{"generated":"2026-08-28T16:42:09Z","year":"2021","count":308,"licence":"Citeer vrij, met bronvermelding en een link naar 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":"a9580242a94a","type":"article","url":"https://hartvaat.nl/2021/12/30/dolutegravir-als-eerste-of-tweedelijnbehandeling-voor-hiv-1-bij-kinderen-nejm/","title":"Dolutegravir als eerste- of tweedelijnbehandeling voor HIV-1 bij kinderen: NEJM","title_en":"Dolutegravir as First- or Second-Line Treatment for HIV-1 Infection in Children.","category":"cholesterol","category_label":"Cholesterol","professions":["internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2108793","source_url":"https://doi.org/10.1056/NEJMoa2108793","authors":["Anna Turkova","Ellen White","Hilda A Mujuru","Adeodata R Kekitiinwa","Cissy M Kityo","Avy Violari","Abbas Lugemwa","Tim R Cressey","Philippa Musoke","Ebrahim Variava","Mark F Cotton","Moherndran Archary","Thanyawee Puthanakit","Osee Behuhuma","Robin Kobbe","Steven B Welch","Mutsa Bwakura-Dangarembizi","Pauline Amuge","Elizabeth Kaudha","Linda Barlow-Mosha","Shafic Makumbi","Nastassja Ramsagar","Chaiwat Ngampiyaskul","Godfrey Musoro","Lorna Atwine","Afaaf Liberty","Victor Musiime","Dickson Bbuye","Grace M Ahimbisibwe","Suwalai Chalermpantmetagul","Shabinah Ali","Tatiana Sarfati","Ben Wynne","Clare Shakeshaft","Angela Colbers","Nigel Klein","Sarah Bernays","Yacine Saïdi","Alexandra Coelho","Tiziana Grossele","Alexandra Compagnucci","Carlo Giaquinto","Pablo Rojo","Deborah Ford","Diana M Gibb"],"significance":5,"published":"2021-12-30","source_date":"2021-12-30","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenverlaging-stappenplan/"],"congress":"","summary_en":"This NEJM trial of dolutegravir in children with HIV is relevant to cardiology through the cardiovascular-metabolic interactions of antiretroviral therapy, including effects on lipids and glucose metabolism in the pediatric population.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:42Z","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":"NEJM trial van dolutegravir bij kinderen met HIV. Relevant voor CV-metabole interacties van antiretrovirale therapie.","abstract_original":"BACKGROUND: Children with human immunodeficiency virus type 1 (HIV-1) infection have limited options for effective antiretroviral treatment (ART). METHODS: We conducted an open-label, randomized, noninferiority trial comparing three-drug ART based on the HIV integrase inhibitor dolutegravir with standard care (non-dolutegravir-based ART) in children and adolescents starting first- or second-line ART. The primary end point was the proportion of participants with virologic or clinical treatment failure by 96 weeks, as estimated by the Kaplan-Meier method. Safety was assessed. RESULTS: From September 2016 through June 2018, a total of 707 children and adolescents who weighed at least 14 kg were randomly assigned to receive dolutegravir-based ART (350 participants) or standard care (357). The median age was 12.2 years (range, 2.9 to 18.0), the median weight was 30.7 kg (range, 14.0 to 85.0), and 49% of the participants were girls. By design, 311 participants (44%) started first-line ART (with 92% of those in the standard-care group receiving efavirenz-based ART), and 396 (56%) started second-line ART (with 98% of those in the standard-care group receiving boosted protease inhibitor-based ART). The median follow-up was 142 weeks. By 96 weeks, 47 participants in the dolutegravir group and 75 in the standard-care group had treatment failure (estimated probability, 0.14 vs. 0.22; difference, -0.08; 95% confidence interval, -0.14 to -0.03; P = 0.004). Treatment effects were similar with first- and second-line therapies (P = 0.16 for heterogeneity). A total of 35 participants in the dolutegravir group and 40 in the standard-care group had at least one serious adverse event (P = 0.53), and 73 and 86, respectively, had at least one adverse event of grade 3 or higher (P = 0.24). At least one ART-modifying adverse event occurred in 5 participants in the dolutegravir group and in 17 in the standard-care group (P = 0.01). CONCLUSIONS: In this trial involving children and adolescents with HIV-1 infection who were starting first- or second-line treatment, dolutegravir-based ART was superior to standard care. (Funded by ViiV Healthcare; ODYSSEY ClinicalTrials.gov number, NCT02259127; EUDRACT number, 2014-002632-14; and ISRCTN number, ISRCTN91737921.)."},{"id":"f611f28b121c","type":"article","url":"https://hartvaat.nl/2021/12/30/chlorthalidon-bij-hypertensie-met-gevorderde-ckd-nejm-click/","title":"Chlorthalidon bij hypertensie met gevorderde CKD: NEJM CLICK","title_en":"Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","chronische-nierziekte"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2110730","source_url":"https://doi.org/10.1056/NEJMoa2110730","authors":["Rajiv Agarwal","Arjun D Sinha","Andrew E Cramer","Mary Balmes-Fenwick","Jazmyn H Dickinson","Fangqian Ouyang","Wanzhu Tu"],"significance":9,"published":"2021-12-30","source_date":"2021-12-30","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/","https://hartvaat.nl/kennis/hypertensie/thiazidediuretica-hypertensie/"],"congress":"","summary_en":"The CLICK trial demonstrated that chlorthalidone effectively lowered blood pressure in patients with advanced CKD (eGFR 15-30 mL/min), a population traditionally thought unresponsive to thiazide diuretics. This evidence-changing result supported the use of thiazide-like diuretics even in severe kidney disease.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","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 CLICK trial die chlorthalidon onderzocht bij hypertensie met gevorderde CKD. Eerste bewijs dat thiazide-achtig diureticum effectief is bij ernstige nierinsufficiëntie.","abstract_original":"BACKGROUND: Little evidence has been available to support the use of thiazide diuretics to treat hypertension in patients with advanced chronic kidney disease. METHODS: We randomly assigned patients with stage 4 chronic kidney disease and poorly controlled hypertension, as confirmed by 24-hour ambulatory blood-pressure monitoring, in a 1:1 ratio to receive chlorthalidone at an initial dose of 12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day, or placebo; randomization was stratified according to previous use of loop diuretics. The primary outcome was the change in 24-hour ambulatory systolic blood pressure from baseline to 12 weeks. Secondary outcomes were the change from baseline to 12 weeks in the urinary albumin-to-creatinine ratio, N-terminal pro-B-type natriuretic peptide level, plasma renin and aldosterone levels, and total body volume. Safety was also assessed. RESULTS: A total of 160 patients underwent randomization, of whom 121 (76%) had diabetes mellitus and 96 (60%) were receiving loop diuretics. At baseline, the mean (±SD) estimated glomerular filtration rate was 23.2±4.2 ml per minute per 1.73 m2 of body-surface area and the mean number of antihypertensive medications prescribed was 3.4±1.4. At randomization, the mean 24-hour ambulatory systolic blood pressure was 142.6±8.1 mm Hg in the chlorthalidone group and 140.1±8.1 mm Hg in the placebo group and the mean 24-hour ambulatory diastolic blood pressure was 74.6±10.1 mm Hg and 72.8±9.3 mm Hg, respectively. The adjusted change in 24-hour systolic blood pressure from baseline to 12 weeks was -11.0 mm Hg (95% confidence interval [CI], -13.9 to -8.1) in the chlorthalidone group and -0.5 mm Hg (95% CI, -3.5 to 2.5) in the placebo group. The between-group difference was -10.5 mm Hg (95% CI, -14.6 to -6.4) (P<0.001). The percent change in the urinary albumin-to-creatinine ratio from baseline to 12 weeks was lower in the chlorthalidone group than in the placebo group by 50 percentage points (95% CI, 37 to 60). Hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia occurred more frequently in the chlorthalidone group than in the placebo group. CONCLUSIONS: Among patients with advanced chronic kidney disease and poorly controlled hypertension, chlorthalidone therapy improved blood-pressure control at 12 weeks as compared with placebo. (Funded by the National Heart, Lung, and Blood Institute and the Indiana Institute of Medical Research; CLICK ClinicalTrials.gov number, NCT02841280.)