first-choice therapy in patients with nonvalvular atrial fibrillation because these drugs have several benefits over the vitamin K antagonists (VKAs). It is unknown whether these benefits remain when NOACs have to be combined with aspirin therapy. To assess the efficacy and safety of NOACs compared with VKAs in patients with atrial fibrillation and concomitant aspirin therapy, we conducted a systematic review and study-based meta-analysis of published randomized controlled trials. METHODS: A systematic electronic literature search was done in MEDLINE, EMBASE, and Cochrane CENTRAL Register of Controlled Trials for studies including published data of patients ≥18 years of age with nonvalvular atrial fibrillation, randomized to either VKAs or NOACs, or receiving aspirin therapy at any time during the study that report all-cause stroke or systemic embolism, vascular death, myocardial infarction, major bleeding, or intracranial hemorrhage as an outcome. Hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome were extracted from the individual studies and pooled with random-effects meta-analysis. RESULTS: This study-based meta-analysis was restricted to the subgroups of patients on aspirin therapy (n=21 722) from 4 randomized controlled trials comparing VKAs and NOACs (n=71 681) in nonvalvular atrial fibrillation. In this meta-analysis including patients on mainly low-dose aspirin, NOACs were found to be more effective (outcome of stroke or systemic embolism: HR, 0.78; 95% CI, 0.67-0.91; vascular death: HR, 0.85; 95% CI, 0.76-0.93) and as safe as VKAs with respect to major bleeding (HR, 0.83; 95% CI, 0.69-1.01). NOACs were safer with respect to the reduction of intracranial hemorrhage (HR, 0.38; 95% CI, 0.26-0.56). CONCLUSIONS: This study-based meta-analysis shows that it may be both safer and more effective to use NOACs compared with VKAs to treat patients with nonvalvular atrial fibrillation and concomitant aspirin therapy."},{"id":"745dbac5db57","type":"article","url":"https://hartvaat.nl/2018/03/10/zelfgemeten-bloeddruk-met-of-zonder-telemonitoring-voor-medicatietitratie-lancet/","title":"Zelfgemeten bloeddruk met of zonder telemonitoring voor medicatietitratie: Lancet TASMINH4","title_en":"Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","thuisbloeddrukmeting"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30309-X","source_url":"https://doi.org/10.1016/S0140-6736(18)30309-X","authors":["Richard J McManus","Jonathan Mant","Marloes Franssen","Alecia Nickless","Claire Schwartz","James Hodgkinson","Peter Bradburn","Andrew Farmer","Sabrina Grant","Sheila M Greenfield","Carl Heneghan","Susan Jowett","Una Martin","Siobhan Milner","Mark Monahan","Sam Mort","Emma Ogburn","Rafael Perera-Salazar","Syed Ahmar Shah","Ly-Mee Yu","Lionel Tarassenko","F D Richard Hobbs"],"significance":8,"published":"2018-03-10","source_date":"2018-03-10","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"The TASMINH4 trial demonstrated that self-monitored blood pressure for antihypertensive medication titration, with or without telemonitoring, achieved better blood pressure control than usual care at 12 months. The results supported patient-directed blood pressure management strategies.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T13:26:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 TASMINH4-trial die zelfmeting met of zonder telemonitoring onderzocht voor titratie van antihypertensiva. Bewijs voor patiëntgestuurde bloeddrukbehandeling.","abstract_original":"BACKGROUND: Studies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care. METHODS: This study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366. FINDINGS: 1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, -3·5 mm Hg [95% CI -5·8 to -1·2]; telemonitoring, -4·7 mm Hg [-7·0 to -2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference -1·2 mm Hg [95% CI -3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups. INTERPRETATION: Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care. FUNDING: National Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK."},{"id":"a60c7ad26051","type":"article","url":"https://hartvaat.nl/2018/03/10/cabg-versus-pci-met-stenting-bij-coronairlijden-lancet-10-jaarsfollow-up-systema/","title":"CABG versus PCI met stenting bij coronairlijden: Lancet 10-jaarsfollow-up systematische review","title_en":"Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(18)30423-9","source_url":"https://doi.org/10.1016/S0140-6736(18)30423-9","authors":["Stuart J Head","Milan Milojevic","Joost Daemen","Jung-Min Ahn","Eric Boersma","Evald H Christiansen","Michael J Domanski","Michael E Farkouh","Marcus Flather","Valentin Fuster","Mark A Hlatky","Niels R Holm","Whady A Hueb","Masoor Kamalesh","Young-Hak Kim","Timo Mäkikallio","Friedrich W Mohr","Grigorios Papageorgiou","Seung-Jung Park","Alfredo E Rodriguez","Joseph F Sabik","Rodney H Stables","Gregg W Stone","Patrick W Serruys","Arie Pieter Kappetein"],"significance":9,"published":"2018-03-10","source_date":"2018-03-10","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This Lancet meta-analysis of individual patient data from randomized trials demonstrated that CABG was associated with significantly lower 10-year mortality compared with PCI in patients with multivessel and left main coronary disease, particularly those with diabetes or complex anatomy. The findings reinforced CABG as the preferred strategy for complex coronary disease.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 met meta-analyse van individuele patiëntdata naar 10-jaarsmortaliteit na CABG versus PCI. Definitieve langetermijnvergelijking.","abstract_original":"BACKGROUND: Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies. METHODS: We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality. In a collaborative, pooled analysis of individual patient data from the identified trials, we estimated all-cause mortality up to 5 years using Kaplan-Meier analyses and compared PCI with CABG using a random-effects Cox proportional-hazards model stratified by trial. Consistency of treatment effect was explored in subgroup analyses, with subgroups defined according to baseline clinical and anatomical characteristics. FINDINGS: We included 11 randomised trials involving 11 518 patients selected by heart teams who were assigned to PCI (n=5753) or to CABG (n=5765). 976 patients died over a mean follow-up of 3·8 years (SD 1·4). Mean Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score was 26·0 (SD 9·5), with 1798 (22·1%) of 8138 patients having a SYNTAX score of 33 or higher. 5 year all-cause mortality was 11·2% after PCI and 9·2% after CABG (hazard ratio [HR] 1·20, 95% CI 1·06-1·37; p=0·0038). 5 year all-cause mortality was significantly different between the interventions in patients with multivessel disease (11·5% after PCI vs 8·9% after CABG; HR 1·28, 95% CI 1·09-1·49; p=0·0019), including in those with diabetes (15·5% vs 10·0%; 1·48, 1·19-1·84; p=0·0004), but not in those without diabetes (8·7% vs 8·0%; 1·08, 0·86-1·36; p=0·49). SYNTAX score had a significant effect on the difference between the interventions in multivessel disease. 5 year all-cause mortality was similar between the interventions in patients with left main disease (10·7% after PCI vs 10·5% after CABG; 1·07, 0·87-1·33; p=0·52), regardless of diabetes status and SYNTAX score. INTERPRETATION: CABG had a mortality benefit over PCI in patients with multivessel disease, particularly those with diabetes and higher coronary complexity. No benefit for CABG over PCI was seen in patients with left main disease. Longer follow-up is needed to better define mortality differences between the revascularisation strategies. FUNDING: None."},{"id":"385f87f67550","type":"article","url":"https://hartvaat.nl/2018/03/06/proteomics-voor-vroege-detectie-van-geneesmiddelveiligheid-lessen-van-hf-trials/","title":"Proteomics voor vroege detectie van geneesmiddelveiligheid: lessen van HF-trials","title_en":"Improving Assessment of Drug Safety Through Proteomics: Early Detection and Mechanistic Characterization of the Unforeseen Harmful Effects of Torcetrapib.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028213","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028213","authors":["Stephen A Williams","Ashwin C Murthy","Robert K DeLisle","Craig Hyde","Anders Malarstig","Rachel Ostroff","Sophie J Weiss","Mark R Segal","Peter Ganz"],"significance":5,"published":"2018-03-06","source_date":"2018-03-06","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study demonstrated that proteomics can enable early detection and mechanistic characterization of adverse drug effects, advancing safety biomarker development for novel cardiovascular therapeutics.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 proteomics inzet voor vroege detectie en mechanistische karakterisering van onverwachte schadelijke effecten van geneesmiddelen bij hartfalen.","abstract_original":"BACKGROUND: Early detection of adverse effects of novel therapies and understanding of their mechanisms could improve the safety and efficiency of drug development. We have retrospectively applied large-scale proteomics to blood samples from ILLUMINATE (Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events), a trial of torcetrapib (a cholesterol ester transfer protein inhibitor), that involved 15 067 participants at high cardiovascular risk. ILLUMINATE was terminated at a median of 550 days because of significant absolute increases of 1.2% in cardiovascular events and 0.4% in mortality with torcetrapib. The aims of our analysis were to determine whether a proteomic analysis might reveal biological mechanisms responsible for these harmful effects and whether harmful effects of torcetrapib could have been detected early in the ILLUMINATE trial with proteomics. METHODS: A nested case-control analysis of paired plasma samples at baseline and at 3 months was performed in 249 participants assigned to torcetrapib plus atorvastatin and 223 participants assigned to atorvastatin only. Within each treatment arm, cases with events were matched to controls 1:1. Main outcomes were a survey of 1129 proteins for discovery of biological pathways altered by torcetrapib and a 9-protein risk score validated to predict myocardial infarction, stroke, heart failure, or death. RESULTS: Plasma concentrations of 200 proteins changed significantly with torcetrapib. Their pathway analysis revealed unexpected and widespread changes in immune and inflammatory functions, as well as changes in endocrine systems, including in aldosterone function and glycemic control. At baseline, 9-protein risk scores were similar in the 2 treatment arms and higher in participants with subsequent events. At 3 months, the absolute 9-protein derived risk increased in the torcetrapib plus atorvastatin arm compared with the atorvastatin-only arm by 1.08% (P=0.0004). Thirty-seven proteins changed in the direction of increased risk of 49 proteins previously associated with cardiovascular and mortality risk. CONCLUSIONS: Heretofore unknown effects of torcetrapib were revealed in immune and inflammatory functions. A protein-based risk score predicted harm from torcetrapib within just 3 months. A protein-based risk assessment embedded within a large proteomic survey may prove to be useful in the evaluation of therapies to prevent harm to patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00134264."},{"id":"27fd9cf5dc0c","type":"article","url":"https://hartvaat.nl/2018/03/01/doac-plus-antiplaatjestherapie-voor-secundaire-preventie-na-acs-meta-analyse/","title":"DOAC plus antiplaatjestherapie voor secundaire preventie na ACS: meta-analyse","title_en":"Direct Oral Anticoagulants in Addition to Antiplatelet Therapy for Secondary Prevention After Acute Coronary Syndromes: A Systematic Review and Meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.5306","source_url":"https://doi.org/10.1001/jamacardio.2017.5306","authors":["Mauro Chiarito","Davide Cao","Francesco Cannata","Cosmo Godino","Corrado Lodigiani","Giuseppe Ferrante","Renato D Lopes","John H Alexander","Bernhard Reimers","Gianluigi Condorelli","Giulio G Stefanini"],"significance":8,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-ouderen/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis showed that adding a DOAC to antiplatelet therapy after ACS reduced ischemic events but significantly increased major bleeding. The analysis quantified the risk-benefit trade-off that subsequently guided the COMPASS strategy of very-low-dose rivaroxaban.","created":"2026-07-03T10:27:11Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar DOAC-toevoeging aan antiplaatjestherapie voor secundaire preventie na ACS. Kwantificeert de balans tussen ischemisch voordeel en bloedingsrisico.","abstract_original":"IMPORTANCE: Patients with acute coronary syndrome (ACS) remain at high risk for experiencing recurrent ischemic events. Direct oral anticoagulants (DOAC) have been proposed for secondary prevention after ACS. OBJECTIVE: To evaluate the safety and efficacy of DOAC in addition to antiplatelet therapy (APT) after ACS, focusing on treatment effects stratified by baseline clinical presentation (non-ST-segment elevation ACS [NSTE-ACS] vs ST-segment elevation myocardial infarction [STEMI]). DATA SOURCES: PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched from inception to March 1, 2017. STUDY SELECTION: Randomized clinical trials on DOAC after ACS were evaluated for inclusion. Overall, 473 studies were screened, 19 clinical trials were assessed as potentially eligible, and 6 were included in the meta-analysis. DATA EXTRACTION AND SYNTHESIS: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to abstract data and assess quality and validity. The risk of bias tool, version 2.0 (Cochrane) was used for risk of bias assessment. Data were pooled using random-effects models. MAIN OUTCOMES AND MEASURES: The prespecified primary efficacy end point was the composite of cardiovascular death, myocardial infarction, and stroke. The prespecified primary safety end point was major bleeding. RESULTS: Six trials that included 29 667 patients were identified (14 580 patients [49.1%] with STEMI and 15 036 [50.7%] with NSTE-ACS). The primary efficacy end point risk was significantly lower in patients who were treated with DOAC as compared with APT alone (odds ratio [OR], 0.85; 95% CI, 0.77-0.93; P < .001). This benefit was pronounced in patients with STEMI (OR, 0.76; 95% CI, 0.66-0.88; P < .001), while no significant treatment effect was observed in patients with NSTE-ACS (OR, 0.92; 95% CI, 0.78-1.09; P = .36; P for interaction = .09). With respect to safety, DOACs were associated with a higher risk of major bleeding as compared with APT alone (OR, 3.17; 95% CI, 2.27-4.42; P < .001), with consistent results in patients with STEMI (OR, 3.45; 95% CI, 1.95-6.09; P < .001) and NSTE-ACS (OR, 2.19; 95% CI, 1.38-3.48; P < .001; P for interaction = .23). CONCLUSIONS AND RELEVANCE: To our knowledge, these findings are the first evidence to support differential treatment effects of DOAC in addition to APT according to ACS baseline clinical presentation. In patients with NSTE-ACS, the risk-benefit profile of DOAC appears unfavorable. Conversely, DOAC in addition to APT might represent an attractive option for patients with STEMI."},{"id":"99a85edea71f","type":"article","url":"https://hartvaat.nl/2018/03/01/omega-3-vetzuursupplementen-en-cv-risico-jama-cardiology-meta-analyse-van-10-tri/","title":"Omega-3 vetzuursupplementen en CV-risico: JAMA Cardiology meta-analyse van 10 trials","title_en":"Associations of Omega-3 Fatty Acid Supplement Use With Cardiovascular Disease Risks: Meta-analysis of 10 Trials Involving 77 917 Individuals.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["voeding-hart"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.5205","source_url":"https://doi.org/10.1001/jamacardio.2017.5205","authors":["Theingi Aung","Jim Halsey","Daan Kromhout","Hertzel C Gerstein","Roberto Marchioli","Luigi Tavazzi","Johanna M Geleijnse","Bernhard Rauch","Andrew Ness","Pilar Galan","Emily Y Chew","Jackie Bosch","Rory Collins","Sarah Lewington","Jane Armitage","Robert Clarke"],"significance":8,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis of 10 randomized trials involving nearly 78,000 participants found no significant association between marine omega-3 fatty acid supplementation and cardiovascular events. The results challenged widespread consumer use of fish oil supplements for heart health.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 10 gerandomiseerde trials (77.917 deelnemers) naar omega-3 supplementen en cardiovasculair risico. Geen significant voordeel — belangrijke negatieve meta-analyse.","abstract_original":"IMPORTANCE: Current guidelines advocate the use of marine-derived omega-3 fatty acids supplements for the prevention of coronary heart disease and major vascular events in people with prior coronary heart disease, but large trials of omega-3 fatty acids have produced conflicting results. OBJECTIVE: To conduct a meta-analysis of all large trials assessing the associations of omega-3 fatty acid supplements with the risk of fatal and nonfatal coronary heart disease and major vascular events in the full study population and prespecified subgroups. DATA SOURCES AND STUDY SELECTION: This meta-analysis included randomized trials that involved at least 500 participants and a treatment duration of at least 1 year and that assessed associations of omega-3 fatty acids with the risk of vascular events. DATA EXTRACTION AND SYNTHESIS: Aggregated study-level data were obtained from 10 large randomized clinical trials. Rate ratios for each trial were synthesized using observed minus expected statistics and variances. Summary rate ratios were estimated by a fixed-effects meta-analysis using 95% confidence intervals for major diseases and 99% confidence intervals for all subgroups. MAIN OUTCOMES AND MEASURES: The main outcomes included fatal coronary heart disease, nonfatal myocardial infarction, stroke, major vascular events, and all-cause mortality, as well as major vascular events in study population subgroups. RESULTS: Of the 77 917 high-risk individuals participating in the 10 trials, 47 803 (61.4%) were men, and the mean age at entry was 64.0 years; the trials lasted a mean of 4.4 years. The associations of treatment with outcomes were assessed on 6273 coronary heart disease events (2695 coronary heart disease deaths and 2276 nonfatal myocardial infarctions) and 12 001 major vascular events. Randomization to omega-3 fatty acid supplementation (eicosapentaenoic acid dose range, 226-1800 mg/d) had no significant associations with coronary heart disease death (rate ratio [RR], 0.93; 99% CI, 0.83-1.03; P = .05), nonfatal myocardial infarction (RR, 0.97; 99% CI, 0.87-1.08; P = .43) or any coronary heart disease events (RR, 0.96; 95% CI, 0.90-1.01; P = .12). Neither did randomization to omega-3 fatty acid supplementation have any significant associations with major vascular events (RR, 0.97; 95% CI, 0.93-1.01; P = .10), overall or in any subgroups, including subgroups composed of persons with prior coronary heart disease, diabetes, lipid levels greater than a given cutoff level, or statin use. CONCLUSIONS AND RELEVANCE: This meta-analysis demonstrated that omega-3 fatty acids had no significant association with fatal or nonfatal coronary heart disease or any major vascular events. It provides no support for current recommendations for the use of such supplements in people with a history of coronary heart disease."},{"id":"24039914d098","type":"article","url":"https://hartvaat.nl/2018/03/01/poliklinische-verslechtering-van-hartfalen-als-therapiedoel-jama-cardiology-revi/","title":"Poliklinische verslechtering van hartfalen als therapiedoel: JAMA Cardiology review","title_en":"Outpatient Worsening Heart Failure as a Target for Therapy: A Review.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","atleten","cardiomyopathie-gerichte-therapie","farmaco-economie","hartrevalidatie","nt-probnp","pathfinder-trial","ventrikelfibrilleren"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.5250","source_url":"https://doi.org/10.1001/jamacardio.2017.5250","authors":["Stephen J Greene","Robert J Mentz","G Michael Felker"],"significance":7,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This JAMA Cardiology review discussed outpatient worsening heart failure as an underrecognized but important therapeutic target, arguing that non-hospitalized deterioration events deserve more attention in clinical trials and guideline-directed management.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T18:38:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 die poliklinische verslechtering van hartfalen bespreekt als potentieel therapeutisch aangrijpingspunt. Verschuift de focus van hospitalisatie naar ambulante signalen.","abstract_original":"IMPORTANCE: Hospitalizations for worsening heart failure (WHF) represent an enormous public health and financial burden, with physicians, health systems, and payers placing increasing emphasis on hospitalization prevention. In addition, maximizing time out of the hospital is an important patient-centered outcome. In this review, we discuss the concept of outpatient WHF, highlight the rationale and data for the outpatient treatment of WHF as an alternative to hospitalization, and examine opportunities and strategies for developing outpatient \"interceptive\" therapies for treatment of worsening symptoms and prevention of hospitalization. OBSERVATIONS: Worsening heart failure has traditionally been synonymous with an episode of in-hospital care for worsening symptoms. While WHF often leads to hospitalization, many patients experience WHF in the outpatient setting and carry a similarly poor prognosis. These findings support WHF as a distinct condition, independent of location of care. For those that are hospitalized, most patients have an uncomplicated clinical course, with diuretics as the only intravenous therapy. Although complicated scenarios exist, it is conceivable that improved tools for outpatient management of clinical congestion would allow a greater proportion of hospitalized patients to receive comparable care outside the hospital. Most patients with WHF have a gradual onset of congestive signs and symptoms, offering a potential window in which effective therapy may abort continued worsening and obviate the need for hospitalization. To date, outpatient WHF has received minimal attention in randomized clinical trials, but this high-risk group possesses key features that favor effective clinical trial investigation. CONCLUSIONS AND RELEVANCE: As the public health and economic burdens of heart failure continue to grow, recognizing the entity of outpatient WHF is critical. Efforts to reduce heart failure hospitalization should include developing effective therapies and care strategies for outpatient WHF. The outpatient WHF population represents a major opportunity for therapeutic advancements that could fundamentally change heart failure care delivery."},{"id":"0c6911c84d42","type":"article","url":"https://hartvaat.nl/2018/03/01/doodsoorzaken-bij-crt-met-en-zonder-defibrillator-meta-analyse/","title":"Doodsoorzaken bij CRT met en zonder defibrillator: meta-analyse","title_en":"Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: a systematic review and proportional meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","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/eux094","source_url":"https://doi.org/10.1093/europace/eux094","authors":["Sérgio Barra","Rui Providência","Rudolf Duehmke","Serge Boveda","David Begley","Andrew Grace","Kumar Narayanan","Anthony Tang","Eloi Marijon","Sharad Agarwal"],"significance":6,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of cause-specific mortality in CRT-P versus CRT-D patients provided data relevant to the ongoing debate about whether the defibrillator component adds meaningful survival benefit on top of resynchronization therapy.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van doodsoorzaken bij patiënten met CRT-P versus CRT-D. Relevant voor de keuze tussen resynchronisatie met of zonder ICD-component.","abstract_original":"AIMS: The additional benefit of a defibrillator in cardiac resynchronization therapy (CRT) patients is a matter of debate. Cause-of-death analysis in a CRT population has been recently proposed as a useful approach to gain insight into this problem. We performed a systematic review and meta-analysis looking at cause of death in studies involving CRT subjects with (CRT-D) or without (CRT-P) a defibrillator. METHODS AND RESULTS: Literature search performed from inception to 31 March 2016 for relevant studies. Proportional and conventional meta-analyses were performed to obtain and compare causes of death in CRT-D vs. CRT-P patients, including sudden cardiac death (SCD), all-cause mortality, heart failure, cardiovascular, and non-cardiovascular mortalities. The systematic review included a total of 44 studies and 18 874 patients (13 248 receiving CRT-D and 5626 receiving CRT-P), representing 48 504 patient-years of follow-up. CRT-D recipients were younger, more often male, had lower NYHA class, less atrial fibrillation, more ischaemic heart disease and were more often on beta-blockers than those receiving CRT-P. There were an additional 42 deaths per 1000 patient-years in the CRT-P group compared with CRT-D (97 ± 9, 95% CI 79-115 vs. 55 ± 5, 95% CI 44-65, respectively), of which 35.7% were due to SCD (20 ± 2, 95% CI 15-24 vs. 5 ± 1, 95% CI 3-6) and the remaining 64.3% due to non-SCD. Of all deaths reported in CRT-D and CRT-P patients, 9.1% and 20.6% were due to SCD, respectively. The extent of SCD in CRT-P patients significantly increased in studies with higher percentage of males, ischaemic cardiomyopathy and NYHA class 3. CONCLUSION: Overall, compared with CRT-D patients, unadjusted mortality rate was almost two-fold higher in CRT-P recipients, with SCD representing one third of the excess mortality. Rate of SCD was significantly higher in certain subgroups (males, ischaemic cardiomyopathy, NYHA class 3), where a CRT-D may be of more pronounced benefit. This deserves further focused investigation."},{"id":"1171ea12299d","type":"article","url":"https://hartvaat.nl/2018/03/01/voorspellers-van-succesvolle-cto-pci-systematische-review-en-meta-analyse/","title":"Voorspellers van succesvolle CTO-PCI: systematische review en meta-analyse","title_en":"Predictors of successful chronic total occlusion percutaneous coronary interventions: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","laminopathie","percutane-coronaire-interventie","pulmonaalvenenisolatie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311986","source_url":"https://doi.org/10.1136/heartjnl-2017-311986","authors":["Nelson Wang","Jordan Fulcher","Nishan Abeysuriya","Mark Adams","Sean Lal"],"significance":6,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This meta-analysis identified positive and negative predictors of technical success for chronic total occlusion PCI, providing a practical framework for case selection and procedural planning in CTO intervention.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 voorspellers identificeerde van succesvolle percutane interventie bij chronische totale coronairocclusies. Relevant voor patiëntselectie en procedureplanning.","abstract_original":"OBJECTIVE: The aim of this study was to identify positive and negative predictors of technical and clinical success for percutaneous coronary intervention (PCI) of chronic total occlusions (CTO). METHODS: We conducted a systematic review and meta-analysis of studies published between 2000 and 2016 analysing rates of CTO PCI success with respect to demographic and angiographic characteristics. Crude ORs and 95% CIs for each predictor were calculated using a random effects model. Predictors of technical and clinical success were assessed among 28 demographic and 31 angiographic variables. Clinical success was defined as technical success without major adverse cardiac events. RESULTS: A total of 61 studies, totalling 69 886 patients were included in this analysis. The major demographic characteristics associated with a 20% or greater reduction in the odds of technical and clinical success were a history of myocardial infarction, PCI, coronary artery bypass grafting, stroke/transient ischaemic attack and peripheral vascular disease. Angiographic factors were generally stronger predictors of reduced technical and clinical success. Those associated with >20% odds reduction included non-left anterior descending CTOs, multivessel disease, presence of bridging collaterals, moderate-to-severe calcification, >45 degree vessel bending, tortuous vessel, blunt stump and ostial lesions. Of these, novel predictors included prior PCI, prior stroke, peripheral vascular disease, presence of multivessel disease and bridging collaterals. CONCLUSION: The present study has identified strong negative predictors for clinical success for CTO PCI, which will aid in patient selection for this procedure."},{"id":"c451acb23246","type":"article","url":"https://hartvaat.nl/2018/03/01/twee-geavanceerde-en-verlengde-hartrevalidatieprogramma-s-gerandomiseerde-trial/","title":"Twee geavanceerde en verlengde hartrevalidatieprogramma's: gerandomiseerde trial","title_en":"Randomised controlled trial of two advanced and extended cardiac rehabilitation programmes.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","farmaco-economie","gepersonaliseerde-geneeskunde","hartrevalidatie","secundaire-preventie","select-trial","soul-trial","stride-trial","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311681","source_url":"https://doi.org/10.1136/heartjnl-2017-311681","authors":["Madoka Sunamura","Nienke Ter Hoeve","Rita J G van den Berg-Emons","Marcel L Geleijnse","Mirjam Haverkamp","Henk J Stam","Eric Boersma","Ron T van Domburg"],"significance":6,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/preventie/cardiovasculair-risico-begrippen/"],"congress":"","summary_en":"The OPTICARE randomized trial compared two extended cardiac rehabilitation programs with standard care, evaluating whether advanced and prolonged rehabilitation provides incremental cardiovascular risk reduction.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 twee uitgebreide hartrevalidatieprogramma's op effectiviteit voor cardiovasculaire risicoreductie.","abstract_original":"OBJECTIVE: The OPTICARE (OPTImal CArdiac REhabilitation) randomised controlled trial compared two advanced and extended cardiac rehabilitation (CR) programmes to standard CR for patients with acute coronary syndrome (ACS). These programmes were designed to stimulate permanent adoption of a heart-healthy lifestyle. The primary outcome was the SCORE (Systematic COronary Risk Evaluation) 10-year cardiovascular mortality risk function at 18 months follow-up. METHODS: In total, 914 patients with ACS (age, 57 years; 81% men) were randomised to: (1) 3 months standard CR (CR-only); (2) standard CR including three additional face-to-face active lifestyle counselling sessions and extended with three group fitness training and general lifestyle counselling sessions in the first 9 months after standard CR (CR+F); or (3) standard CR extended for 9 months with five to six telephone general lifestyle counselling sessions (CR+T). RESULTS: In an intention-to-treat analysis, we found no difference in the SCORE risk function at 18 months between CR+F and CR-only (3.30% vs 3.47%; p=0.48), or CR+T and CR-only (3.02% vs 3.47%; p=0.39). In a per-protocol analysis, two of three modifiable SCORE parameters favoured CR+F over CR-only: current smoking (13.4% vs 21.3%; p<0.001) and total cholesterol (3.9 vs 4.3 mmol/L; p<0.001). The smoking rate was also lower in CR+T compared with the CR-only (12.9% vs 21.3%; p<0.05). CONCLUSIONS: Extending CR with extra behavioural counselling (group sessions or individual telephone sessions) does not confer additional benefits with respect to SCORE parameters. Patients largely reach target levels for modifiable risk factors with few hospital readmissions already following standard CR. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01395095; results."},{"id":"80739436af46","type":"article","url":"https://hartvaat.nl/2018/03/01/medicamenteuze-behandeling-en-uitkomsten-bij-hfpef-systematische-review-en-meta-/","title":"Medicamenteuze behandeling en uitkomsten bij HFpEF: systematische review en meta-analyse","title_en":"Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","farmaco-economie","primaire-preventie","step-hfpef","summit-trial","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311652","source_url":"https://doi.org/10.1136/heartjnl-2017-311652","authors":["Sean Lee Zheng","Fiona T Chan","Adam A Nabeebaccus","Ajay M Shah","Theresa McDonagh","Darlington O Okonko","Salma Ayis"],"significance":8,"published":"2018-03-01","source_date":"2018-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This systematic review and meta-analysis evaluated all drug treatments studied in HFpEF and found that while no single therapy significantly reduced mortality, some agents (including MRAs and ARBs) showed modest reductions in heart failure hospitalization. The analysis highlighted the unmet therapeutic need that SGLT2 inhibitors later addressed.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 meta-analyse die de effecten van alle medicamenteuze behandelingen op uitkomsten bij HFpEF evalueerde. Referentiedocument voor het beperkte therapeutische arsenaal bij behouden EF.","abstract_original":"BACKGROUND: Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality. METHODS: We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI. RESULTS: We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo. CONCLUSION: The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group."},{"id":"d0db060b4bf2","type":"article","url":"https://hartvaat.nl/2018/02/20/genetica-leefstijl-en-ldl-cholesterol-bij-jonge-gezonde-vrouwen/","title":"Genetica, leefstijl en LDL-cholesterol bij jonge gezonde vrouwen","title_en":"Genetics, Lifestyle, and Low-Density Lipoprotein Cholesterol in Young and Apparently Healthy Women.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["cardiovasculaire-genetica","cetp-remmers","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipoproteïne-a","pcsk9-remmers","pelacarsen","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032479","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032479","authors":["Jan-Willem Balder","Antoine Rimbert","Xiang Zhang","Martijn Viel","Roan Kanninga","Freerk van Dijk","Peter Lansberg","Richard Sinke","Jan Albert Kuivenhoven"],"significance":6,"published":"2018-02-20","source_date":"2018-02-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This study examined the interplay between genetics, lifestyle factors, and LDL cholesterol in young apparently healthy women, supporting the concept that early lipid assessment and lifestyle modification can reduce lifelong cardiovascular risk.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 interactie tussen genetische aanleg, leefstijl en LDL-cholesterol bij jonge, schijnbaar gezonde vrouwen. Preventie begint vroeg.","abstract_original":"BACKGROUND: Atherosclerosis starts in childhood but low-density lipoprotein cholesterol (LDL-C), a causal risk factor, is mostly studied and dealt with when clinical events have occurred. Women are usually affected later in life than men and are underdiagnosed, undertreated, and understudied in cardiovascular trials and research. This study aims at a better understanding of lifestyle and genetic factors that affect LDL-C in young women. METHODS: We randomly selected for every year of age 8 women with LDL-C ≤1st percentile (≤50 mg/dL) and 8 women with LDL-C ≥99th percentile (≥186 mg/dL) from 28 000 female participants aged between 25 to 40 years of a population-based cohort study. The resulting groups include 119 and 121 women, respectively, of an average 33 years of age. A gene-sequencing panel was used to assess established monogenic and polygenic origins of these phenotypes. Information on lifestyle was extracted from questionnaires. A healthy lifestyle score was allocated based on a recently developed algorithm. RESULTS: Of the women with LDL-C ≤1st percentile, 19 (15.7%) carried mutations that are causing monogenic hypocholesterolemia and 60 (49.6%) were genetically predisposed to low LDL-C on the basis of an extremely low weighted genetic risk score. In comparison with control groups, a healthier lifestyle was not associated with low LDL-C in women without genetic predispositions. Among women with LDL-C ≥99th percentile, 20 women (16.8%) carried mutations that cause familial hypercholesterolemia, whereas 25 (21%) were predisposed to high LDL-C on the basis of a high-weighted genetic risk score. The women in whom no genetic origin for hypercholesterolemia could be identified were found to exhibit a significantly unfavorable lifestyle in comparison with controls. CONCLUSIONS: This study highlights the need for early assessment of the cardiovascular risk profile in apparently healthy young women to identify those with LDL-C ≥99th percentile for their age: first, because, in this study, 17% of the cases were molecularly diagnosed with familial hypercholesterolemia, which needs further attention; second, because our data indicate that an unfavorable lifestyle is significantly associated with severe hypercholesterolemia in genetically unaffected women, which may also need further attention."},{"id":"4bc82a2bc450","type":"article","url":"https://hartvaat.nl/2018/02/20/sekseverschillen-bij-ischemisch-hartfalen-na-cabg-stich-trial/","title":"Sekseverschillen bij ischemisch hartfalen na CABG: STICH-trial","title_en":"Sex Difference in Patients With Ischemic Heart Failure Undergoing Surgical Revascularization: Results From the STICH Trial (Surgical Treatment for Ischemic Heart Failure).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","newton-cabg"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030526","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030526","authors":["Ileana L Piña","Qi Zheng","Lilin She","Hanna Szwed","Irene M Lang","Pedro S Farsky","Serenella Castelvecchio","Jolanta Biernat","Alexandros Paraforos","Dragana Kosevic","Liliana E Favaloro","José C Nicolau","Padmini Varadarajan","Eric J Velazquez","Ramdas G Pai","Nicole Cyrille","Kerry L Lee","Patrice Desvigne-Nickens"],"significance":6,"published":"2018-02-20","source_date":"2018-02-20","image":"","kennis":[],"congress":"","summary_en":"This STICH subanalysis found that female sex is not an independent risk factor for poor outcomes after CABG in ischemic heart failure when adjusted for baseline characteristics, suggesting that women should not be denied surgical revascularization based on sex alone.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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-subanalyse naar sekseverschillen in uitkomsten na chirurgische revascularisatie bij ischemisch hartfalen. Vrouwen waren ondervertegenwoordigd maar hadden vergelijkbaar voordeel.","abstract_original":"BACKGROUND: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term benefit of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study). METHODS: The STICH trial randomized 1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction ≤35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex. RESULTS: At baseline, women were older (63.4 versus 59.3 years; P=0.016) with higher body mass index (27.9 versus 26.7 kg/m2; P=0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all P<0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all P<0.05). Over 10 years of follow-up, all-cause mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confidence interval, 0.52-0.86; P=0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard ratio, 0.65; 95% confidence interval, 0.48-0.89; P=0.006) were significantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no significant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all P>0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; P=0.187) between sexes among patients randomized to CABG per protocol as initial treatment. CONCLUSIONS: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595."},{"id":"eeabcae53fb0","type":"article","url":"https://hartvaat.nl/2018/02/20/morbiditeit-bij-pulmonaal-arteriele-hypertensie-als-prognostische-marker-voor-mo/","title":"Morbiditeit bij pulmonaal arteriële hypertensie als prognostische marker voor mortaliteit","title_en":"Pulmonary Arterial Hypertension-Related Morbidity Is Prognostic for Mortality.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.12.010","source_url":"https://doi.org/10.1016/j.jacc.2017.12.010","authors":["Vallerie V McLaughlin","Marius M Hoeper","Richard N Channick","Kelly M Chin","Marion Delcroix","Sean Gaine","Hossein-Ardeschir Ghofrani","Pavel Jansa","Irene M Lang","Sanjay Mehta","Tomás Pulido","B K S Sastry","Gérald Simonneau","Olivier Sitbon","Rogério Souza","Adam Torbicki","Victor F Tapson","Loïc Perchenet","Ralph Preiss","Pierre Verweij","Lewis J Rubin","Nazzareno Galiè"],"significance":6,"published":"2018-02-20","source_date":"2018-02-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This study demonstrated that PAH-related morbidity events (hospitalization, functional decline) independently predict mortality, supporting the inclusion of disease-progression endpoints in clinical trials beyond traditional time-to-event outcomes.","created":"2026-07-03T10:27:10Z","updated":"2026-07-03T13:26:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 PAH-gerelateerde morbiditeit (hospitalisatie, functionele verslechtering) een onafhankelijke voorspeller is van mortaliteit.","abstract_original":"BACKGROUND: Registry data suggest that disease progression in pulmonary arterial hypertension (PAH) is indicative of poor prognosis. However, the prognostic relevance of PAH-related morbidity has not been formally evaluated in randomized controlled trials. OBJECTIVES: The purpose of these analyses was to assess the impact of morbidity events on the risk of subsequent mortality using the landmark method and data from the SERAPHIN and GRIPHON studies. METHODS: For each study, the risk of all-cause death up to the end of the study was assessed from the landmark time point (months 3, 6, and 12) according to whether a patient had experienced a primary endpoint morbidity event before the landmark. Each analysis was conducted using data from all patients who were available for survival follow-up at the landmark. RESULTS: In the SERAPHIN study, on the basis of the 3-month landmark time point, patients who experienced a morbidity event before month 3 had an increased risk of death compared with patients who did not (hazard ratio [HR]: 3.39; 95% confidence interval [CI]: 1.94 to 5.92). In the GRIPHON study, on the basis of the 3-month landmark time point, there was also an increased risk with a HR of 4.48; (95% CI: 2.98 to 6.73). Analyses based on 6-month and 12-month landmarks also showed increased risk in patients who experienced morbidity events, albeit with a reduced HR. CONCLUSIONS: These results demonstrate the prognostic relevance of PAH-related morbidity as defined in the SERAPHIN and GRIPHON studies, highlighting the importance of preventing disease progression in patients with PAH and supporting the clinical relevance of SERAPHIN and GRIPHON morbidity events. (Study of Macitentan [ACT-064992] on Morbidity and Mortality in Patients With Symptomatic Pulmonary Arterial Hypertension [SERAPHIN]; NCT00660179; Selexipag [ACT-293987] in Pulmonary Arterial Hypertension [GRIPHON]; NCT01106014)."},{"id":"6aed2a5b1f4f","type":"article","url":"https://hartvaat.nl/2018/02/20/nieuw-onset-af-na-pci-of-cabg-bij-hoofdstamziekte-excel-trial/","title":"Nieuw-onset AF na PCI of CABG bij hoofdstamziekte: EXCEL-trial","title_en":"New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.12.012","source_url":"https://doi.org/10.1016/j.jacc.2017.12.012","authors":["Ioanna Kosmidou","Shmuel Chen","A Pieter Kappetein","Patrick W Serruys","Bernard J Gersh","John D Puskas","David E Kandzari","David P Taggart","Marie-Claude Morice","Paweł E Buszman","Andrzej Bochenek","Erick Schampaert","Pierre Pagé","Joseph F Sabik","Thomas McAndrew","Björn Redfors","Ori Ben-Yehuda","Gregg W Stone"],"significance":6,"published":"2018-02-20","source_date":"2018-02-20","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This EXCEL subanalysis showed that new-onset AF occurs more frequently after CABG than after PCI for left main disease, identifying a procedural advantage of percutaneous intervention for arrhythmia avoidance.","created":"2026-07-03T10:27:09Z","updated":"2026-07-03T13:26:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 subanalyse naar het optreden van nieuw-onset atriumfibrilleren na PCI versus CABG bij hoofdstamcoronairlijden. AF als complicatie beïnvloedt de revascularisatiekeuze.","abstract_original":"BACKGROUND: There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). OBJECTIVES: This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes. METHODS: In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. RESULTS: Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p < 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantly longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001), death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p = 0.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004). CONCLUSIONS: In patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)."},{"id":"26ed01d03cc5","type":"article","url":"https://hartvaat.nl/2018/02/20/cva-risico-bij-verminderde-ef-na-mi-zonder-af/","title":"CVA-risico bij verminderde EF na MI zonder AF","title_en":"Stroke Risk in Patients With Reduced Ejection Fraction After Myocardial Infarction Without Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cerebrovasculair"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.12.011","source_url":"https://doi.org/10.1016/j.jacc.2017.12.011","authors":["João Pedro Ferreira","Nicolas Girerd","John Gregson","Ichraq Latar","Abhinav Sharma","Marc A Pfeffer","John J V McMurray","Azmil H Abdul-Rahim","Bertram Pitt","Kenneth Dickstein","Patrick Rossignol","Faiez Zannad"],"significance":6,"published":"2018-02-20","source_date":"2018-02-20","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"","summary_en":"This study identified risk factors for stroke in patients with reduced ejection fraction after MI without atrial fibrillation, informing the consideration of anticoagulation in the post-MI cardiomyopathy population.","created":"2026-07-03T10:27:09Z","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":"Studie naar het CVA-risico bij patiënten met verminderde ejectiefractie na myocardinfarct die geen atriumfibrilleren hebben. Onderzoekt of antistolling overwogen moet worden bij HFrEF zonder AF.","abstract_original":"BACKGROUND: Stroke can occur after myocardial infarction (MI) in the absence of atrial fibrillation (AF). OBJECTIVES: This study sought to identify risk factors (excluding AF) for the occurrence of stroke and to develop a calibrated and validated stroke risk score in patients with MI and heart failure (HF) and/or systolic dysfunction. METHODS: The datasets included in this pooling initiative were derived from 4 trials: CAPRICORN (Effect of Carvedilol on Outcome After Myocardial Infarction in Patients With Left Ventricular Dysfunction), OPTIMAAL (Optimal Trial in Myocardial Infarction With Angiotensin II Antagonist Losartan), VALIANT (Valsartan in Acute Myocardial Infarction Trial), and EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study); EPHESUS was used for external validation. A total of 22,904 patients without AF or oral anticoagulation were included in this analysis. The primary outcome was stroke, and death was treated as a \"competing risk.