."},{"id":"01eca33a8611","type":"article","url":"https://hartvaat.nl/2021/12/30/angiografie-na-buitenziekenhuis-hartstilstand-zonder-st-elevatie-nejm-tomahawk/","title":"Angiografie na buitenziekenhuis-hartstilstand zonder ST-elevatie: NEJM TOMAHAWK","title_en":"Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2101909","source_url":"https://doi.org/10.1056/NEJMoa2101909","authors":["Steffen Desch","Anne Freund","Ibrahim Akin","Michael Behnes","Michael R Preusch","Thomas A Zelniker","Carsten Skurk","Ulf Landmesser","Tobias Graf","Ingo Eitel","Georg Fuernau","Hendrik Haake","Peter Nordbeck","Fabian Hammer","Stephan B Felix","Christian Hassager","Thomas Engstrøm","Stephan Fichtlscherer","Jakob Ledwoch","Karsten Lenk","Michael Joner","Stephan Steiner","Christoph Liebetrau","Ingo Voigt","Uwe Zeymer","Michael Brand","Roland Schmitz","Jan Horstkotte","Claudius Jacobshagen","Janine Pöss","Mohamed Abdel-Wahab","Philipp Lurz","Alexander Jobs","Suzanne de Waha-Thiele","Denise Olbrich","Frank Sandig","Inke R König","Sabine Brett","Maren Vens","Kathrin Klinge","Holger Thiele"],"significance":9,"published":"2021-12-30","source_date":"2021-12-30","image":"","kennis":[],"congress":"","summary_en":"The TOMAHAWK trial confirmed that immediate coronary angiography did not improve 30-day survival compared with a delayed approach in patients resuscitated from out-of-hospital cardiac arrest without ST-segment elevation. Together with COACT, this definitively argued against routine emergent catheterization in this setting.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","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 TOMAHAWK trial die onmiddellijke versus uitgestelde angiografie vergeleek na hartstilstand zonder ST-elevatie. Bevestigt COACT: geen voordeel van onmiddellijke strategie.","abstract_original":"BACKGROUND: Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear. METHODS: In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days. RESULTS: A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P = 0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups. CONCLUSIONS: Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause. (Funded by the German Center for Cardiovascular Research; TOMAHAWK ClinicalTrials.gov number, NCT02750462.)."},{"id":"d9235284c0d5","type":"article","url":"https://hartvaat.nl/2021/12/28/10-jaars-mortaliteit-na-pci-of-cabg-bij-diabetes-met-complex-coronairlijden/","title":"10-jaars mortaliteit na PCI of CABG bij diabetes met complex coronairlijden","title_en":"Ten-year all-cause death after percutaneous or surgical revascularization in diabetic patients with complex coronary artery disease.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab441","source_url":"https://doi.org/10.1093/eurheartj/ehab441","authors":["Rutao Wang","Patrick W Serruys","Chao Gao","Hironori Hara","Kuniaki Takahashi","Masafumi Ono","Hideyuki Kawashima","Neil O'leary","David R Holmes","Adam Witkowski","Nick Curzen","Francesco Burzotta","Stefan James","Robert-Jan van Geuns","Arie Pieter Kappetein","Marie-Angele Morel","Stuart J Head","Daniel J F M Thuijs","Piroze M Davierwala","Timothy O'Brien","Valentin Fuster","Scot Garg","Yoshinobu Onuma"],"significance":7,"published":"2021-12-28","source_date":"2021-12-28","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This 10-year comparison of PCI versus CABG in diabetic patients with complex coronary disease confirmed the long-term survival advantage of surgical revascularization, consistent with FREEDOM and reinforcing CABG as the preferred strategy in this population.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","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":"10-jaarsresultaten van PCI versus CABG bij diabetespatiënten met complex coronairlijden.","abstract_original":"AIMS: The aim of this article was to compare rates of all-cause death at 10 years following coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with or without diabetes. METHODS AND RESULTS: The SYNTAXES study evaluated up to 10-year survival of 1800 patients with three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death according to diabetic status and revascularization strategy was examined. In diabetics (n = 452), the risk of mortality was numerically higher with PCI compared with CABG at 5 years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10 years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P = 0.366). Irrespective of diabetic status, there was no significant difference in all-cause death at 10 years between patients receiving PCI or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P = 0.551). Among insulin-treated patients (n = 182), all-cause death at 10 years was numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI: -6.5%, 22.5%, P = 0.227). CONCLUSIONS: The treatment effects of PCI vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD were similar irrespective of the presence of diabetes. There may, however, be a survival benefit with CABG in patients with insulin-treated diabetes. The association between revascularization strategy and very long-term ischaemic and safety outcomes for patients with diabetes needs further investigation in dedicated trials. TRIAL REGISTRATION: SYNTAX: ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050."},{"id":"692cf06547ae","type":"article","url":"https://hartvaat.nl/2021/12/28/sekseverschillen-na-cabg-gepoolde-ipd-analyse/","title":"Sekseverschillen na CABG: gepoolde IPD analyse","title_en":"Sex differences in outcomes after coronary artery bypass grafting: a pooled analysis of individual patient data.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab504","source_url":"https://doi.org/10.1093/eurheartj/ehab504","authors":["Mario Gaudino","Antonino Di Franco","John H Alexander","Faisal Bakaeen","Natalia Egorova","Paul Kurlansky","Andreas Boening","Joanna Chikwe","Michelle Demetres","Philip J Devereaux","Anno Diegeler","Arnaldo Dimagli","Marcus Flather","Irbaz Hameed","Andre Lamy","Jennifer S Lawton","Wilko Reents","N Bryce Robinson","Katia Audisio","Mohamed Rahouma","Patrick W Serruys","Hironori Hara","David P Taggart","Leonard N Girardi","Stephen E Fremes","Umberto Benedetto"],"significance":7,"published":"2021-12-28","source_date":"2021-12-28","image":"","kennis":[],"congress":"","summary_en":"This pooled individual patient data analysis of sex differences after CABG found that women have higher perioperative complication rates but similar long-term survival compared with men, informing the ongoing discussion about sex-specific outcomes in cardiac surgery.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","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":"Gepoolde individuele patiëntdata analyse van sekseverschillen in uitkomsten na CABG.","abstract_original":"AIMS: Data suggest that women have worse outcomes than men after coronary artery bypass grafting (CABG), but results have been inconsistent across studies. Due to the large differences in baseline characteristics between sexes, suboptimal risk adjustment due to low-quality data may be the reason for the observed differences. To overcome this limitation, we undertook a systematic review and pooled analysis of high-quality individual patient data from large CABG trials to compare the adjusted outcomes of women and men. METHODS AND RESULTS: The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization (major adverse cardiac and cerebrovascular events, MACCE). The secondary outcome was all-cause mortality. Multivariable mixed-effect Cox regression was used. Four trials involving 13 193 patients (10 479 males; 2714 females) were included. Over 5 years of follow-up, women had a significantly higher risk of MACCE [adjusted hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.21; P = 0.004] but similar mortality (adjusted HR 1.03, 95% CI 0.94-1.14; P = 0.51) compared to men. Women had higher incidence of MI (adjusted HR 1.30, 95% CI 1.11-1.52) and repeat revascularization (adjusted HR 1.22, 95% CI 1.04-1.43) but not stroke (adjusted HR 1.17, 95% CI 0.90-1.52). The difference in MACCE between sexes was not significant in patients 75 years and older. The use of off-pump surgery and multiple arterial grafting did not modify the difference between sexes. CONCLUSIONS: Women have worse outcomes than men in the first 5 years after CABG. This difference is not significant in patients aged over 75 years and is not affected by the surgical technique."