\" RESULTS: During a median follow-up of 1.9 years (interquartile range: 1.3 to 2.7 years), 660 (2.9%) patients had a stroke. These patients were older, more often female, smokers, and hypertensive; they had a higher Killip class; a lower estimated glomerular filtration rate; and a higher proportion of MI, HF, diabetes, and stroke histories. The final stroke risk model retained older age, Killip class 3 or 4, estimated glomerular filtration rate ≤45 ml/min/1.73 m2, hypertension history, and previous stroke. The models were well calibrated and showed moderate to good discrimination (C-index = 0.67). The observed 3-year event rates increased steeply for each sextile of the stroke risk score (1.8%, 2.9%, 4.1%, 5.6%, 8.3%, and 10.9%, respectively) and were in agreement with the expected event rates. CONCLUSIONS: Readily accessible risk factors associated with the occurrence of stroke were identified and incorporated in an easy-to-use risk score. This score may help in the identification of patients with MI and HF and a high risk for stroke despite their not presenting with AF."},{"id":"27ac5b68569c","type":"article","url":"https://hartvaat.nl/2018/02/13/kwaliteitsverbeteringsinterventie-bij-acuut-mi-in-india-jama-acs-quik/","title":"Kwaliteitsverbeteringsinterventie bij acuut MI in India: JAMA ACS QUIK","title_en":"Effect of a Quality Improvement Intervention on Clinical Outcomes in Patients in India With Acute Myocardial Infarction: The ACS QUIK Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2017.21906","source_url":"https://doi.org/10.1001/jama.2017.21906","authors":["Mark D Huffman","Padinhare P Mohanan","Raji Devarajan","Abigail S Baldridge","Dimple Kondal","Lihui Zhao","Mumtaj Ali","Mangalath N Krishnan","Syam Natesan","Rajesh Gopinath","Sunitha Viswanathan","Joseph Stigi","Johny Joseph","Somanathan Chozhakkat","Donald M Lloyd-Jones","Dorairaj Prabhakaran"],"significance":7,"published":"2018-02-13","source_date":"2018-02-13","image":"","kennis":[],"congress":"","summary_en":"The ACS QUIK trial showed that a locally adapted quality improvement intervention did not significantly reduce major cardiovascular events in patients with acute MI in India, highlighting the challenges of implementing standardized ACS protocols in diverse healthcare settings.","created":"2026-07-03T10:27:09Z","updated":"2026-07-03T13:26:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ACS QUIK gerandomiseerde trial naar een kwaliteitsverbeteringsinterventie bij acuut MI in India. Onderzoekt of gestructureerde verbetering de mortaliteit vermindert in lage- en middeninkomenslanden.","abstract_original":"IMPORTANCE: Wide heterogeneity exists in acute myocardial infarction treatment and outcomes in India. OBJECTIVE: To evaluate the effect of a locally adapted quality improvement tool kit on clinical outcomes and process measures in Kerala, a southern Indian state. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized, stepped-wedge clinical trial conducted between November 10, 2014, and November 9, 2016, in 63 hospitals in Kerala, India, with a last date of follow-up of December 31, 2016. During 5 predefined steps over the study period, hospitals were randomly selected to move in a 1-way crossover from the control group to the intervention group. Consecutively presenting patients with acute myocardial infarction were offered participation. INTERVENTIONS: Hospitals provided either usual care (control group; n = 10 066 participants [step 0: n = 2915; step 1: n = 2649; step 2: n = 2251; step 3: n = 1422; step 4; n = 829; step 5: n = 0]) or care using a quality improvement tool kit (intervention group; n = 11 308 participants [step 0: n = 0; step 1: n = 662; step 2: n = 1265; step 3: n = 2432; step 4: n = 3214; step 5: n = 3735]) that consisted of audit and feedback, checklists, patient education materials, and linkage to emergency cardiovascular care and quality improvement training. MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of all-cause death, reinfarction, stroke, or major bleeding using standardized definitions at 30 days. Secondary outcomes included the primary outcome's individual components, 30-day cardiovascular death, medication use, and tobacco cessation counseling. Mixed-effects logistic regression models were used to account for clustering and temporal trends. RESULTS: Among 21 374 eligible randomized participants (mean age, 60.6 [SD, 12.0] years; n = 16 183 men [76%] ; n = 13 689 [64%] with ST-segment elevation myocardial infarction), 21 079 (99%) completed the trial. The primary composite outcome was observed in 5.3% of the intervention participants and 6.4% of the control participants. The observed difference in 30-day major adverse cardiovascular event rates between the groups was not statistically significant after adjustment (adjusted risk difference, -0.09% [95% CI, -1.32% to 1.14%]; adjusted odds ratio, 0.98 [95% CI, 0.80-1.21]). The intervention group had a higher rate of medication use including reperfusion but no effect on tobacco cessation counseling. There were no unexpected adverse events reported. CONCLUSIONS AND RELEVANCE: Among patients with acute myocardial infarction in Kerala, India, use of a quality improvement intervention compared with usual care did not decrease a composite of 30-day major adverse cardiovascular events. Further research is needed to understand the lack of efficacy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02256657."},{"id":"bbb969091dd1","type":"article","url":"https://hartvaat.nl/2018/02/13/richtlijngetrouwe-medicamenteuze-therapie-in-contemporaine-revascularisatietrial/","title":"Richtlijngetrouwe medicamenteuze therapie in contemporaine revascularisatietrials","title_en":"Compliance With Guideline-Directed Medical Therapy in Contemporary Coronary Revascularization Trials.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiorenal-behandelstrategie","diabetes-en-hart","farmaco-economie","lipidenverlaging","niet-statine-therapie","obesitas","ouderen","richtlijnen-esc"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.11.068","source_url":"https://doi.org/10.1016/j.jacc.2017.11.068","authors":["Ana-Catarina Pinho-Gomes","Luis Azevedo","Jung-Min Ahn","Seung-Jung Park","Taye H Hamza","Michael E Farkouh","Patrick W Serruys","Milan Milojevic","Arie Pieter Kappetein","Gregg W Stone","Andre Lamy","Valentin Fuster","David P Taggart"],"significance":5,"published":"2018-02-13","source_date":"2018-02-13","image":"","kennis":[],"congress":"","summary_en":"This analysis documented suboptimal compliance with guideline-directed medical therapy across contemporary coronary revascularization trials, highlighting that even in controlled trial settings, pharmacotherapy optimization remains incomplete.","created":"2026-07-03T10:27:09Z","updated":"2026-07-03T13:26:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 mate van richtlijngetrouwe medicamenteuze achtergrondtherapie in contemporaine coronaire revascularisatietrials. Suboptimale medicamenteuze therapie als confounder.","abstract_original":"BACKGROUND: Despite the well-established benefits of secondary cardiovascular prevention, the importance of concurrent medical therapy in clinical trials of coronary revascularization is often overlooked. OBJECTIVES: The goal of this study was to assess compliance with guideline-directed medical therapy (GDMT) in clinical trials and its potential impact on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). METHODS: The Cochrane Central Register of Controlled Trials and MEDLINE were searched from 2005 to August 2017. Clinical trial registries and reference lists of relevant studies were also searched. Randomized controlled trials comparing PCI with drug-eluting stents versus CABG and reporting medical therapy after revascularization were included. The study outcome was compliance with GDMT, defined as the following: 1) any antiplatelet agent plus beta-blocker plus statin (GDMT1); and 2) any antiplatelet agent plus beta-blocker plus statin plus angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (GDMT2). Data collection and analysis were performed according to the methodological recommendations of The Cochrane Collaboration. RESULTS: From a total of 439 references, 5 trials were included based on our inclusion and exclusion criteria. Overall, compliance with GDMT1 was low and decreased over time from 67% at 1 year to 53% at 5 years. Compliance with GDMT2 was even lower and decreased from 40% at 1 year to 38% at 5 years. Compliance with both GDMT1 and GDMT2 was higher in PCI than in CABG at all time points. Meta-regression suggested an association between lower use of GDMT1 and adverse clinical outcomes in PCI versus CABG at 5 years. CONCLUSIONS: Compliance with GDMT in contemporary clinical trials remains suboptimal and is significantly lower after CABG than after PCI, which may influence the comparison of clinical trial endpoints between those study groups."},{"id":"71b372acb291","type":"article","url":"https://hartvaat.nl/2018/02/07/abc-doodsscore-bij-af-biomarkergebaseerde-risicoscore-voor-mortaliteit/","title":"ABC-doodsscore bij AF: biomarkergebaseerde risicoscore voor mortaliteit","title_en":"A biomarker-based risk score to predict death in patients with atrial fibrillation: the ABC (age, biomarkers, clinical history) death risk score.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx584","source_url":"https://doi.org/10.1093/eurheartj/ehx584","authors":["Ziad Hijazi","Jonas Oldgren","Johan Lindbäck","John H Alexander","Stuart J Connolly","John W Eikelboom","Michael D Ezekowitz","Claes Held","Elaine M Hylek","Renato D Lopes","Salim Yusuf","Christopher B Granger","Agneta Siegbahn","Lars Wallentin"],"significance":7,"published":"2018-02-07","source_date":"2018-02-07","image":"","kennis":[],"congress":"","summary_en":"This study derived and validated the ABC death risk score (Age, Biomarkers, Clinical history) for mortality prediction in atrial fibrillation, complementing the existing ABC bleeding score and providing a comprehensive biomarker-based risk assessment tool.","created":"2026-07-03T10:27:09Z","updated":"2026-07-03T13:26:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Derivatie en validatie van de ABC-doodsscore (Age, Biomarkers, Clinical history) voor mortaliteitsvoorspelling bij AF. Aanvulling op de ABC-bloedingsscore en ABC-CVA-score.","abstract_original":"AIMS: In atrial fibrillation (AF), mortality remains high despite effective anticoagulation. A model predicting the risk of death in these patients is currently not available. We developed and validated a risk score for death in anticoagulated patients with AF including both clinical information and biomarkers. METHODS AND RESULTS: The new risk score was developed and internally validated in 14 611 patients with AF randomized to apixaban vs. warfarin for a median of 1.9 years. External validation was performed in 8548 patients with AF randomized to dabigatran vs. warfarin for 2.0 years. Biomarker samples were obtained at study entry. Variables significantly contributing to the prediction of all-cause mortality were assessed by Cox-regression. Each variable obtained a weight proportional to the model coefficients. There were 1047 all-cause deaths in the derivation and 594 in the validation cohort. The most important predictors of death were N-terminal pro B-type natriuretic peptide, troponin-T, growth differentiation factor-15, age, and heart failure, and these were included in the ABC (Age, Biomarkers, Clinical history)-death risk score. The score was well-calibrated and yielded higher c-indices than a model based on all clinical variables in both the derivation (0.74 vs. 0.68) and validation cohorts (0.74 vs. 0.67). The reduction in mortality with apixaban was most pronounced in patients with a high ABC-death score. CONCLUSION: A new biomarker-based score for predicting risk of death in anticoagulated AF patients was developed, internally and externally validated, and well-calibrated in two large cohorts. The ABC-death risk score performed well and may contribute to overall risk assessment in AF. CLINICALTRIALS.GOV IDENTIFIER: NCT00412984 and NCT00262600."},{"id":"e10ce0f9b6a6","type":"article","url":"https://hartvaat.nl/2018/02/06/ticagrelor-voor-secundaire-preventie-bij-multivaten-coronairlijden/","title":"Ticagrelor voor secundaire preventie bij multivaten coronairlijden","title_en":"Ticagrelor for Secondary Prevention of Atherothrombotic Events in Patients With Multivessel Coronary Disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["stabiel-coronairlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.11.050","source_url":"https://doi.org/10.1016/j.jacc.2017.11.050","authors":["Sameer Bansilal","Marc P Bonaca","Jan H Cornel","Robert F Storey","Deepak L Bhatt","Ph Gabriel Steg","Kyungah Im","Sabina A Murphy","Dominick J Angiolillo","Robert G Kiss","Alexander N Parkhomenko","Jose Lopez-Sendon","Daniel Isaza","Assen Goudev","Frederic Kontny","Peter Held","Eva C Jensen","Eugene Braunwald","Marc S Sabatine","A J Oude Ophuis"],"significance":5,"published":"2018-02-06","source_date":"2018-02-06","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This PEGASUS subanalysis showed that ticagrelor provides particular benefit in post-MI patients with multivessel coronary disease, identifying the highest-risk anatomical subgroup for extended antiplatelet therapy.","created":"2026-07-03T10:27:09Z","updated":"2026-07-03T13:26:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 naar de werkzaamheid van ticagrelor bij patiënten met multivaten coronairlijden. Onderzoekt of het voordeel groter is bij uitgebreider vaatlijden.","abstract_original":"BACKGROUND: Patients with prior myocardial infarction (MI) and multivessel coronary disease (MVD) are at high risk for recurrent coronary events. OBJECTIVES: The authors investigated the efficacy and safety of ticagrelor versus placebo in patients with MVD in 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. METHODS: Patients with a history of MI 1 to 3 years before inclusion in the PEGASUS-TIMI 54 trial were stratified in a pre-specified analysis based on the presence of MVD. The effect of ticagrelor (60 mg and 90 mg) on the composite of cardiovascular death, MI, or stroke (major adverse cardiovascular events [MACE]), as well as the composite of coronary death, MI, or stent thrombosis (coronary events), and on TIMI major bleeding, intracranial hemorrhage (ICH), and fatal bleeding were evaluated over a median of 33 months. RESULTS: A total of 12,558 patients (59.4%) had MVD. In the placebo arm, compared with patients without MVD, those with MVD were at higher risk for MACE (9.37% vs. 8.57%, adjusted hazard ratio [HRadj]: 1.24; p = 0.026) and for coronary events (7.67% vs. 5.34%, HRadj: 1.49; p = 0.0005). In patients with MVD, ticagrelor reduced the risk of MACE (7.94% vs. 9.37%, HR: 0.82; p = 0.004) and coronary events (6.02% vs. 7.67%, HR: 0.76; p < 0.0001), including a 36% reduction in coronary death (HR: 0.64; 95% confidence interval: 0.48 to 0.85; p = 0.002). In this subgroup, ticagrelor increased the risk of TIMI major bleeding (2.52% vs. 1.08%, HR: 2.67; p < 0.0001), but not ICH or fatal bleeds. CONCLUSIONS: Patients with prior MI and MVD are at increased risk of MACE and coronary events, and experience substantial relative and absolute risk reductions in both outcomes with long-term ticagrelor treatment relative to those without MVD. Ticagrelor increases the risk of TIMI major bleeding, but not ICH or fatal bleeding. For patients with prior MI and MVD, ticagrelor is an effective option for long-term antiplatelet therapy. (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":"92d1934683d5","type":"article","url":"https://hartvaat.nl/2018/02/03/sirolimus-eluting-bioabsorbeerbare-stent-versus-everolimus-eluting-stent-na-mi-l/","title":"Sirolimus-eluting bioabsorbeerbare stent versus everolimus-eluting stent na MI: Lancet","title_en":"A sirolimus-eluting bioabsorbable polymer-coated stent (MiStent) versus an everolimus-eluting durable polymer stent (Xience) after percutaneous coronary intervention (DESSOLVE III): a randomised, single-blind, multicentre, non-inferiority, phase 3 trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)33103-3","source_url":"https://doi.org/10.1016/S0140-6736(17)33103-3","authors":["Robbert J de Winter","Yuki Katagiri","Taku Asano","Krzysztof P Milewski","Philipp Lurz","Pawel Buszman","Gillian A J Jessurun","Karel T Koch","Roland P T Troquay","Bas J B Hamer","Ton Oude Ophuis","Jochen Wöhrle","Rafał Wyderka","Guillaume Cayla","Sjoerd H Hofma","Sébastien Levesque","Aleksander Żurakowski","Dieter Fischer","Maciej Kośmider","Pascal Goube","E Karin Arkenbout","Michel Noutsias","Markus W Ferrari","Yoshinobu Onuma","William Wijns","Patrick W Serruys"],"significance":6,"published":"2018-02-03","source_date":"2018-02-03","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial compared a sirolimus-eluting bioabsorbable polymer stent (MiStent) with a durable polymer everolimus-eluting stent, evaluating a next-generation biocompatible coating technology for coronary intervention.","created":"2026-07-03T10:27:09Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 sirolimus-eluting bioabsorbeerbare stent (MiStent) vergeleek met een everolimus-eluting durable polymer stent (Xience) na myocardinfarct.","abstract_original":"BACKGROUND: MiStent is a drug-eluting stent with a fully absorbable polymer coating containing and embedding a microcrystalline form of sirolimus into the vessel wall. It was developed to overcome the limitation of current durable polymer drug-eluting stents eluting amorphous sirolimus. The clinical effect of MiStent sirolimus-eluting stent compared with a durable polymer drug-eluting stents has not been investigated in a large randomised trial in an all-comer population. METHODS: We did a randomised, single-blind, multicentre, phase 3 study (DESSOLVE III) at 20 hospitals in Germany, France, Netherlands, and Poland. Eligible participants were any patients aged at least 18 years who underwent percutaneous coronary intervention in a lesion and had a reference vessel diameter of 2·50-3·75 mm. We randomly assigned patients (1:1) to implantation of either a sirolimus-eluting bioresorbable polymer stent (MiStent) or an everolimus-eluting durable polymer stent (Xience). Randomisation was done by local investigators via web-based software with random blocks according to centre. The primary endpoint was a non-inferiority comparison of a device-oriented composite endpoint (DOCE)-cardiac death, target-vessel myocardial infarction, or clinically indicated target lesion revascularisation-between the groups at 12 months after the procedure assessed by intention-to-treat. A margin of 4·0% was defined for non-inferiority of the MiStent group compared with the Xience group. All participants were included in the safety analyses. This trial is registered with ClinicalTrials.gov, number NCT02385279. FINDINGS: Between March 20, and Dec 3, 2015, we randomly assigned 1398 patients with 2030 lesions; 703 patients with 1037 lesions were assigned to MiStent, of whom 697 received the index procedure, and 695 patients with 993 lesions were asssigned to Xience, of whom 690 received the index procedure. At 12 months, the primary endpoint had occurred in 40 patients (5·8%) in the sirolimus-eluting stent group and in 45 patients (6·5%) in the everolimus-eluting stent group (absolute difference -0·8% [95% CI -3·3 to 1·8], pnon-inferiority=0·0001). Procedural complications occurred in 12 patients (1·7%) in the sirolimus-eluting stent group and ten patients (1·4%) in the everolimus-eluting stent group; no clinical adverse events could be attributed to these dislodgements through a minimum of 12 months of follow-up. The rate of stent thrombosis, a safety indicator, did not differ between groups and was low in both treatment groups. INTERPRETATION: The sirolimus-eluting bioabsorbable polymer stent was non-inferior to the everolimus-eluting durable polymer stent for a device-oriented composite clinical endpoint at 12 months in an all-comer population. MiStent seems a reasonable alternative to other stents in clinical practice. FUNDING: The European Cardiovascular Research Institute, Micell Technologies (Durham, NC, USA), and Stentys (Paris, France)."},{"id":"6a0d59ff2d54","type":"article","url":"https://hartvaat.nl/2018/02/01/katheterablatie-bij-af-met-hartfalen-nejm-castle-af/","title":"Katheterablatie bij AF met hartfalen: NEJM CASTLE-AF","title_en":"Catheter Ablation for Atrial Fibrillation with Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1707855","source_url":"https://doi.org/10.1056/NEJMoa1707855","authors":["Nassir F Marrouche","Johannes Brachmann","Dietrich Andresen","Jürgen Siebels","Lucas Boersma","Luc Jordaens","Béla Merkely","Evgeny Pokushalov","Prashanthan Sanders","Jochen Proff","Heribert Schunkert","Hildegard Christ","Jürgen Vogt","Dietmar Bänsch"],"significance":10,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The CASTLE-AF trial showed that catheter ablation for atrial fibrillation significantly reduced the composite of death and heart failure hospitalization compared with medical therapy in patients with both AF and heart failure. This landmark result established ablation as a disease-modifying intervention in the AF-heart failure overlap population.","created":"2026-07-03T10:27:09Z","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":"Landmark NEJM CASTLE-AF-trial die aantoonde dat katheterablatie voor AF de mortaliteit en HF-hospitalisatie significant vermindert bij patiënten met hartfalen. Game-changer voor AF-ablatie bij HF.","abstract_original":"BACKGROUND: Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS: We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS: After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medical-therapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P=0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P=0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P=0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P=0.009). CONCLUSIONS: Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188 .)."},{"id":"e95ce330e926","type":"article","url":"https://hartvaat.nl/2018/02/01/cv-uitkomsten-naar-albumin-en-nierziekte-bij-diabetes-type-2-met-hoog-cv-risico/","title":"CV-uitkomsten naar albumin en nierziekte bij diabetes type 2 met hoog CV-risico","title_en":"Cardiovascular Outcomes According to Urinary Albumin and Kidney Disease in Patients With Type 2 Diabetes at High Cardiovascular Risk: Observations From the SAVOR-TIMI 53 Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-2","slaapapneu","soul-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.4228","source_url":"https://doi.org/10.1001/jamacardio.2017.4228","authors":["Benjamin M Scirica","Ofri Mosenzon","Deepak L Bhatt","Jacob A Udell","Ph Gabriel Steg","Darren K McGuire","KyungAh Im","Estella Kanevsky","Christina Stahre","Mikaela Sjöstrand","Itamar Raz","Eugene Braunwald"],"significance":6,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that urinary albumin levels and kidney disease status modify cardiovascular outcomes in high-risk type 2 diabetes patients, supporting routine albuminuria screening for comprehensive cardiorenal risk assessment.