},{"id":"36405524ce2f","type":"article","url":"https://hartvaat.nl/2021/12/21/langdurige-omega-3-suppletie-en-af-risico-meta-analyse-van-cv-trials/","title":"Langdurige omega-3 suppletie en AF-risico: meta-analyse van CV-trials","title_en":"Effect of Long-Term Marine ɷ-3 Fatty Acids Supplementation on the Risk of Atrial Fibrillation in Randomized Controlled Trials of Cardiovascular Outcomes: A Systematic Review and Meta-Analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["voeding-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.055654","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.055654","authors":["Baris Gencer","Luc Djousse","Omar T Al-Ramady","Nancy R Cook","JoAnn E Manson","Christine M Albert"],"significance":8,"published":"2021-12-21","source_date":"2021-12-21","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of randomized controlled trials confirmed that long-term marine omega-3 fatty acid supplementation is associated with a significantly increased risk of atrial fibrillation. The definitive safety signal raised concerns about the cardiovascular use of fish oil supplements.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","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":"Meta-analyse die bevestigt dat langdurige omega-3 vetzuursuppletie het risico op AF verhoogt. Definitieve safety-signal.","abstract_original":"BACKGROUND: Some, but not all, large-scale randomized controlled trials (RCTs) investigating the effects of marine ɷ-3 fatty acids supplementation on cardiovascular outcomes have reported increased risks of atrial fibrillation (AF). The potential reasons for disparate findings may be dose-related. METHODS: The MEDLINE and Embase databases were searched for articles and abstracts published between January 1, 2012, and December 31, 2020, in addition to a meta-analysis of large cardiovascular RCTs published in 2019. RCTs of cardiovascular outcomes of marine ɷ-3 fatty acids that reported results for AF, either as a prespecified outcome, an adverse event, or a cause for hospitalization, with a minimum sample size of 500 patients and a median follow-up of at least 1 year were included. RCTs specifically examining shorter-term effects of ɷ-3 fatty acids on recurrent AF in patients with established AF or postoperative AF were not included. The hazard ratio (HR) for the reported AF outcomes within each trial was meta-analyzed using random effects model with Knapp-Hartung adjustment and evaluated a dose-response relationship with a meta-regression model. RESULTS: Of 4049 screened records, 7 studies were included in the meta-analysis. Of those, 5 were already detected in a previous meta-analysis of cardiovascular RCTs. Among the 81 210 patients from 7 trials, 58 939 (72.6%) were enrolled in trials testing ≤1 g/d and 22 271 (27.4%) in trials testing >1 g/d of ɷ-3 fatty acids. The mean age was 65 years, and 31 842 (39%) were female. The weighted average follow-up was 4.9 years. In meta-analysis, the use of marine ɷ-3 fatty acid supplements was associated with an increased risk of AF (n=2905; HR, 1.25 [95% CI, 1.07-1.46]; P=0.013). In analyses stratified by dose, the HR was greater in the trials testing >1 g/d (HR, 1.49 [95% CI, 1.04-2.15]; P=0.042) compared with those testing ≤1 g/d (HR, 1.12 [95% CI, 1.03-1.22]; P=0.024; P for interaction <0.001). In meta-regression, the HR for AF increased per 1 g higher dosage of ɷ-3 fatty acids dosage (HR, 1.11 [95% CI, 1.06-1.15]; P=0.001). CONCLUSIONS: In RCTs examining cardiovascular outcomes, marine ɷ-3 supplementation was associated with an increased risk of AF. The risk appeared to be greater in trials testing >1 g/d."},{"id":"f4edebd0f4ba","type":"article","url":"https://hartvaat.nl/2021/12/21/iv-ijzercarboxymaltose-en-cardiale-reverse-remodellering-na-crt-iron-crt/","title":"IV ijzercarboxymaltose en cardiale reverse remodellering na CRT: IRON-CRT","title_en":"The effect of intravenous ferric carboxymaltose on cardiac reverse remodelling following cardiac resynchronization therapy-the IRON-CRT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["ijzersuppletie","ijzertekort"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab411","source_url":"https://doi.org/10.1093/eurheartj/ehab411","authors":["Pieter Martens","Matthias Dupont","Jeroen Dauw","Petra Nijst","Lieven Herbots","Paul Dendale","Pieter Vandervoort","Liesbeth Bruckers","Wai Hong Wilson Tang","Wilfried Mullens"],"significance":7,"published":"2021-12-21","source_date":"2021-12-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/cardiale-remodellering/"],"congress":"","summary_en":"The IRON-CRT trial demonstrated that intravenous ferric carboxymaltose enhances cardiac reverse remodeling after CRT implantation in iron-deficient heart failure patients, suggesting that iron repletion and resynchronization have synergistic cardiac benefits.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","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":"IRON-CRT trial naar het effect van IV ijzer op cardiale reverse remodellering na CRT.","abstract_original":"AIMS: Iron deficiency is common in heart failure with reduced ejection fraction (HFrEF) and negatively affects cardiac function and structure. The study the effect of ferric carboxymaltose (FCM) on cardiac reverse remodelling and contractile status in HFrEF. METHODS AND RESULTS: Symptomatic HFrEF patients with iron deficiency and a persistently reduced left ventricular ejection fraction (LVEF <45%) at least 6 months after cardiac resynchronization therapy (CRT) implant were prospectively randomized to FCM or standard of care (SOC) in a double-blind manner. The primary endpoint was the change in LVEF from baseline to 3-month follow-up assessed by three-dimensional echocardiography. Secondary endpoints included the change in left ventricular end-systolic (LVESV) and end-diastolic volume (LVEDV) from baseline to 3-month follow-up. Cardiac performance was evaluated by the force-frequency relationship as assessed by the slope change of the cardiac contractility index (CCI = systolic blood pressure/LVESV index) at 70, 90, and 110 beats of biventricular pacing. A total of 75 patients were randomized to FCM (n = 37) or SOC (n = 38). At baseline, both treatment groups were well matched including baseline LVEF (34 ± 7 vs. 33 ± 8, P = 0.411). After 3 months, the change in LVEF was significantly higher in the FMC group [+4.22%, 95% confidence interval (CI) +3.05%; +5.38%] than in the SOC group (-0.23%, 95% CI -1.44%; +0.97%; P < 0.001). Similarly, LVESV (-9.72 mL, 95% CI -13.5 mL; -5.93 mL vs. -1.83 mL, 95% CI -5.7 mL; 2.1 mL; P = 0.001), but not LVEDV (P = 0.748), improved in the FCM vs. the SOC group. At baseline, both treatment groups demonstrated a negative force-frequency relationship, as defined by a decrease in CCI at higher heart rates (negative slope). FCM resulted in an improvement in the CCI slope during incremental biventricular pacing, with a positive force-frequency relationship at 3 months. Functional status and exercise capacity, as measured by the Kansas City Cardiomyopathy Questionnaire and peak oxygen consumption, were improved by FCM. CONCLUSIONS: Treatment with FCM in HFrEF patients with iron deficiency and persistently reduced LVEF after CRT results in an improvement of cardiac function measured by LVEF, LVESV, and cardiac force-frequency relationship."