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 cardiovasculaire uitkomsten gestratificeerd naar albuminurie en nierziekte bij hoogrisico diabetes type 2.","abstract_original":"IMPORTANCE: An elevated level of urinary albumin to creatinine ratio (UACR) is a marker of renal dysfunction and predictor of kidney failure/death in patients with type 2 diabetes. The prognostic use of UACR in established cardiac biomarkers is not well described. OBJECTIVE: To evaluate whether UACR offers incremental prognostic benefit beyond risk factors and established plasma cardiovascular biomarkers. DESIGN, SETTING, AND PARTICIPANTS: The Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus-Thrombolysis in Myocardial Infarction (SAVOR-TIMI) 53 study was performed from May 2010 to May 2013 and evaluated the safety of saxagliptin vs placebo in patients with type 2 diabetes with overt cardiovascular disease or multiple risk factors. Median follow-up was 2.1 years (interquartile range, 1.8-2.3 years). INTERVENTIONS: Patients were randomized to saxagliptin vs placebo plus standard care. MAIN OUTCOMES AND MEASURES: Baseline UACR was measured in 15 760 patients (95.6% of the trial population) and categorized into thresholds. RESULTS: Of 15 760 patients, 5205 were female (33.0%). The distribution of UARC categories were: 5805 patients (36.8%) less than 10 mg/g, 3891 patients (24.7%) at 10 to 30 mg/g, 4426 patients (28.1%) at 30 to 300 mg/g, and 1638 patients (10.4%) at more than 300 mg/g. When evaluated without cardiac biomarkers, there was a stepwise increase with each higher UACR category in the incidence of the primary composite end point (cardiovascular death, myocardial infarction, or ischemic stroke) (3.9%, 6.9%, 9.2%, and 14.3%); cardiovascular death (1.4%, 2.6%, 4.1%, and 6.9%); and hospitalization for heart failure (1.5%, 2.5%, 4.0%, and 8.3%) (adjusted P < .001 for trend). The net reclassification improvement at the event rate for each end point was 0.081 (95% CI, 0.025 to 0.161), 0.129 (95% CI, 0.029 to 0.202), and 0.056 (95% CI, -0.005 to 0.141), respectively. The stepwise increased cardiovascular risk associated with a UACR of more than 10 mg/g was also present within each chronic kidney disease category. The UACR was associated with outcomes after including cardiac biomarkers. However, the improvement in discrimination and reclassification was attenuated; net reclassification improvement at the event rate was 0.022 (95% CI, -0.022 to 0.067), -0.008 (-0.034 to 0.053), and 0.043 (-0.030 to 0.052) for the primary end point, cardiovascular death, and hospitalization for heart failure, respectively. CONCLUSIONS AND RELEVANCE: In patients with type 2 diabetes, UACR was independently associated with increased risk for a spectrum of adverse cardiovascular outcomes. However, the incremental cardiovascular prognostic value of UACR was minimal when evaluated together with contemporary cardiac biomarkers. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01107886."},{"id":"e29adb79d0ac","type":"article","url":"https://hartvaat.nl/2018/02/01/lipoproteine-a-en-recidiverende-ischemische-events-na-acs-dal-outcomes-analyse/","title":"Lipoproteïne(a) en recidiverende ischemische events na ACS: dal-Outcomes-analyse","title_en":"Association of Lipoprotein(a) With Risk of Recurrent Ischemic Events Following Acute Coronary Syndrome: Analysis of the dal-Outcomes Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["acuut-coronair-syndroom","lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.3833","source_url":"https://doi.org/10.1001/jamacardio.2017.3833","authors":["Gregory G Schwartz","Christie M Ballantyne","Philip J Barter","David Kallend","Lawrence A Leiter","Eran Leitersdorf","John J V McMurray","Stephen J Nicholls","Anders G Olsson","Prediman K Shah","Jean-Claude Tardif","John Kittelson"],"significance":7,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This JAMA Cardiology analysis from a post-ACS cohort demonstrated that elevated lipoprotein(a) independently predicts recurrent ischemic events, establishing Lp(a) as a residual risk factor that persists after acute coronary syndrome regardless of LDL cholesterol management.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 Lp(a) en recidiverende ischemische events na ACS. Lp(a) als residueel risicofactor na standaardbehandeling.","abstract_original":"IMPORTANCE: It is uncertain whether lipoprotein(a) [Lp(a)], which is associated with incident cardiovascular disease, is an independent risk factor for recurrent cardiovascular events after acute coronary syndrome (ACS). OBJECTIVE: To determine the association of Lp(a) concentration measured after ACS with the subsequent risk of ischemic cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS: This nested case-cohort analysis was performed as an ad hoc analysis of the dal-Outcomes randomized clinical trial. This trial compared dalcetrapib, the cholesteryl ester transfer protein inhibitor, with placebo in patients with recent ACS and was performed between April 2008 and September 2012 at 935 sites in 27 countries. There were 969 case patients who experienced a primary cardiovascular outcome, and there were 3170 control patients who were event free at the time of a case event and had the same type of index ACS (unstable angina or myocardial infarction) as that of the respective case patients. Concentration of Lp(a) was measured by immunoturbidimetric assay. Data analysis for this present study was conducted from June 8, 2016, to April 21, 2017. INTERVENTIONS: Patients were randomly assigned to receive treatment with dalcetrapib, 600 mg daily, or matching placebo, beginning 4 to 12 weeks after ACS. MAIN OUTCOMES AND MEASURES: Death due to coronary heart disease, a major nonfatal coronary event (myocardial infarction, hospitalization for unstable angina, or resuscitated cardiac arrest), or fatal or nonfatal ischemic stroke. RESULTS: The mean (SD) age was 63 (10) years for the 969 case patients and 60 (9) years for the 3170 control patients, and both cohorts were composed of predominantly male (770 case patients [79%] and 2558 control patients [81%]; P = .40) and white patients (858 case patients [89%] and 2825 control patients [89%]; P = .62). At baseline, the median (interquartile range) Lp(a) level was 12.3 (4.7-50.9) mg/dL. There was broad application of evidence-based secondary prevention strategies after ACS, including use of statins in 4030 patients (97%). The cumulative distribution of baseline Lp(a) levels did not differ between cases and controls at P = .16. Case-cohort regression analysis showed no association of baseline Lp(a) level with risk of cardiovascular events. For a doubling of Lp(a) concentration, the hazard ratio (case to control) was 1.01 (95% CI, 0.96-1.06; P = .66) after adjustment for 16 baseline variables, including assigned study treatment. CONCLUSIONS AND RELEVANCE: For patients with recent ACS who are treated with statins, Lp(a) concentration was not associated with adverse cardiovascular outcomes. These findings call into question whether treatment specifically targeted to reduce Lp(a) levels would thereby lower the risk for ischemic cardiovascular events after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00658515."},{"id":"db10b2fc3868","type":"article","url":"https://hartvaat.nl/2018/02/01/empagliflozine-en-cv-dood-en-hf-hospitalisatie-over-het-hf-spectrum-empa-reg-out/","title":"Empagliflozine en CV-dood en HF-hospitalisatie over het HF-spectrum: EMPA-REG OUTCOME","title_en":"Effects of empagliflozin on risk for cardiovascular death and heart failure hospitalization across the spectrum of heart failure risk in the EMPA-REG OUTCOME® trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","dapa-hf","empagliflozine","emperor-trials"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx511","source_url":"https://doi.org/10.1093/eurheartj/ehx511","authors":["David Fitchett","Javed Butler","Philippe van de Borne","Bernard Zinman","John M Lachin","Christoph Wanner","Hans J Woerle","Stefan Hantel","Jyothis T George","Odd Erik Johansen","Silvio E Inzucchi"],"significance":8,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This EMPA-REG OUTCOME analysis showed that empagliflozin reduced cardiovascular death and heart failure hospitalization across the spectrum of heart failure risk, including patients without prior heart failure. The results foreshadowed the subsequent dedicated heart failure trials with SGLT2 inhibitors.","created":"2026-07-03T10:27:08Z","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":"EMPA-REG OUTCOME analyse naar de effecten van empagliflozine op cardiovasculaire dood en hartfalenhospitalisatie over het volledige spectrum van HF-risico. Bevestigt het breed cardiovasculaire voordeel.","abstract_original":"AIMS: Empagliflozin reduced the risk of cardiovascular (CV) death and heart failure (HF) hospitalizations in patients with type 2 diabetes (T2D) and established CV disease (CVD) in the EMPA-REG OUTCOME® trial. We investigated whether the benefit of empagliflozin was observed across the spectrum of HF risk. METHODS AND RESULTS: Seven thousand and twenty patients with T2D (HbA1c 7-10% and eGFR > 30 mL/min/1.73 m2) were treated with empagliflozin 10 or 25 mg, or placebo once daily and followed for median 3.1 years. In patients without HF at baseline (89.9%), we derived the 5-year risk for incident HF using the 9-variable Health ABC HF Risk score [classified as low-to-average (<10%), high (10-20%), and very high (≥ 20%)]. Overall, 67.2% of the population had low-to-average, 24.2% high, and 5.1% very high 5-year HF risk. Across these groups, the effect on CV death and HF hospitalization with empagliflozin was consistent [hazard ratio 0.71 (95% confidence interval: 0.52, 0.96), 0.52 (0.36, 0.75), and 0.55 (0.30, 1.00), respectively]. Effects on CV death in the ostensibly highest HF risk group (HF at baseline and/or incident HF during the trial) in whom 37.9% of the overall CV deaths occurred, was also beneficial [0.67 (0.47, 0.97)], yet, similar benefits were seen in the lower risk patients. CONCLUSION: In patients with T2D and established CVD, a sizeable proportion without HF at baseline are at high or very high risk for HF outcomes, indicating the need for active case finding in this patient population. Empagliflozin consistently improved HF outcomes both in patients at low or high HF risk."},{"id":"b7684053a01a","type":"article","url":"https://hartvaat.nl/2018/02/01/differentiele-effecten-van-pcsk9-varianten-op-coronairlijden-versus-ischemisch-c/","title":"Differentiële effecten van PCSK9-varianten op coronairlijden versus ischemisch CVA","title_en":"Differential effects of PCSK9 variants on risk of coronary disease and ischaemic stroke.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["pcsk9-remmers"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx373","source_url":"https://doi.org/10.1093/eurheartj/ehx373","authors":["Jemma C Hopewell","Rainer Malik","Elsa Valdés-Márquez","Bradford B Worrall","Rory Collins"],"significance":7,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":[],"congress":"","summary_en":"This genetic study showed that PCSK9 variants have differential effects on coronary heart disease versus ischemic stroke risk, suggesting that PCSK9-mediated LDL lowering may have variable impact across different vascular territories.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 aantoont dat PCSK9-varianten differentiële effecten hebben op coronairlijden versus ischemisch CVA. Nuanceert het voordeel van PCSK9-remming per vasculair bed.","abstract_original":"AIMS: PCSK9 genetic variants that have large effects on low-density lipoprotein cholesterol (LDL-C) and coronary heart disease (CHD) have prompted the development of therapeutic PCSK9-inhibition. However, there is limited evidence that PCSK9 variants are associated with ischaemic stroke (IS). METHODS AND RESULTS: Associations of the loss-of-function PCSK9 genetic variant (rs11591147; R46L), and five additional PCSK9 variants, with IS and IS subtypes (cardioembolic, large vessel, and small vessel) were estimated in a meta-analysis involving 10 307 IS cases and 19 326 controls of European ancestry. They were then compared with the associations of these variants with LDL-C levels (in up to 172 970 individuals) and CHD (in up to 60 801 CHD cases and 123 504 controls). The rs11591147 T allele was associated with 0.5 mmol/L lower LDL-C level (P = 9 × 10-143) and 23% lower CHD risk [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.69-0.87, P = 7 × 10-6]. However, it was not associated with risk of IS (OR: 1.04, 95% CI: 0.84-1.28, P = 0.74) or IS subtypes. Information from additional PCSK9 variants also indicated consistently weaker effects on IS than on CHD. CONCLUSION: PCSK9 genetic variants that confer life-long lower PCSK9 and LDL-C levels appear to have significantly weaker, if any, associations with risk of IS than with risk of CHD. By contrast, similar proportional reductions in risks of IS and CHD have been observed in randomized trials of therapeutic PCSK9-inhibition. These findings have implications for our understanding of when Mendelian randomization can be relied upon to predict the effects of therapeutic interventions."},{"id":"4f0c3901741d","type":"article","url":"https://hartvaat.nl/2018/02/01/dabigatran-versus-warfarine-bij-af-met-linkerventrikelhypertrofie-re-ly/","title":"Dabigatran versus warfarine bij AF met linkerventrikelhypertrofie: RE-LY","title_en":"Dabigatran vs. warfarin in relation to the presence of left ventricular hypertrophy in patients with atrial fibrillation- the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) study.","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/eux022","source_url":"https://doi.org/10.1093/europace/eux022","authors":["Paolo Verdecchia","Gianpaolo Reboldi","Fabio Angeli","Giovanni Mazzotta","Gregory Y H Lip","Martina Brueckmann","Eva Kleine","Lars Wallentin","Michael D Ezekowitz","Salim Yusuf","Stuart J Connolly","Giuseppe Di Pasquale"],"significance":5,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This RE-LY subanalysis tested whether LV hypertrophy modifies the comparative efficacy of dabigatran versus warfarin in AF, evaluating structural cardiac disease as a treatment effect modifier.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 subanalyse naar dabigatran versus warfarine bij AF-patiënten met en zonder linkerventrikelhypertrofie.","abstract_original":"AIM: We tested the hypothesis that left ventricular hypertrophy (LVH) interferes with the antithrombotic effects of dabigatran and warfarin in patients with atrial fibrillation (AF). METHODS AND RESULTS: This is a post-hoc analysis of the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) Study. We defined LVH by electrocardiography (ECG) and included patients with AF on the ECG tracing at entry. Hazard ratios (HR) for each dabigatran dose vs. warfarin were calculated in relation to LVH. LVH was present in 2353 (22.7%) out of 10 372 patients. In patients without LVH, the rates of primary outcome were 1.59%/year with warfarin, 1.60% with dabigatran 110 mg (HR vs. warfarin 1.01, 95% confidence interval (CI) 0.75-1.36) and 1.08% with dabigatran 150 mg (HR vs. warfarin 0.68, 95% CI 0.49-0.95). In patients with LVH, the rates of primary outcome were 3.21%/year with warfarin, 1.69% with dabigatran 110 mg (HR vs. warfarin 0.52, 95% CI 0.32-0.84) and 1.55% with 150 mg (HR vs. warfarin 0.48, 95% CI 0.29-0.78). The interaction between LVH status and dabigatran 110 mg vs. warfarin was significant for the primary outcome (P = 0.021) and stroke (P = 0.016). LVH was associated with a higher event rate with warfarin, not with dabigatran. In the warfarin group, the time in therapeutic range was significantly lower in the presence than in the absence of LVH. CONCLUSIONS: LVH was associated with a lower antithrombotic efficacy of warfarin, but not of dabigatran, in patients with AF. Consequently, the relative benefit of the lower dose of dabigatran compared to warfarin was enhanced in patients with LVH. The higher dose of dabigatran was superior to warfarin regardless of LVH status. CLINICAL TRIAL REGISTRATION: http:www.clinicaltrials.gov. Unique identifier: NCT00262600."},{"id":"9cdfb0f4af49","type":"article","url":"https://hartvaat.nl/2018/02/01/autonome-regulatietherapie-bij-hfpef-anthem-hfpef/","title":"Autonome regulatietherapie bij HFpEF: ANTHEM-HFpEF","title_en":"Autonomic regulation therapy to enhance myocardial function in heart failure patients: the ANTHEM-HFpEF study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12241","source_url":"https://doi.org/10.1002/ehf2.12241","authors":["Lorenzo A DiCarlo","Imad Libbus","H Uday Kumar","Sanjay Mittal","Rajendra K Premchand","Badri Amurthur","Bruce H KenKnight","Jeffrey L Ardell","Inder S Anand"],"significance":6,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"The ANTHEM-HFpEF study of vagus nerve stimulation in HFpEF explored autonomic neuromodulation as a therapeutic approach for this challenging heart failure phenotype, testing whether restoring autonomic balance improves cardiac function.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ANTHEM-HFpEF studie naar autonome regulatietherapie (nervus vagus-stimulatie) bij hartfalen met behouden ejectiefractie. Neuromodulatie als nieuw therapieconcept.","abstract_original":"BACKGROUND: Approximately half of the patients presenting with new-onset heart failure (HF) have HF with preserved left ventricular ejection fraction (HFpEF) and HF with mid-range left ventricular ejection fraction (HFmrEF). These patients have neurohormonal activation like that of HF with reduced ejection fraction; however, beta-blockers and angiotensin-converting enzyme inhibitors have not been shown to improve their outcomes, and current treatment for these patients is symptom based and empiric. Sympathoinhibition using parasympathetic stimulation has been shown to improve central and peripheral aspects of the cardiac nervous system, reflex control, induce myocyte cardioprotection, and can lead to regression of left ventricular hypertrophy. Beneficial effects of autonomic regulation therapy (ART) using vagus nerve stimulation (VNS) have also been observed in several animal models of HFpEF, suggesting a potential role for ART in patients with this disease. METHODS: The Autonomic Neural Regulation Therapy to Enhance Myocardial Function in Patients with Heart Failure and Preserved Ejection Fraction (ANTHEM-HFpEF) study is designed to evaluate the feasibility, tolerability, and safety of ART using right cervical VNS in patients with chronic, stable HFpEF and HFmrEF. Patients with symptomatic HF and HFpEF or HFmrEF fulfilling the enrolment criteria will receive chronic ART with a subcutaneous VNS system attached to the right cervical vagus nerve. Safety parameters will be continuously monitored, and cardiac function and HF symptoms will be assessed every 3 months during a post-titration follow-up period of at least 12 months. CONCLUSIONS: The ANTHEM-HFpEF study is likely to provide valuable information intended to expand our understanding of the potential role of ART in patients with chronic symptomatic HFpEF and HFmrEF."},{"id":"26f270068a97","type":"article","url":"https://hartvaat.nl/2018/02/01/nauwkeurigheid-van-bloeddrukmeters-in-de-zwangerschap-systematische-review/","title":"Nauwkeurigheid van bloeddrukmeters in de zwangerschap: systematische review","title_en":"Accuracy of Blood Pressure Measurement Devices in Pregnancy: A Systematic Review of Validation Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10295","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10295","authors":["Natalie A Bello","Jonathan J Woolley","Kirsten Lawrence Cleary","Louise Falzon","Bruce S Alpert","Suzanne Oparil","Gary Cutter","Ronald Wapner","Paul Muntner","Alan T Tita","Daichi Shimbo"],"significance":6,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This systematic review of blood pressure monitor validation studies in pregnancy highlighted that many commonly used devices have not been specifically validated for use during pregnancy, raising concerns about measurement accuracy in obstetric hypertension.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 van validatiestudies van bloeddrukmeters specifiek in de zwangerschap. Benadrukt dat niet alle apparaten betrouwbaar zijn bij zwangeren.","abstract_original":"The accurate measurement of blood pressure (BP) in pregnancy is essential to guide medical decision making that affects both mother and fetus. The aim of this systematic review was to determine the accuracy of ambulatory, home, and clinic BP measurement devices in pregnant women. We searched Ovid MEDLINE, The Cochrane Library, EMBASE, CINAHL EBSCO, ClinicalTrials.gov, International Clinical Trials Registry Platform, and dabl from inception through August 3, 2017 for articles that assessed the validity of an upper arm BP measurement device against a mercury sphygmomanometer in pregnant women. Two independent investigators determined eligibility, extracted data, and adjudicated protocol violations. From 1798 potential articles identified, 41, that assessed 28 devices, met the inclusion criteria. Most articles (n=32) followed a standard or modified American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization, British Hypertension Society, or European Society of Hypertension validation protocol. Several articles described the results of validation studies performed on >1 device (n=7) or in >1 population of pregnant women (n=12), comprising 64 pairwise validity assessments. The device was validated in 61% (32 of 52) of studies which used a standard or modified protocol. Only 34% (11 of 32) of the studies wherein the device was successfully validated were performed without a protocol violation. Given the implications of inaccurate BP measurement in pregnant women, healthcare providers should be aware of and try to use the BP measurement devices which have been properly validated in this population."},{"id":"eca29d551b63","type":"article","url":"https://hartvaat.nl/2018/02/01/hoeveelheid-of-intensiteit-van-inspanning-bij-hfpef/","title":"Hoeveelheid of intensiteit van inspanning bij HFpEF","title_en":"Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12227","source_url":"https://doi.org/10.1002/ehf2.12227","authors":["Anna Bobenko","Inke Bartels","Marlene Münch","Tobias Trippel","Ruhdja Lindhorst","Kathleen Nolte","Christoph Herrmann-Lingen","Martin Halle","André Duvinage","Hans-Dirk Düngen","Götz Gelbrich","Carsten Tschöpe","Gerd Hasenfuss","Rolf Wachter","Burkert Pieske","Frank Edelmann"],"significance":5,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":[],"congress":"","summary_en":"This study explored whether exercise amount or intensity is more important for improving outcomes in HFpEF, informing the design of optimal physical activity prescriptions for this challenging condition.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 potentiële doelen voor inspanningsinterventies bij HFpEF: hoeveelheid versus intensiteit. Optimaliseert trainingsprogramma's voor HFpEF.","abstract_original":"AIMS: Heart failure with preserved ejection fraction (HFpEF) remains a common condition with no pharmacological treatment. Physical activity (PA) improves symptoms and quality of life (QoL), but no clear recommendations exist on PA in HFpEF patients. We investigated the association of PA (amount/intensity) on clinical phenotype in HFpEF. METHODS AND RESULTS: The Aldosterone in Diastolic Heart Failure trial investigated spironolactone vs. placebo in stable HFpEF patients. At baseline, all patients underwent detailed phenotypization including echocardiography, cardiopulmonary exercise testing, 6 minute walking test (6MWT), and QoL assessment (36-item Short-Form questionnaire). PA was assessed by a self-report questionnaire, classified in metabolic equivalents of task (MET) and analysed with regard to exercise capacity, diastolic function, and QoL. Four hundred twenty-two patients (52% women, age 67 ± 8 years, New York Heart Association II and III) were classified by weekly MET hours into a low (<70), middle (70-140), or high (>140) level of PA. Total PA correlated positively with 6MWT distance (r = 0.17; P = 0.002) and physical function of QoL (r = 0.10; P = 0.05), but not with peak oxygen uptake (peakVO2 ). In contrast, both 6MWT distance and peakVO2 were significantly higher in patients who performed high-intensity PA for >8 h/week (P < 0.001, P = 0.02, respectively). Time of high-intensity PA was related to higher 6MWT distance (r = 0.21, P < 0.001), peakVO2 , and better physical function of QoL (both r = 0.13, P = 0.01), whereas low-intensity PA did not show significant associations. Interestingly, PA was not related to any measure of diastolic function. CONCLUSIONS: A higher amount of PA is related to higher submaximal exercise capacity and physical function of QoL. Regarding maximal exercise capacity, only high-intensity PA showed significant association in HFpEF patients."