},{"id":"f0f02c08bd26","type":"article","url":"https://hartvaat.nl/2021/12/18/pci-met-des-versus-cabg-bij-hoofdstamlijden-lancet-precombat-10-jaars/","title":"PCI met DES versus CABG bij hoofdstamlijden: Lancet PRECOMBAT 10-jaars","title_en":"Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)02334-5","source_url":"https://doi.org/10.1016/S0140-6736(21)02334-5","authors":["Marc S Sabatine","Brian A Bergmark","Sabina A Murphy","Patrick T O'Gara","Peter K Smith","Patrick W Serruys","A Pieter Kappetein","Seung-Jung Park","Duk-Woo Park","Evald H Christiansen","Niels R Holm","Per H Nielsen","Gregg W Stone","Joseph F Sabik","Eugene Braunwald"],"significance":8,"published":"2021-12-18","source_date":"2021-12-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"The PRECOMBAT 10-year follow-up showed no significant difference in the composite of death, MI, stroke, or revascularization between PCI with DES and CABG for left main coronary disease, though individual event rates favored CABG numerically. The long-term Korean data added to the revascularization debate.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:41Z","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":"Lancet PRECOMBAT 10-jaarsfollow-up van PCI met DES versus CABG bij linker-hoofdstamcoronairlijden.","abstract_original":"BACKGROUND: The optimal revascularisation strategy for patients with left main coronary artery disease is uncertain. We therefore aimed to evaluate long-term outcomes for patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents versus coronary artery bypass grafting (CABG). METHODS: In this individual patient data meta-analysis, we searched MEDLINE, Embase, and the Cochrane database using the search terms \"left main\", \"percutaneous coronary intervention\" or \"stent\", and \"coronary artery bypass graft*\" to identify randomised controlled trials (RCTs) published in English between database inception and Aug 31, 2021, comparing PCI with drug-eluting stents with CABG in patients with left main coronary artery disease that had at least 5 years of patient follow-up for all-cause mortality. Two authors (MSS and BAB) identified studies meeting the criteria. The primary endpoint was 5-year all-cause mortality. Secondary endpoints were cardiovascular death, spontaneous myocardial infarction, procedural myocardial infarction, stroke, and repeat revascularisation. We used a one-stage approach; event rates were calculated by use of the Kaplan-Meier method and treatment group comparisons were made by use of a Cox frailty model, with trial as a random effect. In Bayesian analyses, the probabilities of absolute risk differences in the primary endpoint between PCI and CABG being more than 0·0%, and at least 1·0%, 2·5%, or 5·0%, were calculated. FINDINGS: Our literature search yielded 1599 results, of which four RCTs-SYNTAX, PRECOMBAT, NOBLE, and EXCEL-meeting our inclusion criteria were included in our meta-analysis. 4394 patients, with a median SYNTAX score of 25·0 (IQR 18·0-31·0), were randomly assigned to PCI (n=2197) or CABG (n=2197). The Kaplan-Meier estimate of 5-year all-cause death was 11·2% (95% CI 9·9-12·6) with PCI and 10·2% (9·0-11·6) with CABG (hazard ratio 1·10, 95% CI 0·91-1·32; p=0·33), resulting in a non-statistically significant absolute risk difference of 0·9% (95% CI -0·9 to 2·8). In Bayesian analyses, there was an 85·7% probability that death at 5 years was greater with PCI than with CABG; this difference was more likely than not less than 1·0% (<0·2% per year). The numerical difference in mortality was comprised more of non-cardiovascular than cardiovascular death. Spontaneous myocardial infarction (6·2%, 95% CI 5·2-7·3 vs 2·6%, 2·0-3·4; hazard ratio [HR] 2·35, 95% CI 1·71-3·23; p<0·0001) and repeat revascularisation (18·3%, 16·7-20·0 vs 10·7%, 9·4-12·1; HR 1·78, 1·51-2·10; p<0·0001) were more common with PCI than with CABG. Differences in procedural myocardial infarction between strategies depended on the definition used. Overall, there was no difference in the risk of stroke between PCI (2·7%, 2·0-3·5) and CABG (3·1%, 2·4-3·9; HR 0·84, 0·59-1·21; p=0·36), but the risk was lower with PCI in the first year after randomisation (HR 0·37, 0·19-0·69). INTERPRETATION: Among patients with left main coronary artery disease and, largely, low or intermediate coronary anatomical complexity, there was no statistically significant difference in 5-year all-cause death between PCI and CABG, although a Bayesian approach suggested a difference probably exists (more likely than not <0·2% per year) favouring CABG. There were trade-offs in terms of the risk of myocardial infarction, stroke, and revascularisation. A heart team approach to communicate expected outcome differences might be useful to assist patients in reaching a treatment decision. FUNDING: No external funding."},{"id":"aa322482a9a8","type":"article","url":"https://hartvaat.nl/2021/12/16/daprodustat-bij-anemie-bij-niet-dialysepatienten-nejm/","title":"Daprodustat bij anemie bij niet-dialysepatiënten: NEJM","title_en":"Daprodustat for the Treatment of Anemia in Patients Not Undergoing Dialysis.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["anemie-ckd","chronische-nierziekte","fidelio-dkd","flow-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2113380","source_url":"https://doi.org/10.1056/NEJMoa2113380","authors":["Ajay K Singh","Kevin Carroll","John J V McMurray","Scott Solomon","Vivekanand Jha","Kirsten L Johansen","Renato D Lopes","Iain C Macdougall","Gregorio T Obrador","Sushrut S Waikar","Christoph Wanner","David C Wheeler","Andrzej Więcek","Allison Blackorby","Borut Cizman","Alexander R Cobitz","Rich Davies","Tara L DiMino","Lata Kler","Amy M Meadowcroft","Lin Taft","Vlado Perkovic"],"significance":7,"published":"2021-12-16","source_date":"2021-12-16","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"This NEJM trial showed that daprodustat effectively treats anemia in CKD patients not on dialysis, with cardiovascular safety comparable to darbepoetin alfa, expanding the oral HIF inhibitor option to the non-dialysis CKD population.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:41Z","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 trial van daprodustat bij anemie bij CKD-patiënten niet op dialyse.","abstract_original":"BACKGROUND: Daprodustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor. In patients with chronic kidney disease (CKD) who are not undergoing dialysis, the efficacy and safety of daprodustat, as compared with the conventional erythropoiesis-stimulating agent darbepoetin alfa, are unknown. METHODS: In this randomized, open-label, phase 3 trial with blinded adjudication of cardiovascular outcomes, we compared daprodustat with darbepoetin alfa for the treatment of anemia in patients with CKD who were not undergoing dialysis. The primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 and the first occurrence of a major adverse cardiovascular event (MACE; a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke). RESULTS: Overall, 3872 patients were randomly assigned to receive daprodustat or darbepoetin alfa. The mean (±SD) baseline hemoglobin levels were similar in the two groups. The mean (±SE) change in the hemoglobin level from baseline to weeks 28 through 52 was 0.74±0.02 g per deciliter in the daprodustat group and 0.66±0.02 g per deciliter in the darbepoetin alfa group (difference, 0.08 g per deciliter; 95% confidence interval [CI], 0.03 to 0.13), which met the prespecified noninferiority margin of -0.75 g per deciliter. During a median follow-up of 1.9 years, a first MACE occurred in 378 of 1937 patients (19.5%) in the daprodustat group and in 371 of 1935 patients (19.2%) in the darbepoetin alfa group (hazard ratio, 1.03; 95% CI, 0.89 to 1.19), which met the prespecified noninferiority margin of 1.25. The percentages of patients with adverse events were similar in the two groups. CONCLUSIONS: Among patients with CKD and anemia who were not undergoing dialysis, daprodustat was noninferior to darbepoetin alfa with respect to the change in the hemoglobin level from baseline and with respect to cardiovascular outcomes. (Funded by GlaxoSmithKline; ASCEND-ND ClinicalTrials.gov number, NCT02876835.)