},{"id":"417b168f7837","type":"article","url":"https://hartvaat.nl/2018/02/01/bnp-prognostische-waarde-bij-hartfalen-met-lvef-35/","title":"BNP-prognostische waarde bij hartfalen met LVEF >35%","title_en":"The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub-analysis of the J-MELODIC study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","hfpef","hfref","nt-probnp","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12206","source_url":"https://doi.org/10.1002/ehf2.12206","authors":["Shuichi Kitada","Shohei Kikuchi","Takeshi Tsujino","Tohru Masuyama","Nobuyuki Ohte"],"significance":5,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This study evaluated the prognostic value of BNP in heart failure patients with relatively preserved ejection fraction (>35%), refining natriuretic peptide-based risk stratification for the HFmrEF/HFpEF population.","created":"2026-07-03T10:27:07Z","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":"Studie naar de prognostische waarde van BNP bij hartfalenpatiënten met relatief behouden ejectiefractie (>35%). Relevant voor risicostratificatie bij de grijze zone van LVEF.","abstract_original":"AIMS: Cardiac function varies in the population of patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF). This study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF. METHODS AND RESULTS: The study enrolled 288 patients with stable HF and serum creatinine <1.5 mg/dL who were part of the original J-MELODIC study cohort. They were categorized as having HF with reduced LVEF (HFrEF; EF ≤ 40%, n = 83) or as having HFpEF (EF > 40%, n = 205). Patients with HFpEF were further categorized as having relatively low LVEF (HFrlEF; EF 40-60%, n = 107) or as having relatively high LVEF (HFrhEF; EF ≥ 60%, n = 98). We defined cardiovascular death and hospitalization for HF as adverse events and evaluated the prognostic value of the BNP levels in each group. There was no significant difference in event-free survival between HFpEF and HFrEF patients or between HFrhEF and HFrlEF patients. A multivariate Cox proportional hazards model revealed that the BNP level was an independent predictor of adverse events in HFrEF patients (hazard ratio: 4.088, 95% confidence interval: 1.178-14.179, P = 0.027) and in HFrlEF patients (hazard ratio: 14.888, 95% confidence interval: 4.969-44.608, P < 0.001) but not in HFrhEF patients (P = 0.767). CONCLUSIONS: The BNP level has prognostic value in HFrlEF but not in HFrhEF. This indicates that HFrhEF and HFrlEF are distinct entities that may require different approaches for the management of HF."},{"id":"fcdfcc4beace","type":"article","url":"https://hartvaat.nl/2018/02/01/ct-coronairangiografie-volgens-2016-nice-richtlijn-diagnostisch-en-prognostisch-/","title":"CT-coronairangiografie volgens 2016 NICE-richtlijn: diagnostisch en prognostisch voordeel","title_en":"Diagnostic and prognostic benefits of computed tomography coronary angiography using the 2016 National Institute for Health and Care Excellence guidance within a randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["coronaire-ct-angiografie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311508","source_url":"https://doi.org/10.1136/heartjnl-2017-311508","authors":["Philip D Adamson","Amanda Hunter","Michelle C Williams","Anoop S V Shah","David A McAllister","Tania A Pawade","Marc R Dweck","Nicholas L Mills","Colin Berry","Nicholas A Boon","Elizabeth Clark","Marcus Flather","John Forbes","Scott McLean","Giles Roditi","Edwin J R van Beek","Adam D Timmis","David E Newby"],"significance":6,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the diagnostic and prognostic benefits of CT coronary angiography according to the 2016 NICE guidelines for chest pain assessment, providing real-world validation of guideline-based CCTA use.","created":"2026-07-03T10:27:07Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Evaluatie van het diagnostisch en prognostisch voordeel van CT-coronairangiografie volgens de NICE-2016 richtlijn voor pijn op de borst.","abstract_original":"OBJECTIVES: To evaluate the diagnostic and prognostic benefits of CT coronary angiography (CTCA) using the 2016 National Institute for Health and Care Excellence (NICE) guidelines for the assessment of suspected stable angina. METHODS: Post hoc analysis of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial of 4146 participants with suspected angina randomised to CTCA. Patients were dichotomised into NICE guideline-defined possible angina and non-anginal presentations. Primary (diagnostic) endpoint was diagnostic certainty of angina at 6 weeks and prognostic endpoint comprised fatal and non-fatal myocardial infarction (MI). RESULTS: In 3770 eligible participants, CTCA increased diagnostic certainty more in those with possible angina (relative risk (RR) 2.22 (95% CI 1.91 to 2.60), p<0.001) than those with non-anginal symptoms (RR 1.30 (1.11 to 1.53), p=0.002; pinteraction <0.001). In the possible angina cohort, CTCA did not change rates of invasive angiography (p=0.481) but markedly reduced rates of normal coronary angiography (HR 0.32 (0.19 to 0.52), p<0.001). In the non-anginal cohort, rates of invasive angiography increased (HR 1.82 (1.13 to 2.92), p=0.014) without reducing rates of normal coronary angiography (HR 0.78 (0.30 to 2.05), p=0.622). At 3.2 years of follow-up, fatal or non-fatal MI was reduced in patients with possible angina (3.2% to 1.9%%; HR 0.58 (0.34 to 0.99), p=0.045) but not in those with non-anginal symptoms (HR 0.65 (0.25 to 1.69), p=0.379). CONCLUSIONS: NICE-guided patient selection maximises the benefits of CTCA on diagnostic certainty, use of invasive coronary angiography and reductions in fatal and non-fatal myocardial infarction. Patients with non-anginal chest pain derive minimal benefit from CTCA and increase the rates of invasive investigation. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT01149590;post results."},{"id":"cfc99c8491bb","type":"article","url":"https://hartvaat.nl/2018/02/01/herstel-zonder-hartfalen-na-acs-en-revascularisatie/","title":"Herstel zonder hartfalen na ACS en revascularisatie","title_en":"Recovery free of heart failure after acute coronary syndrome and coronary revascularization.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","acuut-hartfalen","myocardinfarct"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12197","source_url":"https://doi.org/10.1002/ehf2.12197","authors":["Alec Falkenham","Manoj K Saraswat","Chloe Wong","Kareem Gawdat","Tanya Myers","Jahanara Begum","Karen J Buth","Ian Haidl","Jean Marshall","Jean-Francois Légaré"],"significance":5,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":[],"congress":"","summary_en":"This study characterized recovery from heart failure after acute coronary syndrome and coronary revascularization, identifying factors associated with freedom from HF events after successful treatment.","created":"2026-07-03T10:27:07Z","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":"Studie naar herstel van hartfunctie en vrijheid van hartfalen na ACS en coronaire revascularisatie. Prognose na succesvolle revascularisatie bij initieel verminderde LV-functie.","abstract_original":"AIMS: Previous studies have examined risk factors for the development of heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study seeks to clarify the clinical variables that best characterize patients who remain free from HF after coronary artery bypass grafting (CABG) surgery for ACS to determine novel biological factors favouring freedom from HF in prospective translational studies. METHODS AND RESULTS: Nova Scotia residents (1995-2012) undergoing CABG within 3 weeks of ACS were included. The primary outcome was freedom from readmission to hospital due to HF. Descriptive statistics were generated, and a Cox proportional hazards model assessed outcome with adjustment for clinical characteristics. Of 11 936 Nova Scotians who underwent isolated CABG, 3264 (27%) had a recent ACS and were included. Deaths occurred in 210 (6%) of subjects prior to discharge. A total of 3054 patients were included in the long-term analysis. During follow-up, HF necessitating readmission occurred in 688 (21%) subjects with a hazard ratio of 12% at 2 years. The adjusted Cox model demonstrated significantly better freedom from HF for younger, male subjects without metabolic syndrome and no history of chronic obstructive pulmonary disease, renal insufficiency, atrial fibrillation, or HF. CONCLUSIONS: Our findings have outlined important clinical variables that predict freedom from HF. Furthermore, we have shown that 12% of patients undergoing CABG after ACS develop HF (2 years). Our findings support our next phase in which we plan to prospectively collect blood and tissue specimens from ACS patients undergoing CABG in order to determine novel biological mechanism(s) that favour resolution of post-ACS inflammation."},{"id":"ba9c8825a703","type":"article","url":"https://hartvaat.nl/2018/01/30/prasugrel-versus-ticagrelor-bij-primaire-pci-voor-mi-1-jaarsuitkomsten/","title":"Prasugrel versus ticagrelor bij primaire PCI voor MI: 1-jaarsuitkomsten","title_en":"1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.11.008","source_url":"https://doi.org/10.1016/j.jacc.2017.11.008","authors":["Zuzana Motovska","Ota Hlinomaz","Petr Kala","Milan Hromadka","Jiri Knot","Ivo Varvarovsky","Jaroslav Dusek","Jiri Jarkovsky","Roman Miklik","Richard Rokyta","Frantisek Tousek","Petra Kramarikova","Michal Svoboda","Bohumil Majtan","Stanislav Simek","Marian Branny","Jan Mrozek","Pavel Cervinka","Jiri Ostransky","Petr Widimsky"],"significance":6,"published":"2018-01-30","source_date":"2018-01-30","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"The PRAGUE-18 1-year results showed no significant difference between prasugrel and ticagrelor in patients undergoing primary PCI for MI, an early comparison preceding the definitive ISAR-REACT 5 results.","created":"2026-07-03T10:27:07Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 een directe vergelijking van prasugrel versus ticagrelor bij patiënten die primaire PCI ondergingen voor myocardinfarct.","abstract_original":"BACKGROUND: Early outcomes of patients in the PRAGUE-18 (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction) study did not find any significant differences between 2 potent P2Y12 inhibitors. OBJECTIVES: The 1-year follow-up of the PRAGUE-18 study focused on: 1) a comparison of efficacy and safety between prasugrel and ticagrelor; and 2) the risk of major ischemic events related to an economically motivated post-discharge switch to clopidogrel. METHODS: A total of 1,230 patients with acute myocardial infarction (MI) treated with primary percutaneous coronary intervention were randomized to prasugrel or ticagrelor with an intended treatment duration of 12 months. The combined endpoint was cardiovascular death, MI, or stroke at 1 year. Because patients had to cover the costs of study medication after hospital discharge, some patients decided to switch to clopidogrel. RESULTS: The endpoint occurred in 6.6% of prasugrel patients and in 5.7% of ticagrelor patients (hazard ratio: 1.167; 95% confidence interval: 0.742 to 1.835; p = 0.503). No significant differences were found in: cardiovascular death (3.3% vs. 3.0%; p = 0.769), MI (3.0% vs. 2.5%; p = 0.611), stroke (1.1% vs. 0.7%; p = 0.423), all-cause death (4.7% vs. 4.2%; p = 0.654), definite stent thrombosis (1.1% vs. 1.5%; p = 0.535), all bleeding (10.9% vs. 11.1%; p = 0.999), and TIMI (Thrombolysis In Myocardial Infarction) major bleeding (0.9% vs. 0.7%; p = 0.754). The percentage of patients who switched to clopidogrel for economic reasons was 34.1% (n = 216) for prasugrel and 44.4% (n = 265) for ticagrelor (p = 0.003). Patients who were economically motivated to switch to clopidogrel had (compared with patients who continued the study medications) a lower risk of major cardiovascular events; however, they also had lower ischemic risk. CONCLUSIONS: Prasugrel and ticagrelor are similarly effective during the first year after MI. Economically motivated early post-discharge switches to clopidogrel were not associated with an increased risk of ischemic events. (Comparison of Prasugrel and Ticagrelor in the Treatment of Acute Myocardial Infarction [PRAGUE-18]; NCT02808767)."},{"id":"977565fd8d4b","type":"article","url":"https://hartvaat.nl/2018/01/30/kosteneffectiviteit-van-ffr-geleide-pci-bij-stabiele-coronairlijden/","title":"Kosteneffectiviteit van FFR-geleide PCI bij stabiele coronairlijden","title_en":"Clinical Outcomes and Cost-Effectiveness of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease: Three-Year Follow-Up of the FAME 2 Trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["farmaco-economie","fractional-flow-reserve","ouderen","stabiel-coronairlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.031907","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.031907","authors":["William F Fearon","Takeshi Nishi","Bernard De Bruyne","Derek B Boothroyd","Emanuele Barbato","Pim Tonino","Peter Jüni","Nico H J Pijls","Mark A Hlatky"],"significance":6,"published":"2018-01-30","source_date":"2018-01-30","image":"","kennis":[],"congress":"","summary_en":"This cost-effectiveness analysis confirmed that FFR-guided PCI is economically favorable compared with angiography-guided PCI in stable coronary disease, with lower healthcare costs driven by reduced unnecessary stenting.","created":"2026-07-03T10:27:07Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 FFR-geleide PCI vergeleken met angiografie-geleide PCI bij stabiel coronairlijden. Economische onderbouwing voor routinematig FFR-gebruik.","abstract_original":"BACKGROUND: Previous studies found that percutaneous coronary intervention (PCI) does not improve outcome compared with medical therapy (MT) in patients with stable coronary artery disease, but PCI was guided by angiography alone. FAME 2 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared PCI guided by fractional flow reserve with best MT in patients with stable coronary artery disease to assess clinical outcomes and cost-effectiveness. METHODS: A total of 888 patients with stable single-vessel or multivessel coronary artery disease with reduced fractional flow reserve were randomly assigned to PCI plus MT (n=447) or MT alone (n=441). Major adverse cardiac events included death, myocardial infarction, and urgent revascularization. Costs were calculated on the basis of resource use and Medicare reimbursement rates. Changes in quality-adjusted life-years were assessed with utilities determined by the European Quality of Life-5 Dimensions health survey at baseline and over follow-up. RESULTS: Major adverse cardiac events at 3 years were significantly lower in the PCI group compared with the MT group (10.1% versus 22.0%; P<0.001), primarily as a result of a lower rate of urgent revascularization (4.3% versus 17.2%; P<0.001). Death and myocardial infarction were numerically lower in the PCI group (8.3% versus 10.4%; P=0.28). Angina was significantly less severe in the PCI group at all follow-up points to 3 years. Mean initial costs were higher in the PCI group ($9944 versus $4440; P<0.001) but by 3 years were similar between the 2 groups ($16 792 versus $16 737; P=0.94). The incremental cost-effectiveness ratio for PCI compared with MT was $17 300 per quality-adjusted life-year at 2 years and $1600 per quality-adjusted life-year at 3 years. The above findings were robust in sensitivity analyses. CONCLUSIONS: PCI of lesions with reduced fractional flow reserve improves long-term outcome and is economically attractive compared with MT alone in patients with stable coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01132495."},{"id":"931a9ac80af1","type":"article","url":"https://hartvaat.nl/2018/01/30/absorb-bioresorbeerbare-scaffold-3-jaarsresultaten-ipd-meta-analyse/","title":"Absorb bioresorbeerbare scaffold 3-jaarsresultaten: IPD meta-analyse","title_en":"Three-Year Outcomes With the Absorb Bioresorbable Scaffold: Individual-Patient-Data Meta-Analysis From the ABSORB Randomized Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.031843","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.031843","authors":["Ziad A Ali","Runlin Gao","Takeshi Kimura","Yoshinobu Onuma","Dean J Kereiakes","Stephen G Ellis","Bernard Chevalier","Minh-Thien Vu","Zhen Zhang","Charles A Simonton","Patrick W Serruys","Gregg W Stone"],"significance":7,"published":"2018-01-30","source_date":"2018-01-30","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis of all ABSORB bioresorbable scaffold trials at 3 years confirmed definitively that the device is inferior to metallic everolimus-eluting stents in safety, particularly for late and very late scaffold thrombosis.","created":"2026-07-03T10:27:07Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 alle ABSORB-trials met 3-jaarsuitkomsten. Definitief bewijs dat BRS inferieur is aan metallic DES.","abstract_original":"BACKGROUND: The Absorb bioresorbable vascular scaffold (BVS) completely resorbs within 3 years after coronary artery implantation. The safety and effectiveness of BVS through this critical 3-year period have not been characterized. METHODS: We performed an individual-patient-data pooled meta-analysis of the 4 randomized ABSORB trials in which 3389 patients with coronary artery disease were randomly assigned to everolimus-eluting Absorb BVS (n=2164) or cobalt-chromium everolimus-eluting stents (n=1225). The primary efficacy outcome measure was target lesion failure (cardiac mortality, target vessel myocardial infarction, or ischemia-driven target lesion revascularization), and the primary safety outcome measure was device thrombosis. RESULTS: BVS compared with cobalt-chromium everolimus-eluting stents resulted in higher 3-year rates of target lesion failure (11.7% versus 8.1%; risk ratio [RR], 1.38; 95% confidence interval [CI], 1.10-1.73; P=0.006), driven by greater target vessel myocardial infarction (7.8% versus 4.2%; RR, 1.72; 95% CI, 1.26-2.35; P=0.0006) and ischemia-driven target lesion revascularization (6.6% versus 4.4%; RR, 1.44; 95% CI, 1.05-1.98; P=0.02), with comparable cardiac mortality (1.1% versus 1.1%; RR, 0.93; 95% CI, 0.47-1.88; P=0.85). Device thrombosis rates through 3 years were also higher with BVS (2.4% versus 0.6%; RR, 3.71; 95% CI, 1.70-8.11; P=0.001). Between 1 and 3 years, target lesion failure rates (6.1% versus 3.9%; P=0.02) and device thrombosis rates (1.1% versus 0.0%; P<0.0001) were higher with BVS than cobalt-chromium everolimus-eluting stents. CONCLUSIONS: In the present individual-patient-data pooled meta-analysis of the ABSORB trials, BVS was associated with increased rates of target lesion failure and device thrombosis between 1 and 3 years and cumulatively through 3 years of follow-up compared with everolimus-eluting stents. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifiers: NCT01751906, NCT01844284, NCT01923740, and NCT01425281."},{"id":"23fe074807a4","type":"article","url":"https://hartvaat.nl/2018/01/23/transcatheter-interatriale-shunt-bij-hfpef-reduce-lap-hf-i/","title":"Transcatheter interatriale shunt bij HFpEF: REDUCE LAP-HF I","title_en":"Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure With Preserved Ejection Fraction (REDUCE LAP-HF I [Reduce Elevated Left Atrial Pressure in Patients With Heart Failure]): A Phase 2, Randomized, Sham-Controlled Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","hfpef","hfref","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032094","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032094","authors":["Ted Feldman","Laura Mauri","Rami Kahwash","Sheldon Litwin","Mark J Ricciardi","Pim van der Harst","Martin Penicka","Peter S Fail","David M Kaye","Mark C Petrie","Anupam Basuray","Scott L Hummel","Rhondalyn Forde-McLean","Christopher D Nielsen","Scott Lilly","Joseph M Massaro","Daniel Burkhoff","Sanjiv J Shah"],"significance":7,"published":"2018-01-23","source_date":"2018-01-23","image":"","kennis":[],"congress":"","summary_en":"The REDUCE LAP-HF I trial evaluated a transcatheter interatrial shunt device for HFpEF, testing whether reducing left atrial pressure through a controlled shunt can improve hemodynamics and symptoms in this challenging heart failure phenotype.","created":"2026-07-03T10:27:07Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"REDUCE LAP-HF I-trial naar een transcatheter interatriale shunt device voor behandeling van HFpEF. Innovatief structureel concept voor verlaging van linkeratriumdruk.","abstract_original":"BACKGROUND: In nonrandomized, open-label studies, a transcatheter interatrial shunt device (IASD, Corvia Medical) was associated with lower pulmonary capillary wedge pressure (PCWP), fewer symptoms, and greater quality of life and exercise capacity in patients with heart failure (HF) and midrange or preserved ejection fraction (EF ≥40%). We conducted the first randomized sham-controlled trial to evaluate the IASD in HF with EF ≥40%. METHODS: REDUCE LAP-HF I (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) was a phase 2, randomized, parallel-group, blinded multicenter trial in patients with New York Heart Association class III or ambulatory class IV HF, EF ≥40%, exercise PCWP ≥25 mm Hg, and PCWP-right atrial pressure gradient ≥5 mm Hg. Participants were randomized (1:1) to the IASD versus a sham procedure (femoral venous access with intracardiac echocardiography but no IASD placement). The participants and investigators assessing the participants during follow-up were blinded to treatment assignment. The primary effectiveness end point was exercise PCWP at 1 month. The primary safety end point was major adverse cardiac, cerebrovascular, and renal events at 1 month. PCWP during exercise was compared between treatment groups using a mixed-effects repeated measures model analysis of covariance that included data from all available stages of exercise. RESULTS: A total of 94 patients were enrolled, of whom 44 met inclusion/exclusion criteria and were randomized to the IASD (n=22) and control (n=22) groups. Mean age was 70±9 years, and 50% were female. At 1 month, the IASD resulted in a greater reduction in PCWP compared with sham control (P=0.028 accounting for all stages of exercise). Peak PCWP decreased by 3.5±6.4 mm Hg in the treatment group versus 0.5±5.0 mm Hg in the control group (P=0.14). There were no peri-procedural or 1-month major adverse cardiac, cerebrovascular, and renal events in the IASD group and 1 event (worsening renal function) in the control group (P=1.0). CONCLUSIONS: In patients with HF and EF ≥40%, IASD treatment reduces PCWP during exercise. Whether this mechanistic effect will translate into sustained improvements in symptoms and outcomes requires further evaluation. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT02600234."},{"id":"83112a6f434b","type":"article","url":"https://hartvaat.nl/2018/01/23/ldl-verlaging-met-evolocumab-en-uitkomsten-bij-pav-fourier-inzichten/","title":"LDL-verlaging met evolocumab en uitkomsten bij PAV: FOURIER-inzichten","title_en":"Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease: Insights From the FOURIER Trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["ezetimibe","ldl-cholesterol","perifeer-vaatlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032235","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032235","authors":["Marc P Bonaca","Patrice Nault","Robert P Giugliano","Anthony C Keech","Armando Lira Pineda","Estella Kanevsky","Julia Kuder","Sabina A Murphy","J Wouter Jukema","Basil S Lewis","Lale Tokgozoglu","Ransi Somaratne","Peter S Sever","Terje R Pedersen","Marc S Sabatine"],"significance":7,"published":"2018-01-23","source_date":"2018-01-23","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This FOURIER subanalysis in patients with peripheral artery disease showed that evolocumab reduces both cardiovascular and limb-related events, extending the benefit of PCSK9 inhibition to the peripheral vascular population.","created":"2026-07-03T10:27:07Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"FOURIER subanalyse bij patiënten met perifeer arterieel vaatlijden. Evolocumab vermindert ook ledemaat-gerelateerde events — voordeel voorbij coronairlijden.","abstract_original":"BACKGROUND: The PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor evolocumab reduced low-density lipoprotein cholesterol and cardiovascular events in the FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). We investigated the efficacy and safety of evolocumab in patients with peripheral artery disease (PAD) as well as the effect on major adverse limb events. METHODS: FOURIER was a randomized trial of evolocumab versus placebo in 27 564 patients with atherosclerotic disease on statin therapy followed for a median of 2.2 years. Patients were identified as having PAD at baseline if they had intermittent claudication and an ankle brachial index of <0.85, or if they had a prior peripheral vascular procedure. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, hospital admission for unstable angina, or coronary revascularization. The key secondary end point was a composite of cardiovascular death, myocardial infarction, or stroke. An additional outcome of interest was major adverse limb events defined as acute limb ischemia, major amputation, or urgent peripheral revascularization for ischemia. RESULTS: Three thousand six hundred forty-two patients (13.2%) had PAD (1505 with no prior myocardial infarction or stroke). Evolocumab significantly reduced the primary end point consistently in patients with PAD (hazard ratio [HR] 0.79; 95% confidence interval [CI], 0.66-0.94; P=0.0098) and without PAD (HR 0.86; 95% CI, 0.80-0.93; P=0.0003; Pinteraction=0.40). For the key secondary end point, the HRs were 0.73 (0.59-0.91; P=0.0040) for those with PAD and 0.81 (0.73-0.90; P<0.0001) for those without PAD (Pinteraction=0.41). Because of their higher risk, patients with PAD had larger absolute risk reductions for the primary end point (3.5% with PAD, 1.6% without PAD) and the key secondary end point (3.5% with PAD, 1.4% without PAD). Evolocumab reduced the risk of major adverse limb events in all patients (HR, 0.58; 95% CI, 0.38-0.88; P=0.0093) with consistent effects in those with and without known PAD. There was a consistent relationship between lower achieved low-density lipoprotein cholesterol and lower risk of limb events (P=0.026 for the beta coefficient) that extended down to <10 mg/dL. CONCLUSIONS: Patients with PAD are at high risk of cardiovascular events, and PCSK9 inhibition with evolocumab significantly reduced that risk with large absolute risk reductions. Moreover, lowering of low-density lipoprotein cholesterol with evolocumab reduced the risk of major adverse limb events. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01764633."},{"id":"c1adaef27356","type":"article","url":"https://hartvaat.nl/2018/01/23/canagliflozine-voor-primaire-en-secundaire-cardiovasculaire-preventie-canvas/","title":"Canagliflozine voor primaire en secundaire cardiovasculaire preventie: CANVAS","title_en":"Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events: Results From the CANVAS Program (Canagliflozin Cardiovascular Assessment Study).","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032038","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032038","authors":["Kenneth W Mahaffey","Bruce Neal","Vlado Perkovic","Dick de Zeeuw","Greg Fulcher","Ngozi Erondu","Wayne Shaw","Elisa Fabbrini","Tao Sun","Qiang Li","Mehul Desai","David R Matthews"],"significance":8,"published":"2018-01-23","source_date":"2018-01-23","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This CANVAS analysis demonstrated that canagliflozin provided cardiovascular benefit in both primary and secondary prevention populations with type 2 diabetes, though the magnitude was greater in those with established cardiovascular disease. The findings informed the positioning of SGLT2 inhibitors across the cardiovascular risk spectrum.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CANVAS-analyse die het voordeel van canagliflozine onderzocht voor zowel primaire als secundaire cardiovasculaire preventie bij diabetes type 2.","abstract_original":"BACKGROUND: Canagliflozin is a sodium glucose cotransporter 2 inhibitor that significantly reduces the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke in patients with type 2 diabetes mellitus and elevated cardiovascular risk. The comparative effects among participants with and without a history of cardiovascular disease (secondary versus primary prevention) were prespecified for evaluation. METHODS: The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) randomly assigned 10 142 participants with type 2 diabetes mellitus to canagliflozin or placebo. The primary prevention cohort comprised individuals ≥50 years of age with ≥2 risk factors for cardiovascular events but with no prior cardiovascular event, and the secondary prevention cohort comprised individuals ≥30 years of age with a prior cardiovascular event. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Secondary outcomes included heart failure hospitalization and a renal composite (40% reduction in estimated glomerular filtration rate, renal replacement therapy, or renal death). RESULTS: Primary prevention participants (N=3486; 34%) were younger (63 versus 64 years of age), were more often female (45% versus 31%), and had a longer duration of diabetes mellitus (14 versus 13 years) compared with secondary prevention participants (N=6656; 66%). The primary end point event rate was higher in the secondary prevention group compared with the primary prevention group (36.9 versus 15.7/1000 patient-years, P<0.001). In the total cohort, the primary end point was reduced with canagliflozin compared with placebo (26.9 versus 31.5/1000 patient-years; hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.75-0.97; P<0.001 for noninferiority, P=0.02 for superiority) with no statistical evidence of heterogeneity (interaction P value=0.18) between the primary (HR, 0.98; 95% CI, 0.74-1.30) and secondary prevention (HR, 0.82; 95% CI, 0.72-0.95) cohorts. Renal outcomes (HR, 0.59; 95% CI, 0.44-0.79 versus HR, 0.63; 95% CI, 0.39-1.02; interaction P value=0.73) and heart failure hospitalization (HR, 0.68; 95% CI, 0.51-0.90 versus HR, 0.64; 95% CI, 0.35-1.15; interaction P value=0.91) were similarly reduced in the secondary and primary prevention cohorts, respectively. Lower extremity amputations were similarly increased in the secondary and primary prevention cohorts (HR, 2.07; 95% CI, 1.43-3.00 versus HR, 1.52; 95% CI, 0.70-3.29; interaction P value=0.63). CONCLUSIONS: Patients with type 2 diabetes mellitus and prior cardiovascular events had higher rates of cardiovascular outcomes compared with the primary prevention patients. Canagliflozin reduced cardiovascular and renal outcomes with no statistical evidence of heterogeneity of the treatment effect across the primary and secondary prevention groups. Additional studies will provide further insights into the effects of canagliflozin in these patient populations. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01032629 and NCT01989754."},{"id":"28b98b0cf88f","type":"article","url":"https://hartvaat.nl/2018/01/23/empagliflozine-bij-diabetes-type-2-met-perifeer-vaatlijden-empa-reg-outcome/","title":"Empagliflozine bij diabetes type 2 met perifeer vaatlijden: EMPA-REG OUTCOME","title_en":"Cardiovascular Outcomes and Safety of Empagliflozin in Patients With Type 2 Diabetes Mellitus and Peripheral Artery Disease: A Subanalysis of EMPA-REG OUTCOME.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-type-2","empagliflozine","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.032031","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.032031","authors":["Subodh Verma","C David Mazer","Mohammed Al-Omran","Silvio E Inzucchi","David Fitchett","Uwe Hehnke","Jyothis T George","Bernard Zinman"],"significance":7,"published":"2018-01-23","source_date":"2018-01-23","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This EMPA-REG OUTCOME subanalysis showed that empagliflozin's cardiovascular benefit is preserved in diabetic patients with peripheral arterial disease, a particularly high-risk population with elevated limb and cardiovascular event rates.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPA-REG OUTCOME subanalyse bij diabetespatiënten met perifeer arterieel vaatlijden — een hoogrisicopopulatie. Cardiovasculaire veiligheid en potentieel voordeel bevestigd.","abstract_original":""},{"id":"1f294146d865","type":"article","url":"https://hartvaat.nl/2018/01/20/rivaroxaban-met-of-zonder-aspirine-bij-stabiel-perifeer-vaatlijden-lancet-compas/","title":"Rivaroxaban met of zonder aspirine bij stabiel perifeer vaatlijden: Lancet COMPASS PAD","title_en":"Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["perifeer-vaatlijden","rivaroxaban"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32409-1","source_url":"https://doi.org/10.1016/S0140-6736(17)32409-1","authors":["Sonia S Anand","Jackie Bosch","John W Eikelboom","Stuart J Connolly","Rafael Diaz","Peter Widimsky","Victor Aboyans","Marco Alings","Ajay K Kakkar","Katalin Keltai","Aldo P Maggioni","Basil S Lewis","Stefan Störk","Jun Zhu","Patricio Lopez-Jaramillo","Martin O'Donnell","Patrick J Commerford","Dragos Vinereanu","Nana Pogosova","Lars Ryden","Keith A A Fox","Deepak L Bhatt","Frank Misselwitz","John D Varigos","Thomas Vanassche","Alvaro A Avezum","Edmond Chen","Kelley Branch","Darryl P Leong","Shrikant I Bangdiwala","Robert G Hart","Salim Yusuf"],"significance":9,"published":"2018-01-20","source_date":"2018-01-20","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/claudicatio-intermittens/"],"congress":"","summary_en":"This COMPASS substudy confirmed that low-dose rivaroxaban with or without aspirin reduced major adverse limb events and cardiovascular outcomes in patients with stable peripheral or carotid artery disease. The findings extended the dual-pathway inhibition strategy specifically to the peripheral arterial disease population.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 COMPASS subanalyse bij patiënten met stabiel perifeer of carotis vaatlijden. Bevestigt het voordeel van rivaroxaban-gebaseerde strategie ook bij PAV.","abstract_original":"BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications. METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. FINDINGS: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043). INTERPRETATION: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding. FUNDING: Bayer AG."},{"id":"b875f297a95b","type":"article","url":"https://hartvaat.nl/2018/01/20/rivaroxaban-met-of-zonder-aspirine-bij-stabiel-coronairlijden-lancet-compass/","title":"Rivaroxaban met of zonder aspirine bij stabiel coronairlijden: Lancet COMPASS","title_en":"Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["rivaroxaban"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32458-3","source_url":"https://doi.org/10.1016/S0140-6736(17)32458-3","authors":["Stuart J Connolly","John W Eikelboom","Jackie Bosch","Gilles Dagenais","Leanne Dyal","Fernando Lanas","Kaj Metsarinne","Martin O'Donnell","Anthony L Dans","Jong-Won Ha","Alexandr N Parkhomenko","Alvaro A Avezum","Eva Lonn","Liu Lisheng","Christian Torp-Pedersen","Petr Widimsky","Aldo P Maggioni","Camilo Felix","Katalin Keltai","Masatsugu Hori","Khalid Yusoff","Tomasz J Guzik","Deepak L Bhatt","Kelley R H Branch","Nancy Cook Bruns","Scott D Berkowitz","Sonia S Anand","John D Varigos","Keith A A Fox","Salim Yusuf"],"significance":10,"published":"2018-01-20","source_date":"2018-01-20","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/rivaroxaban/"],"congress":"","summary_en":"The COMPASS trial demonstrated that low-dose rivaroxaban plus aspirin significantly reduced cardiovascular death, stroke, and MI compared with aspirin alone in patients with stable coronary or peripheral artery disease. This dual-pathway inhibition strategy established a new paradigm in secondary prevention for chronic atherosclerotic disease.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 COMPASS-trial die laaggedoseerd rivaroxaban met of zonder aspirine vergeleek met aspirine alleen bij stabiel coronairlijden. Paradigmaverschuiving in secundaire preventie.","abstract_original":"BACKGROUND: Coronary artery disease is a major cause of morbidity and mortality worldwide, and is a consequence of acute thrombotic events involving activation of platelets and coagulation proteins. Factor Xa inhibitors and aspirin each reduce thrombotic events but have not yet been tested in combination or against each other in patients with stable coronary artery disease. METHODS: In this multicentre, double-blind, randomised, placebo-controlled, outpatient trial, patients with stable coronary artery disease or peripheral artery disease were recruited at 602 hospitals, clinics, or community centres in 33 countries. This paper reports on patients with coronary artery disease. Eligible patients with coronary artery disease had to have had a myocardial infarction in the past 20 years, multi-vessel coronary artery disease, history of stable or unstable angina, previous multi-vessel percutaneous coronary intervention, or previous multi-vessel coronary artery bypass graft surgery. After a 30-day run in period, patients were randomly assigned (1:1:1) to receive rivaroxaban (2·5 mg orally twice a day) plus aspirin (100 mg once a day), rivaroxaban alone (5 mg orally twice a day), or aspirin alone (100 mg orally once a day). Randomisation was computer generated. Each treatment group was double dummy, and the patients, investigators, and central study staff were masked to treatment allocation. The primary outcome of the COMPASS trial was the occurrence of myocardial infarction, stroke, or cardiovascular death. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants. FINDINGS: Between March 12, 2013, and May 10, 2016, 27 395 patients were enrolled to the COMPASS trial, of whom 24 824 patients had stable coronary artery disease from 558 centres. The combination of rivaroxaban plus aspirin reduced the primary outcome more than aspirin alone (347 [4%] of 8313 vs 460 [6%] of 8261; hazard ratio [HR] 0·74, 95% CI 0·65-0·86, p<0·0001). By comparison, treatment with rivaroxaban alone did not significantly improve the primary outcome when compared with treatment with aspirin alone (411 [5%] of 8250 vs 460 [6%] of 8261; HR 0·89, 95% CI 0·78-1·02, p=0·094). Combined rivaroxaban plus aspirin treatment resulted in more major bleeds than treatment with aspirin alone (263 [3%] of 8313 vs 158 [2%] of 8261; HR 1·66, 95% CI 1·37-2·03, p<0·0001), and similarly, more bleeds were seen in the rivaroxaban alone group than in the aspirin alone group (236 [3%] of 8250 vs 158 [2%] of 8261; HR 1·51, 95% CI 1·23-1·84, p<0·0001). The most common site of major bleeding was gastrointestinal, occurring in 130 [2%] patients who received combined rivaroxaban plus aspirin, in 84 [1%] patients who received rivaroxaban alone, and in 61 [1%] patients who received aspirin alone. Rivaroxaban plus aspirin reduced mortality when compared with aspirin alone (262 [3%] of 8313 vs 339 [4%] of 8261; HR 0·77, 95% CI 0·65-0·90, p=0·0012). INTERPRETATION: In patients with stable coronary artery disease, addition of rivaroxaban to aspirin lowered major vascular events, but increased major bleeding. There was no significant increase in intracranial bleeding or other critical organ bleeding. There was also a significant net benefit in favour of rivaroxaban plus aspirin and deaths were reduced by 23%. Thus, addition of rivaroxaban to aspirin has the potential to substantially reduce morbidity and mortality from coronary artery disease worldwide. FUNDING: Bayer AG."},{"id":"790c1d825ccc","type":"article","url":"https://hartvaat.nl/2018/01/16/laparoscopische-sleeve-gastrectomie-versus-gastric-bypass-bij-obesitas-jama-5-ja/","title":"Laparoscopische sleeve gastrectomie versus gastric bypass bij obesitas: JAMA 5-jaarsresultaten","title_en":"Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2017.20313","source_url":"https://doi.org/10.1001/jama.2017.20313","authors":["Paulina Salminen","Mika Helmiö","Jari Ovaska","Anne Juuti","Marja Leivonen","Pipsa Peromaa-Haavisto","Saija Hurme","Minna Soinio","Pirjo Nuutila","Mikael Victorzon"],"significance":7,"published":"2018-01-16","source_date":"2018-01-16","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bariatrische-chirurgie-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/"],"congress":"","summary_en":"This JAMA 5-year comparison showed comparable weight loss between laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in patients with morbid obesity, supporting both procedures as effective long-term options for surgical weight management.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 5-jaarsresultaten die gewichtsverlies vergeleek na laparoscopische sleeve gastrectomie versus Roux-en-Y gastric bypass bij morbide obesitas met cardiometabole comorbiditeit.","abstract_original":"IMPORTANCE: Laparoscopic sleeve gastrectomy for treatment of morbid obesity has increased substantially despite the lack of long-term results compared with laparoscopic Roux-en-Y gastric bypass. OBJECTIVE: To determine whether laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass are equivalent for weight loss at 5 years in patients with morbid obesity. DESIGN, SETTING, AND PARTICIPANTS: The Sleeve vs Bypass (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted from March 2008 until June 2010 in Finland. The trial enrolled 240 morbidly obese patients aged 18 to 60 years, who were randomly assigned to sleeve gastrectomy or gastric bypass with a 5-year follow-up period (last follow-up, October 14, 2015). INTERVENTIONS: Laparoscopic sleeve gastrectomy (n = 121) or laparoscopic Roux-en-Y gastric bypass (n = 119). MAIN OUTCOMES AND MEASURES: The primary end point was weight loss evaluated by percentage excess weight loss. Prespecified equivalence margins for the clinical significance of weight loss differences between gastric bypass and sleeve gastrectomy were -9% to +9% excess weight loss. Secondary end points included resolution of comorbidities, improvement of quality of life (QOL), all adverse events (overall morbidity), and mortality. RESULTS: Among 240 patients randomized (mean age, 48 [SD, 9] years; mean baseline body mass index, 45.9, [SD, 6.0]; 69.6% women), 80.4% completed the 5-year follow-up. At baseline, 42.1% had type 2 diabetes, 34.6% dyslipidemia, and 70.8% hypertension. The estimated mean percentage excess weight loss at 5 years was 49% (95% CI, 45%-52%) after sleeve gastrectomy and 57% (95% CI, 53%-61%) after gastric bypass (difference, 8.2 percentage units [95% CI, 3.2%-13.2%], higher in the gastric bypass group) and did not meet criteria for equivalence. Complete or partial remission of type 2 diabetes was seen in 37% (n = 15/41) after sleeve gastrectomy and in 45% (n = 18/40) after gastric bypass (P > .99). Medication for dyslipidemia was discontinued in 47% (n = 14/30) after sleeve gastrectomy and 60% (n = 24/40) after gastric bypass (P = .15) and for hypertension in 29% (n = 20/68) and 51% (n = 37/73) (P = .02), respectively. There was no statistically significant difference in QOL between groups (P = .85) and no treatment-related mortality. At 5 years the overall morbidity rate was 19% (n = 23) for sleeve gastrectomy and 26% (n = 31) for gastric bypass (P = .19). CONCLUSIONS AND RELEVANCE: Among patients with morbid obesity, use of laparoscopic sleeve gastrectomy compared with use of laparoscopic Roux-en-Y gastric bypass did not meet criteria for equivalence in terms of percentage excess weight loss at 5 years. Although gastric bypass compared with sleeve gastrectomy was associated with greater percentage excess weight loss at 5 years, the difference was not statistically significant, based on the prespecified equivalence margins. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00793143."},{"id":"2ba353d8d12b","type":"article","url":"https://hartvaat.nl/2018/01/16/hoog-sensitief-troponine-t-bij-chronisch-hartfalen-individuele-patientdata-meta-/","title":"Hoog-sensitief troponine T bij chronisch hartfalen: individuele patiëntdata meta-analyse","title_en":"Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure: An Individual Patient Data Meta-Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","hs-crp","nt-probnp","troponine","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.031560","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.031560","authors":["Alberto Aimo","James L Januzzi","Giuseppe Vergaro","Andrea Ripoli","Roberto Latini","Serge Masson","Michela Magnoli","Inder S Anand","Jay N Cohn","Luigi Tavazzi","Gianni Tognoni","Jørgen Gravning","Thor Ueland","Ståle H Nymo","Hans-Peter Brunner-La Rocca","Antoni Bayes-Genis","Josep Lupón","Rudolf A de Boer","Akiomi Yoshihisa","Yasuchika Takeishi","Michael Egstrup","Ida Gustafsson","Hanna K Gaggin","Kai M Eggers","Kurt Huber","Ioannis Tentzeris","Wai H W Tang","Justin Grodin","Claudio Passino","Michele Emdin"],"significance":7,"published":"2018-01-16","source_date":"2018-01-16","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"This individual patient data meta-analysis established the continuous prognostic value of high-sensitivity troponin T in chronic heart failure, quantifying the incremental risk prediction beyond natriuretic peptides and providing clinical troponin thresholds.","created":"2026-07-03T10:27:06Z","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":"IPD meta-analyse naar de prognostische waarde van hoog-sensitief troponine T bij chronisch hartfalen. Kwantificeert het risico per stijging en definieert afkapwaarden.","abstract_original":"BACKGROUND: Most patients with chronic heart failure have detectable troponin concentrations when evaluated by high-sensitivity assays. The prognostic relevance of this finding has not been clearly established so far. We aimed to assess high-sensitivity troponin assay for risk stratification in chronic heart failure through a meta-analysis approach. METHODS: Medline, EMBASE, Cochrane Library, and Scopus were searched in April 2017 by 2 independent authors. The terms were \"troponin\" AND \"heart failure\" OR \"cardiac failure\" OR \"cardiac dysfunction\" OR \"cardiac insufficiency\" OR \"left ventricular dysfunction.