."},{"id":"8314f8063c78","type":"article","url":"https://hartvaat.nl/2021/12/16/daprodustat-bij-anemie-bij-dialysepatienten-nejm/","title":"Daprodustat bij anemie bij dialysepatiënten: NEJM","title_en":"Daprodustat for the Treatment of Anemia in Patients Undergoing Dialysis.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["internist"],"tags":["anemie-ckd","dapa-hf","flow-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2113379","source_url":"https://doi.org/10.1056/NEJMoa2113379","authors":["Ajay K Singh","Kevin Carroll","Vlado Perkovic","Scott Solomon","Vivekanand Jha","Kirsten L Johansen","Renato D Lopes","Iain C Macdougall","Gregorio T Obrador","Sushrut S Waikar","Christoph Wanner","David C Wheeler","Andrzej Więcek","Allison Blackorby","Borut Cizman","Alexander R Cobitz","Rich Davies","Jo Dole","Lata Kler","Amy M Meadowcroft","Xinyi Zhu","John J V McMurray"],"significance":7,"published":"2021-12-16","source_date":"2021-12-16","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"This NEJM trial demonstrated that daprodustat, an oral HIF prolyl hydroxylase inhibitor, is noninferior to darbepoetin alfa for treating anemia in dialysis patients, with a favorable cardiovascular safety profile and the convenience of oral dosing.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:41Z","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 trial van daprodustat (HIF-PHI) bij anemie bij dialysepatiënten. Orale anemiebehandeling voor CKD.","abstract_original":"BACKGROUND: Among patients with chronic kidney disease (CKD), the use of recombinant human erythropoietin and its derivatives for the treatment of anemia has been linked to a possibly increased risk of stroke, myocardial infarction, and other adverse events. Several trials have suggested that hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitors (PHIs) are as effective as erythropoiesis-stimulating agents (ESAs) in increasing hemoglobin levels. METHODS: In this randomized, open-label, phase 3 trial, we assigned patients with CKD who were undergoing dialysis and who had a hemoglobin level of 8.0 to 11.5 g per deciliter to receive an oral HIF-PHI (daprodustat) or an injectable ESA (epoetin alfa if they were receiving hemodialysis or darbepoetin alfa if they were receiving peritoneal dialysis). The two primary outcomes were the mean change in the hemoglobin level from baseline to weeks 28 through 52 (noninferiority margin, -0.75 g per deciliter) and the first occurrence of a major adverse cardiovascular event (a composite of death from any cause, nonfatal myocardial infarction, or nonfatal stroke), with a noninferiority margin of 1.25. RESULTS: A total of 2964 patients underwent randomization. The mean (±SD) baseline hemoglobin level was 10.4±1.0 g per deciliter overall. The mean (±SE) change in the hemoglobin level from baseline to weeks 28 through 52 was 0.28±0.02 g per deciliter in the daprodustat group and 0.10±0.02 g per deciliter in the ESA group (difference, 0.18 g per deciliter; 95% confidence interval [CI], 0.12 to 0.24), which met the prespecified noninferiority margin of -0.75 g per deciliter. During a median follow-up of 2.5 years, a major adverse cardiovascular event occurred in 374 of 1487 patients (25.2%) in the daprodustat group and in 394 of 1477 (26.7%) in the ESA group (hazard ratio, 0.93; 95% CI, 0.81 to 1.07), which also met the prespecified noninferiority margin for daprodustat. The percentages of patients with other adverse events were similar in the two groups. CONCLUSIONS: Among patients with CKD undergoing dialysis, daprodustat was noninferior to ESAs regarding the change in the hemoglobin level from baseline and cardiovascular outcomes. (Funded by GlaxoSmithKline; ASCEND-D ClinicalTrials.gov number, NCT02879305.)."},{"id":"1d91bf9ca435","type":"article","url":"https://hartvaat.nl/2021/12/11/qfr-geleide-coronaire-interventie-lancet-favor-iii-china-sham-gecontroleerd/","title":"QFR-geleide coronaire interventie: Lancet FAVOR III China sham-gecontroleerd","title_en":"Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)02248-0","source_url":"https://doi.org/10.1016/S0140-6736(21)02248-0","authors":["Bo Xu","Shengxian Tu","Lei Song","Zening Jin","Bo Yu","Guosheng Fu","Yujie Zhou","Jian'an Wang","Yundai Chen","Jun Pu","Lianglong Chen","Xinkai Qu","Junqing Yang","Xuebo Liu","Lijun Guo","Chengxing Shen","Yaojun Zhang","Qi Zhang","Hongwei Pan","Xiaogang Fu","Jian Liu","Yanyan Zhao","Javier Escaned","Yang Wang","William F Fearon","Kefei Dou","Ajay J Kirtane","Yongjian Wu","Patrick W Serruys","Weixian Yang","William Wijns","Changdong Guan","Martin B Leon","Shubin Qiao","Gregg W Stone"],"significance":8,"published":"2021-12-11","source_date":"2021-12-11","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"The FAVOR III China trial demonstrated that angiographic quantitative flow ratio (QFR)-guided PCI significantly improved 1-year outcomes compared with angiography-guided PCI. The wire-free virtual physiological assessment offered a practical alternative to pressure wire-based FFR measurement.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:40Z","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 FAVOR III China sham-gecontroleerde trial die QFR-geleide PCI vergeleek met angiografie-geleide PCI. Virtuele fysiologie zonder drukdraad.","abstract_original":"BACKGROUND: Compared with visual angiographic assessment, pressure wire-based physiological measurement more accurately identifies flow-limiting lesions in patients with coronary artery disease. Nonetheless, angiography remains the most widely used method to guide percutaneous coronary intervention (PCI). In FAVOR III China, we aimed to establish whether clinical outcomes might be improved by lesion selection for PCI using the quantitative flow ratio (QFR), a novel angiography-based approach to estimate the fractional flow reserve. METHODS: FAVOR III China is a multicentre, blinded, randomised, sham-controlled trial done at 26 hospitals in China. Patients aged 18 years or older, with stable or unstable angina pectoris or patients who had a myocardial infarction at least 72 h before screening, who had at least one lesion with a diameter stenosis of 50-90% in a coronary artery with a reference vessel of at least 2·5 mm diameter by visual assessment were eligible. Patients were randomly assigned to a QFR-guided strategy (PCI performed only if QFR ≤0·80) or an angiography-guided strategy (PCI based on standard visual angiographic assessment). Participants and clinical assessors were masked to treatment allocation. The primary endpoint was the 1-year rate of major adverse cardiac events, a composite of death from any cause, myocardial infarction, or ischaemia-driven revascularisation. The primary analysis was done in the intention-to-treat population. The trial was registered with ClinicalTrials.gov (NCT03656848). FINDINGS: Between Dec 25, 2018, and Jan 19, 2020, 3847 patients were enrolled. After exclusion of 22 patients who elected not to undergo PCI or who were withdrawn by their physicians, 3825 participants were included in the intention-to-treat population (1913 in the QFR-guided group and 1912 in the angiography-guided group). The mean age was 62·7 years (SD 10·1), 2699 (70·6%) were men and 1126 (29·4%) were women, 1295 (33·9%) had diabetes, and 2428 (63·5%) presented with an acute coronary syndrome. The 1-year primary endpoint occurred in 110 (Kaplan-Meier estimated rate 5·8%) participants in the QFR-guided group and in 167 (8·8%) participants in the angiography-guided group (difference, -3·0% [95% CI -4·7 to -1·4]; hazard ratio 0·65 [95% CI 0·51 to 0·83]; p=0·0004), driven by fewer myocardial infarctions and ischaemia-driven revascularisations in the QFR-guided group than in the angiography-guided group. INTERPRETATION: In FAVOR III China, among patients undergoing PCI, a QFR-guided strategy of lesion selection improved 1-year clinical outcomes compared with standard angiography guidance. FUNDING: Beijing Municipal Science and Technology Commission, Chinese Academy of Medical Sciences, and the National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital."},{"id":"d2563e2b36ce","type":"article","url":"https://hartvaat.nl/2021/12/09/finerenon-bij-nierziekte-met-diabetes-type-2-nejm-figaro-dkd/","title":"Finerenon bij nierziekte met diabetes type 2: NEJM FIGARO-DKD","title_en":"Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anemie-ckd","chronische-nierziekte","diabetes-en-hart","diabetes-type-2","diabetische-nefropathie","fidelio-dkd","figaro-dkd","finerenon-hartfalen-nierziekte","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2110956","source_url":"https://doi.org/10.1056/NEJMoa2110956","authors":["Bertram Pitt","Gerasimos Filippatos","Rajiv Agarwal","Stefan D Anker","George L Bakris","Peter Rossing","Amer Joseph","Peter Kolkhof","Christina Nowack","Patrick Schloemer","Luis M Ruilope"],"significance":10,"published":"2021-12-09","source_date":"2021-12-09","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"The FIGARO-DKD trial demonstrated that finerenone reduced cardiovascular events in patients with type 2 diabetes and a broader range of CKD severity than FIDELIO, including those with earlier-stage kidney disease and less severely elevated albuminuria. Together with FIDELIO, the FIDELITY program established finerenone's cardiorenal benefit across the full CKD spectrum in diabetes.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:40Z","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":"Landmark NEJM FIGARO-DKD trial die aantoonde dat finerenon cardiovasculaire events vermindert bij een bredere CKD-populatie dan FIDELIO. Samen completeren ze het FIDELITY-programma.","abstract_original":"BACKGROUND: Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has favorable effects on cardiorenal outcomes in patients with predominantly stage 3 or 4 chronic kidney disease (CKD) with severely elevated albuminuria and type 2 diabetes. The use of finerenone in patients with type 2 diabetes and a wider range of CKD is unclear. METHODS: In this double-blind trial, we randomly assigned patients with CKD and type 2 diabetes to receive finerenone or placebo. Eligible patients had a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of 30 to less than 300 and an estimated glomerular filtration rate (eGFR) of 25 to 90 ml per minute per 1.73 m2 of body-surface area (stage 2 to 4 CKD) or a urinary albumin-to-creatinine ratio of 300 to 5000 and an eGFR of at least 60 ml per minute per 1.73 m2 (stage 1 or 2 CKD). Patients were treated with renin-angiotensin system blockade that had been adjusted before randomization to the maximum dose on the manufacturer's label that did not cause unacceptable side effects. The primary outcome, assessed in a time-to-event analysis, was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. The first secondary outcome was a composite of kidney failure, a sustained decrease from baseline of at least 40% in the eGFR, or death from renal causes. Safety was assessed as investigator-reported adverse events. RESULTS: A total of 7437 patients underwent randomization. Among the patients included in the analysis, during a median follow-up of 3.4 years, a primary outcome event occurred in 458 of 3686 patients (12.4%) in the finerenone group and in 519 of 3666 (14.2%) in the placebo group (hazard ratio, 0.87; 95% confidence interval [CI], 0.76 to 0.98; P = 0.03), with the benefit driven primarily by a lower incidence of hospitalization for heart failure (hazard ratio, 0.71; 95% CI, 0.56 to 0.90). The secondary composite outcome occurred in 350 patients (9.5%) in the finerenone group and in 395 (10.8%) in the placebo group (hazard ratio, 0.87; 95% CI, 0.76 to 1.01). The overall frequency of adverse events did not differ substantially between groups. The incidence of hyperkalemia-related discontinuation of the trial regimen was higher with finerenone (1.2%) than with placebo (0.4%). CONCLUSIONS: Among patients with type 2 diabetes and stage 2 to 4 CKD with moderately elevated albuminuria or stage 1 or 2 CKD with severely elevated albuminuria, finerenone therapy improved cardiovascular outcomes as compared with placebo. (Funded by Bayer; FIGARO-DKD ClinicalTrials.gov number, NCT02545049.)."},{"id":"03fc73711555","type":"article","url":"https://hartvaat.nl/2021/12/07/av-junctieablatie-plus-crt-bij-permanent-af-met-smal-qrs-apaf-crt-mortaliteitsan/","title":"AV-junctieablatie plus CRT bij permanent AF met smal QRS: APAF-CRT mortaliteitsanalyse","title_en":"AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab569","source_url":"https://doi.org/10.1093/eurheartj/ehab569","authors":["Michele Brignole","Francesco Pentimalli","Pietro Palmisano","Maurizio Landolina","Fabio Quartieri","Eraldo Occhetta","Leonardo Calò","Giuseppe Mascia","Lluis Mont","Kevin Vernooy","Vincent van Dijk","Cor Allaart","Laurent Fauchier","Maurizio Gasparini","Gianfranco Parati","Davide Soranna","Michiel Rienstra","Isabelle C Van Gelder"],"significance":8,"published":"2021-12-07","source_date":"2021-12-07","image":"","kennis":[],"congress":"","summary_en":"The APAF-CRT mortality analysis confirmed that AV junction ablation combined with cardiac resynchronization therapy significantly reduced all-cause mortality in patients with permanent atrial fibrillation, narrow QRS, and heart failure. The result established this strategy as a life-saving intervention in drug-refractory AF with HF.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:40Z","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":"APAF-CRT mortaliteitsanalyse van AV-junctieablatie plus CRT bij permanent AF met smal QRS. Bevestigt mortaliteitsreductie.","abstract_original":"AIMS: In patients with atrial fibrillation (AF) and heart failure (HF), strict and regular rate control with atrioventricular junction ablation and biventricular pacemaker (Ablation + CRT) has been shown to be superior to pharmacological rate control in reducing HF hospitalizations. However, whether it also improves survival is unknown. METHODS AND RESULTS: In this international, open-label, blinded outcome trial, we randomly assigned patients with severely symptomatic permanent AF >6 months, narrow QRS (≤110 ms) and at least one HF hospitalization in the previous year to Ablation + CRT or to pharmacological rate control. We hypothesized that Ablation + CRT is superior in reducing the primary endpoint of all-cause mortality. A total of 133 patients were randomized. The mean age was 73 ± 10 years, and 62 (47%) were females. The trial was stopped for efficacy at interim analysis after a median of 29 months of follow-up per patient. The primary endpoint occurred in 7 patients (11%) in the Ablation + CRT arm and in 20 patients (29%) in the Drug arm [hazard ratio (HR) 0.26, 95% confidence interval (CI) 0.10-0.65; P = 0.004]. The estimated death rates at 2 years were 5% and 21%, respectively; at 4 years, 14% and 41%. The benefit of Ablation + CRT of all-cause mortality was similar in patients with ejection fraction (EF) ≤35% and in those with >35%. The secondary endpoint combining all-cause mortality or HF hospitalization was significantly lower in the Ablation + CRT arm [18 (29%) vs. 36 (51%); HR 0.40, 95% CI 0.22-0.73; P = 0.002]. CONCLUSIONS: Ablation + CRT was superior to pharmacological therapy in reducing mortality in patients with permanent AF and narrow QRS who were hospitalized for HF, irrespective of their baseline EF. STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT02137187."