\" Inclusion criteria were English language, clinical stability, use of a high-sensitivity troponin assay, follow-up studies, and availability of individual patient data after request to authors. Data retrieved from articles and provided by authors were used in agreement with the PRISMA statement. The end points were all-cause death, cardiovascular death, and hospitalization for cardiovascular cause. RESULTS: Ten studies were included, reporting data on 11 cohorts and 9289 patients (age 66±12 years, 77% men, 60% ischemic heart failure, 85% with left ventricular ejection fraction <40%). High-sensitivity troponin T data were available for all patients, whereas only 209 patients also had high-sensitivity troponin I assayed. When added to a prognostic model including established risk markers (sex, age, ischemic versus nonischemic etiology, left ventricular ejection fraction, estimated glomerular filtration rate, and N-terminal fraction of pro-B-type natriuretic peptide), high-sensitivity troponin T remained independently associated with all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.41-1.55), cardiovascular mortality (hazard ratio, 1.40; 95% confidence interval, 1.33-1.48), and cardiovascular hospitalization (hazard ratio, 1.42; 95% confidence interval, 1.36-1.49), over a median 2.4-year follow-up (all P<0.001). High-sensitivity troponin T significantly improved risk prediction when added to a prognostic model including the variables above. It also displayed an independent prognostic value for all outcomes in almost all population subgroups. The area under the curve-derived 18 ng/L cutoff yielded independent prognostic value for the 3 end points in both men and women, patients with either ischemic or nonischemic etiology, and across categories of renal dysfunction. CONCLUSIONS: In chronic heart failure, high-sensitivity troponin T is a strong and independent predictor of all-cause and cardiovascular mortality, and of hospitalization for cardiovascular causes, as well. This biomarker then represents an additional tool for prognostic stratification."},{"id":"394930486db6","type":"article","url":"https://hartvaat.nl/2018/01/16/intraveneus-fentanyl-en-ticagrelorabsorptie-bij-pci/","title":"Intraveneus fentanyl en ticagrelorabsorptie bij PCI","title_en":"Effect of Intravenous Fentanyl on Ticagrelor Absorption and Platelet Inhibition Among Patients Undergoing Percutaneous Coronary Intervention: The PACIFY Randomized Clinical Trial (Platelet Aggregation With Ticagrelor Inhibition and Fentanyl).","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.031678","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.031678","authors":["John W McEvoy","Khalil Ibrahim","Thomas S Kickler","William A Clarke","Rani K Hasan","Matthew J Czarny","Ali R Keramati","Rakesh R Goli","Travis P Gratton","Jeffrey A Brinker","Matthews Chacko","Chao-Wei Hwang","Peter V Johnston","Julie M Miller","Jeffrey C Trost","William R Herzog","Roger S Blumenthal","David R Thiemann","Jon R Resar","Steven P Schulman"],"significance":6,"published":"2018-01-16","source_date":"2018-01-16","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study showed that intravenous fentanyl delays ticagrelor absorption and attenuates platelet inhibition during PCI, adding to the evidence for opioid-antiplatelet drug interactions in the catheterization laboratory.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 het effect van IV fentanyl op de absorptie en plaatjesremming van ticagrelor onderzocht tijdens PCI. Opioïde-antiplaatjesinteractie analoog aan het morfineprobleem.","abstract_original":""},{"id":"6fea372f7c8d","type":"article","url":"https://hartvaat.nl/2018/01/09/risico-s-van-overinterpretatie-van-interimdata-lessen-uit-de-total-trial/","title":"Risico's van overinterpretatie van interimdata: lessen uit de TOTAL-trial","title_en":"Risks of Overinterpreting Interim Data: Lessons From the TOTAL Trial (Thrombectomy With PCI Versus PCI Alone in Patients With STEMI).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030656","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030656","authors":["Sanjit S Jolly","Peggy Gao","John A Cairns","Salim Yusuf","Deepak L Bhatt","D George Wyse","George A Wells","Vladimír Džavík"],"significance":5,"published":"2018-01-09","source_date":"2018-01-09","image":"","kennis":[],"congress":"","summary_en":"This analysis discussed the risks of overinterpreting interim trial data using the TOTAL thrombectomy trial as a case study, providing methodological lessons for clinical trial conduct and reporting.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 risico's bespreekt van overinterpretatie van interimdata, geïllustreerd aan de hand van de TOTAL-trial over trombectomie bij STEMI. Methodologisch relevant.","abstract_original":""},{"id":"effd67a11e00","type":"article","url":"https://hartvaat.nl/2018/01/09/diastolische-bloeddruk-en-intensieve-bloeddrukcontrole-sprint-analyse/","title":"Diastolische bloeddruk en intensieve bloeddrukcontrole: SPRINT-analyse","title_en":"Influence of Baseline Diastolic Blood Pressure on Effects of Intensive Compared With Standard Blood Pressure Control.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030848","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030848","authors":["Srinivasan Beddhu","Glenn M Chertow","Alfred K Cheung","William C Cushman","Mahboob Rahman","Tom Greene","Guo Wei","Ruth C Campbell","Margaret Conroy","Barry I Freedman","William Haley","Edward Horwitz","Dalane Kitzman","James Lash","Vasilios Papademetriou","Roberto Pisoni","Erik Riessen","Clive Rosendorff","Suzanne G Watnick","Jeffrey Whittle","Paul K Whelton"],"significance":7,"published":"2018-01-09","source_date":"2018-01-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This SPRINT analysis examined whether the benefits of intensive blood pressure lowering are attenuated in patients with low baseline diastolic blood pressure, finding that intensive treatment remains beneficial without excess harm in patients with low DBP.","created":"2026-07-03T10:27:06Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 invloed van diastolische uitgangsdruk op het effect van intensieve bloeddrukcontrole. Onderzoekt het J-curve risico bij lage diastolische druk.","abstract_original":"BACKGROUND: In individuals with a low diastolic blood pressure (DBP), the potential benefits or risks of intensive systolic blood pressure (SBP) lowering are unclear. METHODS: SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized controlled trial that compared the effects of intensive (target <120 mm Hg) and standard (target <140 mm Hg) SBP control in 9361 older adults with high blood pressure at increased risk of cardiovascular disease. The primary outcome was a composite of cardiovascular disease events. All-cause death and incident chronic kidney disease were secondary outcomes. This post hoc analysis examined whether the effects of the SBP intervention differed by baseline DBP. RESULTS: Mean baseline SBP and DBP were 139.7±15.6 and 78.1±11.9 mm Hg, respectively. Regardless of the randomized treatment, baseline DBP had a U-shaped association with the hazard of the primary cardiovascular disease outcome. However, the effects of the intensive SBP intervention on the primary outcome were not influenced by baseline DBP level (P for interaction=0.83). The primary outcome hazard ratio for intensive versus standard treatment was 0.78 (95% confidence interval, 0.57-1.07) in the lowest DBP quintile (mean baseline DBP, 61±5 mm Hg) and 0.74 (95% confidence interval, 0.61-0.90) in the upper 4 DBP quintiles (mean baseline DBP, 82±9 mm Hg), with an interaction P value of 0.78. Results were similar for all-cause death and kidney events. CONCLUSIONS: Low baseline DBP was associated with increased risk of cardiovascular disease events, but there was no evidence that the benefit of the intensive SBP lowering differed by baseline DBP. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062."},{"id":"fec098c4c155","type":"article","url":"https://hartvaat.nl/2018/01/09/empagliflozine-bij-diabetes-type-2-met-cardiovasculaire-ziekte-en-ckd-empa-reg-o/","title":"Empagliflozine bij diabetes type 2 met cardiovasculaire ziekte en CKD: EMPA-REG OUTCOME","title_en":"Empagliflozin and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus, Established Cardiovascular Disease, and Chronic Kidney Disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["credence-trial","diabetes-type-2","empagliflozine","fidelio-dkd","flow-trial","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028268","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028268","authors":["Christoph Wanner","John M Lachin","Silvio E Inzucchi","David Fitchett","Michaela Mattheus","Jyothis George","Hans J Woerle","Uli C Broedl","Maximilian von Eynatten","Bernard Zinman"],"significance":8,"published":"2018-01-09","source_date":"2018-01-09","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This EMPA-REG OUTCOME subanalysis showed that empagliflozin reduced cardiovascular events and slowed renal decline in patients with the triple burden of type 2 diabetes, established cardiovascular disease, and chronic kidney disease, demonstrating the greatest absolute benefit in this high-risk population.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPA-REG OUTCOME subanalyse bij patiënten met zowel diabetes type 2, vastgestelde cardiovasculaire ziekte als chronische nierziekte. Drievoudige risicopopulatie met maximaal voordeel.","abstract_original":"BACKGROUND: Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduced cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus and established cardiovascular disease in the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients). Urinary glucose excretion with empagliflozin decreases with declining renal function, resulting in less potency for glucose lowering in patients with kidney disease. We investigated the effects of empagliflozin on clinical outcomes in patients with type 2 diabetes mellitus, established cardiovascular disease, and chronic kidney disease. METHODS: Patients with type 2 diabetes mellitus, established cardiovascular disease, and estimated glomerular filtration rate (eGFR) ≥30 mL·min-1·1.73 m-2 at screening were randomized to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo once daily in addition to standard of care. We analyzed cardiovascular death, hospitalization for heart failure, all-cause hospitalization, and all-cause mortality in patients with prevalent kidney disease (defined as eGFR <60 mL·min-1·1.73 m-2 and/or urine albumin-creatinine ratio >300 mg/g) at baseline. Additional analyses were performed in subgroups by baseline eGFR (<45, 45-<60, 60-<90, ≥90 mL·min-1·1.73 m-2) and baseline urine albumin-creatinine ratio (>300, 30-≤300, <30 mg/g). RESULTS: Of 7020 patients treated, 2250 patients had prevalent kidney disease at baseline, of whom 67% had a diagnosis of type 2 diabetes mellitus for >10 years, 58% were receiving insulin, and 84% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In patients with prevalent kidney disease at baseline, empagliflozin reduced the risk of cardiovascular death by 29% compared with placebo (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52-0.98), the risk of all-cause mortality by 24% (HR, 0.76; 95% CI, 0.59-0.99), the risk of hospitalization for heart failure by 39% (HR, 0.61; 95% CI, 0.42-0.87), and the risk of all-cause hospitalization by 19% (HR, 0.81; 95% CI, 0.72-0.92). Effects of empagliflozin on these outcomes were consistent across categories of eGFR and urine albumin-creatinine ratio at baseline and across the 2 doses studied. The adverse event profile of empagliflozin in patients with eGFR <60 mL·min-1·1.73 m-2 was consistent with the overall trial population. CONCLUSIONS: Empagliflozin improved clinical outcomes and reduced mortality in vulnerable patients with type 2 diabetes mellitus, established cardiovascular disease, and chronic kidney disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01131676."},{"id":"7254b637857c","type":"article","url":"https://hartvaat.nl/2018/01/07/2017-esc-richtlijn-voor-stemi-management/","title":"2017 ESC-richtlijn voor STEMI-management","title_en":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["myocardinfarct","richtlijnen-esc","stemi"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx393","source_url":"https://doi.org/10.1093/eurheartj/ehx393","authors":["Borja Ibanez","Stefan James","Stefan Agewall","Manuel J Antunes","Chiara Bucciarelli-Ducci","Héctor Bueno","Alida L P Caforio","Filippo Crea","John A Goudevenos","Sigrun Halvorsen","Gerhard Hindricks","Adnan Kastrati","Mattie J Lenzen","Eva Prescott","Marco Roffi","Marco Valgimigli","Christoph Varenhorst","Pascal Vranckx","Petr Widimský"],"significance":10,"published":"2018-01-07","source_date":"2018-01-07","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/ischemische-beroerte-tia/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The 2017 ESC Guidelines for ST-elevation myocardial infarction updated recommendations for reperfusion strategy, antithrombotic therapy, and secondary prevention. The document reinforced primary PCI as the preferred strategy, defined quality-of-care time targets, and integrated contemporary evidence on dual antiplatelet therapy duration.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ESC-richtlijn 2017 voor de behandeling van acuut myocardinfarct met ST-elevatie. Geactualiseerde aanbevelingen voor reperfusie, antitrombotica en secundaire preventie.","abstract_original":""},{"id":"c7f253b38cb2","type":"article","url":"https://hartvaat.nl/2018/01/06/pci-bij-stabiele-angina-lancet-orbita-dubbelblinde-gerandomiseerde-trial/","title":"PCI bij stabiele angina: Lancet ORBITA dubbelblinde gerandomiseerde trial","title_en":"Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32714-9","source_url":"https://doi.org/10.1016/S0140-6736(17)32714-9","authors":["Rasha Al-Lamee","David Thompson","Hakim-Moulay Dehbi","Sayan Sen","Kare Tang","John Davies","Thomas Keeble","Michael Mielewczik","Raffi Kaprielian","Iqbal S Malik","Sukhjinder S Nijjer","Ricardo Petraco","Christopher Cook","Yousif Ahmad","James Howard","Christopher Baker","Andrew Sharp","Robert Gerber","Suneel Talwar","Ravi Assomull","Jamil Mayet","Roland Wensel","David Collier","Matthew Shun-Shin","Simon A Thom","Justin E Davies","Darrel P Francis"],"significance":10,"published":"2018-01-06","source_date":"2018-01-06","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"ORBITA was the first double-blind, placebo-controlled randomized trial of PCI versus a sham procedure in stable angina. PCI did not significantly improve exercise time beyond the placebo effect, challenging the assumed symptomatic benefit of PCI in stable coronary artery disease and transforming the evidence-based discussion around elective intervention.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 ORBITA-trial — eerste dubbelblinde placebogecontroleerde trial van PCI versus sham-procedure bij stabiele angina. Veranderde het denken over PCI bij stabiel coronairlijden.","abstract_original":"BACKGROUND: Symptomatic relief is the primary goal of percutaneous coronary intervention (PCI) in stable angina and is commonly observed clinically. However, there is no evidence from blinded, placebo-controlled randomised trials to show its efficacy. METHODS: ORBITA is a blinded, multicentre randomised trial of PCI versus a placebo procedure for angina relief that was done at five study sites in the UK. We enrolled patients with severe (≥70%) single-vessel stenoses. After enrolment, patients received 6 weeks of medication optimisation. Patients then had pre-randomisation assessments with cardiopulmonary exercise testing, symptom questionnaires, and dobutamine stress echocardiography. Patients were randomised 1:1 to undergo PCI or a placebo procedure by use of an automated online randomisation tool. After 6 weeks of follow-up, the assessments done before randomisation were repeated at the final assessment. The primary endpoint was difference in exercise time increment between groups. All analyses were based on the intention-to-treat principle and the study population contained all participants who underwent randomisation. This study is registered with ClinicalTrials.gov, number NCT02062593. FINDINGS: ORBITA enrolled 230 patients with ischaemic symptoms. After the medication optimisation phase and between Jan 6, 2014, and Aug 11, 2017, 200 patients underwent randomisation, with 105 patients assigned PCI and 95 assigned the placebo procedure. Lesions had mean area stenosis of 84·4% (SD 10·2), fractional flow reserve of 0·69 (0·16), and instantaneous wave-free ratio of 0·76 (0·22). There was no significant difference in the primary endpoint of exercise time increment between groups (PCI minus placebo 16·6 s, 95% CI -8·9 to 42·0, p=0·200). There were no deaths. Serious adverse events included four pressure-wire related complications in the placebo group, which required PCI, and five major bleeding events, including two in the PCI group and three in the placebo group. INTERPRETATION: In patients with medically treated angina and severe coronary stenosis, PCI did not increase exercise time by more than the effect of a placebo procedure. The efficacy of invasive procedures can be assessed with a placebo control, as is standard for pharmacotherapy. FUNDING: NIHR Imperial Biomedical Research Centre, Foundation for Circulatory Health, Imperial College Healthcare Charity, Philips Volcano, NIHR Barts Biomedical Research Centre."},{"id":"c34934f831d2","type":"article","url":"https://hartvaat.nl/2018/01/06/drug-eluting-stents-bij-oudere-patienten-met-coronairlijden-lancet-senior-trial/","title":"Drug-eluting stents bij oudere patiënten met coronairlijden: Lancet SENIOR-trial","title_en":"Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ouderen","stabiel-coronairlijden"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32713-7","source_url":"https://doi.org/10.1016/S0140-6736(17)32713-7","authors":["Olivier Varenne","Stéphane Cook","Georgios Sideris","Sasko Kedev","Thomas Cuisset","Didier Carrié","Thomas Hovasse","Philippe Garot","Rami El Mahmoud","Christian Spaulding","Gérard Helft","José F Diaz Fernandez","Salvatore Brugaletta","Eduardo Pinar-Bermudez","Josepa Mauri Ferre","Philippe Commeau","Emmanuel Teiger","Kris Bogaerts","Manel Sabate","Marie-Claude Morice","Peter R Sinnaeve"],"significance":8,"published":"2018-01-06","source_date":"2018-01-06","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"The SENIOR trial confirmed that drug-eluting stents reduce ischemic events compared with bare-metal stents in elderly patients (≥75 years) with coronary artery disease, supporting universal DES use regardless of age and with shortened DAPT duration.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 SENIOR-trial die DES vergeleek met BMS specifiek bij oudere (≥75 jaar) patiënten met coronairlijden. Bevestigt het voordeel van DES ook op hoge leeftijd.","abstract_original":"BACKGROUND: Elderly patients regularly receive bare-metal stents (BMS) instead of drug-eluting stents (DES) to shorten the duration of double antiplatelet therapy (DAPT). The aim of this study was to compare outcomes between these two types of stents with a short duration of DAPT in such patients. METHODS: In this randomised single-blind trial, we recruited patients from 44 centres in nine countries. Patients were eligible if they were aged 75 years or older; had stable angina, silent ischaemia, or an acute coronary syndrome; and had at least one coronary artery with a stenosis of at least 70% (≥50% for the left main stem) deemed eligible for percutaneous coronary intervention (PCI). Exclusion criteria were indication for myocardial revascularisation by coronary artery bypass grafting; inability to tolerate, obtain, or comply with DAPT; requirement for additional surgery; non-cardiac comorbidities with a life expectancy of less than 1 year; previous haemorrhagic stroke; allergy to aspirin or P2Y12 inhibitors; contraindication to P2Y12 inhibitors; and silent ischaemia of less than 10% of the left myocardium with a fractional flow reserve of 0·80 or higher. After the intended duration of DAPT was recorded (1 month for patients with stable presentation and 6 months for those with unstable presentation), patients were randomly allocated (1:1) by a central computer system (blocking used with randomly selected block sizes [two, four, eight, or 16]; stratified by site and antiplatelet agent) to either a DES or similar BMS in a single-blind fashion (ie, patients were masked), but those assessing outcomes were masked. The primary outcome was to compare major adverse cardiac and cerebrovascular events (ie, a composite of all-cause mortality, myocardial infarction, stroke, or ischaemia-driven target lesion revascularisation) between groups at 1 year in the intention-to-treat population, assessed at 30 days, 180 days, and 1 year. This trial is registered with ClinicalTrials.gov, number NCT02099617. FINDINGS: Between May 21, 2014, and April 16, 2016, we randomly assigned 1200 patients (596 [50%] to the DES group and 604 [50%] to the BMS group). The primary endpoint occurred in 68 (12%) patients in the DES group and 98 (16%) in the BMS group (relative risk [RR] 0·71 [95% CI 0·52-0·94]; p=0·02). Bleeding complications (26 [5%] in the DES group vs 29 [5%] in the BMS group; RR 0·90 [0·51-1·54]; p=0·68) and stent thrombosis (three [1%] vs eight [1%]; RR 0·38 [0·00-1·48]; p=0·13) at 1 year were infrequent in both groups. INTERPRETATION: Among elderly patients who have PCI, a DES and a short duration of DAPT are better than BMS and a similar duration of DAPT with respect to the occurrence of all-cause mortality, myocardial infarction, stroke, and ischaemia-driven target lesion revascularisation. A strategy of combination of a DES to reduce the risk of subsequent repeat revascularisations with a short BMS-like DAPT regimen to reduce the risk of bleeding event is an attractive option for elderly patients who have PCI. FUNDING: Boston Scientific."},{"id":"586e06dbadaf","type":"article","url":"https://hartvaat.nl/2018/01/01/genetische-associatie-van-lipiden-en-lipide-doelwitten-met-abdominaal-aorta-aneu/","title":"Genetische associatie van lipiden en lipide-doelwitten met abdominaal aorta-aneurysma","title_en":"Genetic Association of Lipids and Lipid Drug Targets With Abdominal Aortic Aneurysm: A Meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.4293","source_url":"https://doi.org/10.1001/jamacardio.2017.4293","authors":["Seamus C Harrison","Michael V Holmes","Stephen Burgess","Folkert W Asselbergs","Gregory T Jones","Annette F Baas","F N van 't Hof","Paul I W de Bakker","Jan D Blankensteijn","Janet T Powell","Athanasios Saratzis","Gert J de Borst","Daniel I Swerdlow","Yolanda van der Graaf","Andre M van Rij","David J Carey","James R Elmore","Gerard Tromp","Helena Kuivaniemi","Robert D Sayers","Nilesh J Samani","Matthew J Bown","Steve E Humphries"],"significance":6,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis identified genetic associations between lipid levels, lipid-modifying drug targets, and abdominal aortic aneurysm risk, providing insights into the pathogenesis and potential pharmacological targets for AAA.