},{"id":"9356bdad4e5b","type":"article","url":"https://hartvaat.nl/2021/12/07/minimaal-onderbroken-versus-continue-doac-bij-af-ablatie-meta-analyse/","title":"Minimaal onderbroken versus continue DOAC bij AF-ablatie: meta-analyse","title_en":"Meta-analysis of controlled studies on minimally interrupted vs. continuous use of non-vitamin K antagonist oral anticoagulants in catheter ablation for atrial fibrillation.","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/euab175","source_url":"https://doi.org/10.1093/europace/euab175","authors":["Stijn P G van Vugt","Sjoerd W Westra","Rick H J A Volleberg","Gerjon Hannink","Rena Nakamura","Carlo de Asmundis","Gian-Battista Chierchia","Eliano P Navarese","Marc A Brouwer"],"significance":6,"published":"2021-12-07","source_date":"2021-12-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This meta-analysis compared minimally interrupted with continuous DOAC use during AF catheter ablation, showing similar safety and efficacy for both periprocedural anticoagulation strategies.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:40Z","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":"Meta-analyse van gecontroleerde studies naar minimaal onderbroken versus continue DOAC bij AF-ablatie.","abstract_original":"AIMS: At present, there are no guideline recommendations for minimally interrupted use of non-vitamin K antagonist oral anticoagulants (mi-NOAC) during catheter ablation (CA) for atrial fibrillation (AF). Current evidence is predominantly based on observational studies, with continuous use of vitamin K antagonist in the control arm. This quantitative summary reflects the first high-level evidence on contemporary regimens, with continuous NOAC use (c-NOAC) as the current gold standard. METHODS AND RESULTS: Meta-analysis (Pubmed, Embase, and Web of Science) on prospective, controlled studies comparing contemporary mi-NOAC (without bridging) with c-NOAC. Net adverse clinical events (major bleeding, thrombo-embolic events) were the primary outcome. In addition, we analysed total bleeding, minor bleeding, and silent cerebral embolism. Eight studies (six randomized, two observational) with 2168 patients were summarized. The primary endpoint occurred in 1.0% (18/1835): 1.1% (11/1005) vs. 0.8% (7/830) for the mi-NOAC and c-NOAC groups, respectively; odds ratio (OR) 1.20 [95% confidence interval (CI) 0.49-2.92, P = 0.64]. The OR for total bleeding on mi-NOAC was 1.26 (95% CI 0.97-1.63, P = 0.07). ORs for minor bleeding and silent cerebral embolism were 1.17 (95% CI 0.80-1.70, P = 0.34) and 2.62 (95% CI 0.54-12.61, P = 0.12), respectively. CONCLUSION: This synopsis provides a quantitative synthesis of high-level evidence on a contemporary strategy of mi-NOAC in CA for AF, and overall clinical outcomes were not different from continuous NOAC use. Despite preprocedural interruption, there was no sign of lower bleeding rates. Additional higher volume datasets are warranted for more precise treatment effect estimations of this everyday alternative anticoagulation strategy in AF ablation."},{"id":"6457210cbaae","type":"article","url":"https://hartvaat.nl/2021/12/07/gold-force-multi-elektrode-rf-versus-irrigated-rf-bij-af-gerandomiseerde-trial/","title":"GOLD FORCE multi-elektrode RF versus irrigated RF bij AF: gerandomiseerde trial","title_en":"Efficacy and safety of the GOLD FORCE multicentre randomized clinical trial: multielectrode phased radiofrequency vs. irrigated radiofrequency single-tip catheter with contact force ablation for treatment of symptomatic 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/euab168","source_url":"https://doi.org/10.1093/europace/euab168","authors":["Lisette I S Wintgens","Martijn N Klaver","Moniek Maarse","Stefan G Spitzer","Anke Langbein","Martin J Swaans","Vincent F Van Dijk","Jippe C Balt","Maurits C E F Wijffels","Jan G P Tijssen","Arif Elvan","Lucas V A Boersma"],"significance":5,"published":"2021-12-07","source_date":"2021-12-07","image":"","kennis":[],"congress":"","summary_en":"The GOLD FORCE trial compared multielectrode phased RF ablation with irrigated RF ablation for AF, evaluating a balloon-based multielectrode technology against the conventional single-tip approach.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T13:28:40Z","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":"GOLD FORCE gerandomiseerde trial die multi-elektrode phased RF vergeleek met geïrrigeerde RF-ablatie bij AF.","abstract_original":"AIMS: Pulmonary vein isolation (PVI) for atrial fibrillation (AF) has become increasingly safe and effective with the evolution of single-tip ablation catheters aided by contact force sensing (ST-CF) and single-shot devices such as the second-generation pulmonary vein ablation catheter (PVAC) Gold multi-electrode array. The multicentre randomized GOLD FORCE trial was conducted to evaluate non-inferiority of safety and efficacy of PVAC Gold PVI compared to ST-CF ablation for paroxysmal AF. METHODS AND RESULTS: The primary efficacy endpoint documented AF recurrence ≥30 s was assessed by time-to-first-event analysis after a 90-day blanking period using repeated 7-day Holters. Secondary endpoints include acute success and procedural characteristics. Safety endpoints included procedural complications, stroke/transient ischaemic attack (TIA), tamponade, bleeding, and access site complications. Two hundred and eight patients underwent randomization and PVI (103 assigned to PVAC Gold, 105 to ST-CF). Acute success rates were 95% and 97% for PVAC Gold and ST-CF, respectively. At 12 months, AF recurrence was observed in 46.6% of the PVAC Gold group and in 26.2% of the ST-CF group [absolute efficacy difference 20.4% (95% confidence interval, CI 7.5-33.2%), hazard ratio 2.05 (95% CI 1.28-3.29), P = 0.003]. PVAC Gold had significantly shorter procedure and ablation times. Complication rates were 5.7% and 4.9% for PVAC Gold and ST-CF, respectively (P = 0.782). CONCLUSION: In this multicentre randomized clinical trial, ablation with ST-CF and PVAC Gold ablation catheters non-inferiority for efficacy was not met. AF recurrence was significantly more frequent in the PVAC Gold group compared to single-tip contact force group. Both groups had similarly low rates of adverse events. PVAC Gold ablation had significantly shorter procedure and ablation times."},{"id":"82f9e2229b04","type":"article","url":"https://hartvaat.nl/2021/12/04/posterieure-pericardiotomie-ter-preventie-van-af-na-hartchirurgie-lancet-palacs/","title":"Posterieure pericardiotomie ter preventie van AF na hartchirurgie: Lancet PALACS","title_en":"Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aspirine","pericarditis","secundaire-preventie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)02490-9","source_url":"https://doi.org/10.1016/S0140-6736(21)02490-9","authors":["Mario Gaudino","Tommaso Sanna","Karla V Ballman","N Bryce Robinson","Irbaz Hameed","Katia Audisio","Mohamed Rahouma","Antonino Di Franco","Giovanni J Soletti","Christopher Lau","Lisa Q Rong","Massimo Massetti","Marc Gillinov","Niv Ad","Pierre Voisine","J Michael DiMaio","Joanna Chikwe","Stephen E Fremes","Filippo Crea","John D Puskas","Leonard Girardi"],"significance":8,"published":"2021-12-04","source_date":"2021-12-04","image":"","kennis":[],"congress":"","summary_en":"The PALACS trial demonstrated that posterior left pericardiotomy, a simple 30-second surgical addition during cardiac surgery, significantly reduced the incidence of postoperative atrial fibrillation. The low-cost, low-risk intervention offered an elegant preventive strategy.","created":"2026-07-03T10:29:33Z","updated":"2026-07-03T18:38:51Z","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":"Lancet PALACS adaptieve trial die posterieure linkspericardiotomie onderzocht voor preventie van postoperatief AF. Simpele chirurgische techniek met groot effect.","abstract_original":"BACKGROUND: Atrial fibrillation is the most common