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 genetische associaties tussen lipidenniveaus, lipide-geneesmiddeldoelwitten en het risico op abdominaal aorta-aneurysma.","abstract_original":"IMPORTANCE: Risk factors for abdominal aortic aneurysm (AAA) are largely unknown, which has hampered the development of nonsurgical treatments to alter the natural history of disease. OBJECTIVE: To investigate the association between lipid-associated single-nucleotide polymorphisms (SNPs) and AAA risk. DESIGN, SETTING, AND PARTICIPANTS: Genetic risk scores, composed of lipid trait-associated SNPs, were constructed and tested for their association with AAA using conventional (inverse-variance weighted) mendelian randomization (MR) and data from international AAA genome-wide association studies. Sensitivity analyses to account for potential genetic pleiotropy included MR-Egger and weighted median MR, and multivariable MR method was used to test the independent association of lipids with AAA risk. The association between AAA and SNPs in loci that can act as proxies for drug targets was also assessed. Data collection took place between January 9, 2015, and January 4, 2016. Data analysis was conducted between January 4, 2015, and December 31, 2016. EXPOSURES: Genetic elevation of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). MAIN OUTCOMES AND MEASURES: The association between genetic risk scores of lipid-associated SNPs and AAA risk, as well as the association between SNPs in lipid drug targets (HMGCR, CETP, and PCSK9) and AAA risk. RESULTS: Up to 4914 cases and 48 002 controls were included in our analysis. A 1-SD genetic elevation of LDL-C was associated with increased AAA risk (odds ratio [OR], 1.66; 95% CI, 1.41-1.96; P = 1.1 × 10-9). For HDL-C, a 1-SD increase was associated with reduced AAA risk (OR, 0.67; 95% CI, 0.55-0.82; P = 8.3 × 10-5), whereas a 1-SD increase in triglycerides was associated with increased AAA risk (OR, 1.69; 95% CI, 1.38-2.07; P = 5.2 × 10-7). In multivariable MR analysis and both MR-Egger and weighted median MR methods, the association of each lipid fraction with AAA risk remained largely unchanged. The LDL-C-reducing allele of rs12916 in HMGCR was associated with AAA risk (OR, 0.93; 95% CI, 0.89-0.98; P = .009). The HDL-C-raising allele of rs3764261 in CETP was associated with lower AAA risk (OR, 0.89; 95% CI, 0.85-0.94; P = 3.7 × 10-7). Finally, the LDL-C-lowering allele of rs11206510 in PCSK9 was weakly associated with a lower AAA risk (OR, 0.94; 95% CI, 0.88-1.00; P = .04), but a second independent LDL-C-lowering variant in PCSK9 (rs2479409) was not associated with AAA risk (OR, 0.97; 95% CI, 0.92-1.02; P = .28). CONCLUSIONS AND RELEVANCE: The MR analyses in this study lend support to the hypothesis that lipids play an important role in the etiology of AAA. Analyses of individual genetic variants used as proxies for drug targets support LDL-C lowering as a potential effective treatment strategy for preventing and managing AAA."},{"id":"80f575fd61fa","type":"article","url":"https://hartvaat.nl/2018/01/01/betablokkers-bij-hfref-hfmref-en-hfpef-individuele-patientanalyse/","title":"Bètablokkers bij HFrEF, HFmrEF en HFpEF: individuele patiëntanalyse","title_en":"Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","bloeddrukbehandeling","dapa-hf","step-hfpef","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx564","source_url":"https://doi.org/10.1093/eurheartj/ehx564","authors":["John G F Cleland","Karina V Bunting","Marcus D Flather","Douglas G Altman","Jane Holmes","Andrew J S Coats","Luis Manzano","John J V McMurray","Frank Ruschitzka","Dirk J van Veldhuisen","Thomas G von Lueder","Michael Böhm","Bert Andersson","John Kjekshus","Milton Packer","Alan S Rigby","Giuseppe Rosano","Hans Wedel","Åke Hjalmarson","John Wikstrand","Dipak Kotecha"],"significance":8,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This individual patient-level analysis across multiple trials demonstrated that beta-blockers significantly reduce mortality in HFrEF but showed no benefit in patients with mid-range or preserved ejection fraction. The analysis defined the EF boundary below which beta-blocker therapy is effective.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 patiëntanalyse van meerdere trials naar het effect van bètablokkers bij alle drie de HF-fenotypen. Bevestigt voordeel bij HFrEF in sinusritme maar niet bij HFpEF.","abstract_original":"AIMS: Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials. METHODS AND RESULTS: Individual patient data meta-analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-to-treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except for those in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%] randomized to beta-blockers compared to 35/283 [12.4%] with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%] with beta-blockers and 26/283 [9.2%] with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis. CONCLUSION: Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%."},{"id":"191c0ace4ac5","type":"article","url":"https://hartvaat.nl/2018/01/01/2017-af-ablatieconsensus-samenvatting/","title":"2017 AF-ablatieconsensus: samenvatting","title_en":"2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary.","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/eux275","source_url":"https://doi.org/10.1093/europace/eux275","authors":["Hugh Calkins","Gerhard Hindricks","Riccardo Cappato","Young-Hoon Kim","Eduardo B Saad","Luis Aguinaga","Joseph G Akar","Vinay Badhwar","Josep Brugada","John Camm","Peng-Sheng Chen","Shih-Ann Chen","Mina K Chung","Jens Cosedis Nielsen","Anne B Curtis","D Wyn Davies","John D Day","André d'Avila","N M S Natasja de Groot","Luigi Di Biase","Mattias Duytschaever","James R Edgerton","Kenneth A Ellenbogen","Patrick T Ellinor","Sabine Ernst","Guilherme Fenelon","Edward P Gerstenfeld","David E Haines","Michel Haissaguerre","Robert H Helm","Elaine Hylek","Warren M Jackman","Jose Jalife","Jonathan M Kalman","Josef Kautzner","Hans Kottkamp","Karl Heinz Kuck","Koichiro Kumagai","Richard Lee","Thorsten Lewalter","Bruce D Lindsay","Laurent Macle","Moussa Mansour","Francis E Marchlinski","Gregory F Michaud","Hiroshi Nakagawa","Andrea Natale","Stanley Nattel","Ken Okumura","Douglas Packer","Evgeny Pokushalov","Matthew R Reynolds","Prashanthan Sanders","Mauricio Scanavacca","Richard Schilling","Claudio Tondo","Hsuan-Ming Tsao","Atul Verma","David J Wilber","Teiichi Yamane"],"significance":8,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":[],"congress":"","summary_en":"Executive summary of the 2017 international expert consensus on catheter and surgical ablation of atrial fibrillation, providing a concise version of the comprehensive document with key recommendations on indications, techniques, and periprocedural management.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Executive summary van het 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expertconsensusstatement over AF-ablatie. Beknopte versie van het volledige document.","abstract_original":""},{"id":"8d31ff1bfff0","type":"article","url":"https://hartvaat.nl/2018/01/01/2017-hrs-ehra-ecas-aphrs-solaece-expertconsensus-katheter-en-chirurgische-af-abl/","title":"2017 HRS/EHRA/ECAS/APHRS/SOLAECE expertconsensus: katheter- en chirurgische AF-ablatie","title_en":"2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation.","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/eux274","source_url":"https://doi.org/10.1093/europace/eux274","authors":["Hugh Calkins","Gerhard Hindricks","Riccardo Cappato","Young-Hoon Kim","Eduardo B Saad","Luis Aguinaga","Joseph G Akar","Vinay Badhwar","Josep Brugada","John Camm","Peng-Sheng Chen","Shih-Ann Chen","Mina K Chung","Jens Cosedis Nielsen","Anne B Curtis","D Wyn Davies","John D Day","André d'Avila","N M S Natasja de Groot","Luigi Di Biase","Mattias Duytschaever","James R Edgerton","Kenneth A Ellenbogen","Patrick T Ellinor","Sabine Ernst","Guilherme Fenelon","Edward P Gerstenfeld","David E Haines","Michel Haissaguerre","Robert H Helm","Elaine Hylek","Warren M Jackman","Jose Jalife","Jonathan M Kalman","Josef Kautzner","Hans Kottkamp","Karl Heinz Kuck","Koichiro Kumagai","Richard Lee","Thorsten Lewalter","Bruce D Lindsay","Laurent Macle","Moussa Mansour","Francis E Marchlinski","Gregory F Michaud","Hiroshi Nakagawa","Andrea Natale","Stanley Nattel","Ken Okumura","Douglas Packer","Evgeny Pokushalov","Matthew R Reynolds","Prashanthan Sanders","Mauricio Scanavacca","Richard Schilling","Claudio Tondo","Hsuan-Ming Tsao","Atul Verma","David J Wilber","Teiichi Yamane"],"significance":9,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"The 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on AF ablation provided comprehensive guidance on indications, techniques, endpoints, and complications for catheter and surgical ablation of atrial fibrillation. The document serves as the standard reference for electrophysiology practice.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 expertconsensus over katheter- en chirurgische ablatie van atriumfibrilleren. Standaardwerk voor indicatiestelling, technieken en uitkomstdefinities.","abstract_original":""},{"id":"1147b78d60d7","type":"article","url":"https://hartvaat.nl/2018/01/01/linkeratriumvolume-voorspelt-af-recidief-na-radiofrequentieablatie-meta-analyse/","title":"Linkeratriumvolume voorspelt AF-recidief na radiofrequentieablatie: meta-analyse","title_en":"Left atrial volume predicts atrial fibrillation recurrence after radiofrequency 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/eux013","source_url":"https://doi.org/10.1093/europace/eux013","authors":["Augustine Njoku","Munish Kannabhiran","Rishi Arora","Pratap Reddy","Rakesh Gopinathannair","Dhanunjaya Lakkireddy","Paari Dominic"],"significance":6,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that left atrial volume (rather than diameter alone) independently predicts AF recurrence after radiofrequency ablation, supporting volumetric assessment for patient selection.","created":"2026-07-03T10:27:04Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 bevestigt dat linkeratriumvolume een onafhankelijke voorspeller is van AF-recidief na radiofrequentieablatie.","abstract_original":"AIMS: Left atrial (LA) diameter is a predictor of atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFA). However, LA volume (LAV) is more accurate in assessing LA size. Studies evaluating LAV as a predictor of AF recurrence are contradictory; therefore, we performed a meta-analysis to assess whether LAV is an independent predictor of AF recurrence following RFA. METHODS AND RESULTS: All studies reporting LAV/LAV index (LAVi) as a predictor of AF recurrence following RFA were included. For studies reporting mean LAV/ LAVi in patients with and without AF recurrence, standard difference in means (SDM) and standard errors were calculated, and combined using meta-analytical techniques. For studies reporting adjusted odds ratio (OR) for AF recurrence based on LAV/LAVi, log ORs were combined using generic inverse variance. Twenty one studies (3822 subjects) were included. Meta-analysis of 11 studies (1559 subjects) reporting LAV, showed that patients with AF recurrence had a higher mean LA volume compared to patients with no recurrence (SDM 0.801; CI 0.387-1.216). Data from 9 studies (1425 subjects) comparing LAVi showed that, patients with AF recurrence had a higher mean LAVi compared to patients with no recurrence (SDM-0.596; CI 0.305-0.888). Thirteen studies (2886 patients) reporting ORs for AF recurrence based on LAV/ LAVi, showed that LAV/LAVi was independently predictive of AF recurrence post-RFA (OR-1.032, CI- 1.012-1.052). CONCLUSIONS: Patients with AF recurrence following RFA have a higher mean LAV/LAVi compared to patients with no recurrence. Large LAV/LAVi increases the odds of AF recurrence post RFA."},{"id":"64055c61b4ff","type":"article","url":"https://hartvaat.nl/2018/01/01/endocardiale-linkerkamer-pacing-voor-crt-systematische-review-en-meta-analyse/","title":"Endocardiale linkerkamer pacing voor CRT: systematische review en meta-analyse","title_en":"Endocardial left ventricular pacing for cardiac resynchronization: systematic review and meta-analysis.","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/euw381","source_url":"https://doi.org/10.1093/europace/euw381","authors":["James Hugo Phillimore Gamble","Neil Herring","Matthew Ginks","Kim Rajappan","Yaver Bashir","Timothy Rider Betts"],"significance":5,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"This meta-analysis of endocardial versus epicardial LV pacing for CRT evaluated whether endocardial lead positioning improves resynchronization response and clinical outcomes compared with conventional coronary sinus approaches.","created":"2026-07-03T10:27:04Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (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 endocardiale versus epicardiale linkerkamerpacing bij CRT. Onderzoekt of endocardiale positionering de CRT-respons verbetert.","abstract_original":"AIMS: Endocardial left ventricular (LV) pacing for Cardiac Resynchronization Therapy has been proposed as an alternative to conventional LV lead placement via the coronary sinus. In order to assess the relative benefits and risks of this technique, we have performed a meta-analysis of published reports. METHODS AND RESULTS: A systemic search was performed using online databases to identify studies of lead-based endocardial pacing. A random-effects meta-analysis was performed, to assess the rate of complications and clinical response (defined as ≥1 decrease in NYHA class). We selected 23 studies, including 384 patients. The trans-atrial septal technique was used in 20 studies, 1 used the trans-ventricular apical technique, and 2 used the trans-ventricular septal technique. Mean age was 66 years, male 66%, EF 26%, NYHA class 3.0. Procedural success rates were over 95% in all studies. Clinical response was reported by 16 studies for 262 patients, giving a response estimate of 82% (95% CI 71-89%). There was significant heterogeneity, and response in the only large study was 59%. Thromboembolic (TE) complications were reported by all studies, over 22 ±32 months follow up. The rate of stroke was 2.5 events per 100 patient years (95% CI 1.5-4.3), and TIA 2.6 (1.1-6.1). The mortality rate was 4.5 (1.5-13.6) per 100 patient years. CONCLUSION: LV endocardial pacing appears to be a viable technique when conventional lead placement is not possible. Response rates were heterogeneous but comparable with conventional CRT. There is likely to be a small increase over expected rates of stroke, although included patients were high risk."},{"id":"c92929316548","type":"article","url":"https://hartvaat.nl/2018/01/01/supraventriculaire-ectopie-na-af-ablatie-voorspelt-recidief/","title":"Supraventriculaire ectopie na AF-ablatie voorspelt recidief","title_en":"Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation.","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/euw329","source_url":"https://doi.org/10.1093/europace/euw329","authors":["Christina Alhede","Arne Johannessen","Ulrik Dixen","Jan S Jensen","Pekka Raatikainen","Gerhard Hindricks","Håkan Walfridsson","Ole Kongstad","Steen Pehrson","Anders Englund","Juha Hartikainen","Peter S Hansen","Jens C Nielsen","Christian Jons"],"significance":5,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/katheterablatie-vt/"],"congress":"","summary_en":"This study showed that a higher burden of supraventricular ectopic complexes early after AF catheter ablation predicts long-term arrhythmia recurrence, identifying an early monitoring marker for re-intervention candidacy.","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":"Studie die aantoont dat een hogere last van supraventriculaire ectopie vroeg na katheterablatie geassocieerd is met een verhoogd risico op AF-recidief.","abstract_original":"AIMS: Early identification of patients who could benefit from early re-intervention after catheter ablation is highly warranted. Our aim was to investigate the association between post-procedural burden of supraventricular ectopic complexes (SVEC) and the risk of long-term atrial fibrillation (AF) recurrence. METHODS AND RESULTS: A total of 125 patients undergoing catheter ablation for AF were included. Patients underwent 7-day Holter recordings immediately post-procedural. The number of SVEC in post-procedural Holter recordings was categorized into quartiles: 0-72, 73-212, 213-782 and ≥ 783 SVEC/day. Long-term AF recurrence was defined as a combined endpoint of AF ≥ 1 min during follow-up Holter recordings, cardioversion or hospitalization for AF after a 3-month blanking period and within 24 months of follow-up. High post-procedural supraventricular ectopy burden was associated with an increased risk of long-term AF recurrence in a dose-dependent manner (≥ 783 SVEC: HR 4.6 [1.9-11.5], P < 0.001) irrespective of AF recurrence during the blanking period or other risk factors. In patients with early AF recurrence < 90 days after catheter ablation ectopy burden was also highly predictive of long-term AF recurrence (SVEC ≥ 213: HR 3.0 [1.3-6.7], P = 0.007). Correspondingly, patients with early AF recurrence but low ectopy burden remained at low risk of long-term AF recurrence after the blanking period. CONCLUSION: Our results indicate that post-procedural ectopy burden is highly associated with long-term AF recurrence and could be a potent risk marker for selection of patients for early re-ablation. Development of future ablation risk stratification and strategies should include focus on post-procedural ectopy burden."},{"id":"034274139fe0","type":"article","url":"https://hartvaat.nl/2018/01/01/energiebron-en-vroeg-af-recidief-cryoballon-versus-radiofrequentie/","title":"Energiebron en vroeg AF-recidief: cryoballon versus radiofrequentie","title_en":"Influence of energy source on early atrial fibrillation recurrences: a comparison of cryoballoon vs. radiofrequency current energy ablation with the endpoint of unexcitability in pulmonary vein isolation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["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/euw307","source_url":"https://doi.org/10.1093/europace/euw307","authors":["Melanie A Gunawardene","Boris A Hoffmann","Benjamin Schaeffer","Da-Un Chung","Julia Moser","Ruken Oezge Akbulak","Mario Jularic","Christian Eickholt","Jana Nuehrich","Christian Meyer","Stephan Willems"],"significance":5,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":[],"congress":"","summary_en":"This comparison of early AF recurrence rates between second-generation cryoballoon and radiofrequency ablation characterized the post-ablation inflammatory response and its influence on early rhythm outcomes.","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":"Vergelijking van vroege AF-recidieven na cryoballon- versus radiofrequentieablatie. Onderzoekt of de energiebron het postablatie-inflammatiepatroon beïnvloedt.","abstract_original":"INTRODUCTION: Comparative data of early recurrence rates of atrial fibrillation (ERAF) following second-generation cryoballoon (CB-G2) and radiofrequency current (RFC) ablation for pulmonary vein isolation (PVI) in paroxysmal AF (PAF) are rare. We randomized PAF patients into either PVI with CB-G2 (group 1) or PVI with a combined RFC-approach applying contact force (CF) with the endpoint of unexcitability (group 2) to investigate ERAF. METHODS AND RESULTS: In group 1 (n = 30), CB-G2-PVI was performed. After CF-PVI in group 2 (n = 30), bipolar pacing on the ablation line and additional ablation until unexcitability was conducted. Follow-up included 48 h of in-hospital monitoring followed by 5-day Holter ECGs 1, 2, 3, 6, 12 months postablation to evaluate ERAF. Acute PVI was reached in 100% of group 2 and in 99% of group 1. Shorter procedure durations (98.0 ± 21.9 vs. 114.3 ± 18.7 min, P < 0.05) but extended fluoroscopy times (15.4 ± 3.9 vs. 10.0 ± 4.3 min, P < 0.05) were found in the CB-G2 group. Ten non-severe complications occurred (6 vs. 4 in group 1 and 2, P = 0.73). In group 2, five patients suffered from ERAF vs. seven patients in group 1 (P = 0.67). The time until the occurrence of ERAF was shorter in group 2 (1 day (q1-q3: 1-4.5)) when compared with group 1 (22 (q1-q3: 6-54) days, P = 0.025). CONCLUSION: ERAF rates were equal among groups; however, they occurred earlier in the initial phase after RFC ablation when compared with CB-G2. PVI utilizing cryoablation is associated with shorter procedure durations but extended fluoroscopy time while being similarly secure."},{"id":"b659d99e241d","type":"article","url":"https://hartvaat.nl/2018/01/01/bijniervenesampling-als-voorkeursmethode-bij-primair-hyperaldosteronisme/","title":"Bijniervenesampling als voorkeursmethode bij primair hyperaldosteronisme","title_en":"Adrenal Vein Sampling Is the Preferred Method to Select Patients With Primary Aldosteronism for Adrenalectomy: Con Side of the Argument.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["lorundrostat"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09294","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09294","authors":["Jaap Deinum","Aleksander Prejbisz","Jacques W M Lenders","Gert Jan van der Wilt"],"significance":6,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":[],"congress":"","summary_en":"This article presented the argument against adrenal vein sampling as the preferred method for selecting primary aldosteronism patients for adrenalectomy, discussing alternative non-invasive approaches.","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":"Argumentatie tegen bijniervenesampling als voorkeursmethode voor selectie van patiënten met primair hyperaldosteronisme voor adrenalectomie. Deel van het voortdurende debat.","abstract_original":""},{"id":"7ad4be29cdd6","type":"article","url":"https://hartvaat.nl/2018/01/01/sacubitril-valsartan-en-inspanningsgemedieerd-lipidenmetabolisme-bij-obesitas-me/","title":"Sacubitril/valsartan en inspanningsgemedieerd lipidenmetabolisme bij obesitas met hypertensie","title_en":"Effect of Sacubitril/Valsartan on Exercise-Induced Lipid Metabolism in Patients With Obesity and Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["answer-hf","bloeddrukbehandeling","lipidenverlaging","obesitas","sacubitril-valsartan"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10224","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10224","authors":["Stefan Engeli","Rudi Stinkens","Tim Heise","Marcus May","Gijs H Goossens","Ellen E Blaak","Bas Havekes","Thomas Jax","Diego Albrecht","Parasar Pal","Uwe Tegtbur","Sven Haufe","Thomas H Langenickel","Jens Jordan"],"significance":5,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This study examined the effect of sacubitril-valsartan on exercise-induced lipid metabolism in patients with obesity and hypertension, exploring metabolic mechanisms of ARNI benefit beyond hemodynamic effects.","created":"2026-07-03T10:27:04Z","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":"Studie naar het effect van sacubitril/valsartan op inspanningsgemedieerd lipidenmetabolisme bij patiënten met obesitas en hypertensie.","abstract_original":"UNLABELLED: Sacubitril/valsartan (LCZ696), a novel angiotensin receptor-neprilysin inhibitor, was recently approved for the treatment of heart failure with reduced ejection fraction. Neprilysin degrades several peptides that modulate lipid metabolism, including natriuretic peptides. In this study, we investigated the effects of 8 weeks' treatment with sacubitril/valsartan on whole-body and adipose tissue lipolysis and lipid oxidation during defined physical exercise compared with the metabolically neutral comparator amlodipine. This was a multicenter, randomized, double-blind, active-controlled, parallel-group study enrolling subjects with abdominal obesity and moderate hypertension (mean sitting systolic blood pressure ≥130-180 mm Hg). Lipolysis during rest and exercise was assessed by microdialysis and [1,1,2,3,3-2H]-glycerol tracer kinetics. Energy expenditure and substrate oxidation were measured simultaneously using indirect calorimetry. Plasma nonesterified fatty acids, glycerol, insulin, glucose, adrenaline and noradrenaline concentrations, blood pressure, and heart rate were also determined. Exercise elevated plasma glycerol, free fatty acids, and interstitial glycerol concentrations and increased the rate of glycerol appearance. However, exercise-induced stimulation of lipolysis was not augmented on sacubitril/valsartan treatment compared with amlodipine treatment. Furthermore, sacubitril/valsartan did not alter energy expenditure and substrate oxidation during exercise compared with amlodipine treatment. In conclusion, sacubitril/valsartan treatment for 8 weeks did not elicit clinically relevant changes in exercise-induced lipolysis or substrate oxidation in obese patients with hypertension, implying that its beneficial cardiovascular effects cannot be explained by changes in lipid metabolism during exercise. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01631864."}]}