complication after cardiac surgery and is associated with extended in-hospital stay and increased adverse outcomes, including death and stroke. Pericardial effusion is common after cardiac surgery and can trigger atrial fibrillation. We tested the hypothesis that posterior left pericardiotomy, a surgical manoeuvre that drains the pericardial space into the left pleural cavity, might reduce the incidence of atrial fibrillation after cardiac surgery. METHODS: In this adaptive, randomised, controlled trial, we recruited adult patients (aged ≥18 years) undergoing elective interventions on the coronary arteries, aortic valve, or ascending aorta, or a combination of these, performed by members of the Department of Cardiothoracic Surgery from Weill Cornell Medicine at the New York Presbyterian Hospital in New York, NY, USA. Patients were eligible if they had no history of atrial fibrillation or other arrhythmias or contraindications to the experimental intervention. Eligible patients were randomly assigned (1:1), stratified by CHA2DS2-VASc score and using a mixed-block randomisation approach (block sizes of 4, 6, and 8), to posterior left pericardiotomy or no intervention. Patients and assessors were blinded to treatment assignment. Patients were followed up until 30 days after hospital discharge. The primary outcome was the incidence of atrial fibrillation during postoperative in-hospital stay, which was assessed in the intention-to-treat (ITT) population. Safety was assessed in the as-treated population. This study is registered with ClinicalTrials.gov, NCT02875405, and is now complete. FINDINGS: Between Sept 18, 2017, and Aug 2, 2021, 3601 patients were screened and 420 were included and randomly assigned to the posterior left pericardiotomy group (n=212) or the no intervention group (n=208; ITT population). The median age was 61·0 years (IQR 53·0-70·0), 102 (24%) patients were female, and 318 (76%) were male, with a median CHA2DS2-VASc score of 2·0 (IQR 1·0-3·0). The two groups were balanced with respect to clinical and surgical characteristics. No patients were lost to follow-up and data completeness was 100%. Three patients in the posterior left pericardiotomy group did not receive the intervention. In the ITT population, the incidence of postoperative atrial fibrillation was significantly lower in the posterior left pericardiotomy group than in the no intervention group (37 [17%] of 212 vs 66 [32%] of 208 [p=0·0007]; odds ratio adjusted for the stratification variable 0·44 [95% CI 0·27-0·70; p=0·0005]). Two (1%) of 209 patients in the posterior left pericardiotomy group and one (<1%) of 211 in the no intervention group died within 30 days after hospital discharge. The incidence of postoperative pericardial effusion was lower in the posterior left pericardiotomy group than in the no intervention group (26 [12%] of 209 vs 45 [21%] of 211; relative risk 0·58 [95% CI 0·37-0·91]). Postoperative major adverse events occurred in six (3%) patients in the posterior left pericardiotomy group and in four (2%) in the no intervention group. No posterior left pericardiotomy related complications were seen. INTERPRETATION: Posterior left pericardiotomy is highly effective in reducing the incidence of atrial fibrillation after surgery on the coronary arteries, aortic valve, or ascending aorta, or a combination of these without additional risk of postoperative complications. FUNDING: None."},{"id":"c1aac3be3ae6","type":"article","url":"https://hartvaat.nl/2021/12/02/edoxaban-versus-vka-bij-af-na-tavr-nejm-envisage-tavi-af/","title":"Edoxaban versus VKA bij AF na TAVR: NEJM ENVISAGE-TAVI AF","title_en":"Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2111016","source_url":"https://doi.org/10.1056/NEJMoa2111016","authors":["Nicolas M Van Mieghem","Martin Unverdorben","Christian Hengstenberg","Helge Möllmann","Roxana Mehran","Diego López-Otero","Luis Nombela-Franco","Raul Moreno","Peter Nordbeck","Holger Thiele","Irene Lang","José L Zamorano","Fayaz Shawl","Masanori Yamamoto","Yusuke Watanabe","Kentaro Hayashida","Rainer Hambrecht","Felix Meincke","Pascal Vranckx","James Jin","Eric Boersma","Josep Rodés-Cabau","Patrick Ohlmann","Piera Capranzano","Hyo-Soo Kim","Thomas Pilgrim","Richard Anderson","Usman Baber","Anil Duggal","Petra Laeis","Hans Lanz","Cathy Chen","Marco Valgimigli","Roland Veltkamp","Shigeru Saito","George D Dangas"],"significance":8,"published":"2021-12-02","source_date":"2021-12-02","image":"","kennis":[],"congress":"","summary_en":"The ENVISAGE-TAVI AF trial showed that edoxaban was noninferior to vitamin K antagonists for the composite of net adverse clinical events in patients with AF after TAVR, but was associated with more gastrointestinal bleeding. The results informed DOAC use in the growing post-TAVR AF population.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:40Z","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":"NEJM ENVISAGE-TAVI AF trial die edoxaban vergeleek met VKA bij AF na TAVR. Verandert het anticoagulantiebeleid na klepinterventie.","abstract_original":"BACKGROUND: The role of direct oral anticoagulants as compared with vitamin K antagonists for atrial fibrillation after successful transcatheter aortic-valve replacement (TAVR) has not been well studied. METHODS: We conducted a multicenter, prospective, randomized, open-label, adjudicator-masked trial comparing edoxaban with vitamin K antagonists in patients with prevalent or incident atrial fibrillation as the indication for oral anticoagulation after successful TAVR. The primary efficacy outcome was a composite of adverse events consisting of death from any cause, myocardial infarction, ischemic stroke, systemic thromboembolism, valve thrombosis, or major bleeding. The primary safety outcome was major bleeding. On the basis of a hierarchical testing plan, the primary efficacy and safety outcomes were tested sequentially for noninferiority, with noninferiority of edoxaban established if the upper boundary of the 95% confidence interval for the hazard ratio did not exceed 1.38. Superiority testing of edoxaban for efficacy would follow if noninferiority and superiority were established for major bleeding. RESULTS: A total of 1426 patients were enrolled (713 in each group). The mean age of the patients was 82.1 years, and 47.5% of the patients were women. Almost all the patients had atrial fibrillation before TAVR. The rate of the composite primary efficacy outcome was 17.3 per 100 person-years in the edoxaban group and 16.5 per 100 person-years in the vitamin K antagonist group (hazard ratio, 1.05; 95% confidence interval [CI], 0.85 to 1.31; P = 0.01 for noninferiority). Rates of major bleeding were 9.7 per 100 person-years and 7.0 per 100 person-years, respectively (hazard ratio, 1.40; 95% CI, 1.03 to 1.91; P = 0.93 for noninferiority); the difference between groups was mainly due to more gastrointestinal bleeding with edoxaban. Rates of death from any cause or stroke were 10.0 per 100 person-years in the edoxaban group and 11.7 per 100 person-years in the vitamin K antagonist group (hazard ratio, 0.85; 95% CI, 0.66 to 1.11). CONCLUSIONS: In patients with mainly prevalent atrial fibrillation who underwent successful TAVR, edoxaban was noninferior to vitamin K antagonists as determined by a hazard ratio margin of 38% for a composite primary outcome of adverse clinical events. The incidence of major bleeding was higher with edoxaban than with vitamin K antagonists. (Funded by Daiichi Sankyo; ENVISAGE-TAVI AF ClinicalTrials.gov number, NCT02943785.)."},{"id":"b7b034d9593a","type":"article","url":"https://hartvaat.nl/2021/12/01/ticagrelor-monotherapie-bij-hoog-bloedingsrisico-na-pci-twilight-hbr/","title":"Ticagrelor monotherapie bij hoog bloedingsrisico na PCI: TWILIGHT-HBR","title_en":"Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab702","source_url":"https://doi.org/10.1093/eurheartj/ehab702","authors":["Javier Escaned","Davide Cao","Usman Baber","Johny Nicolas","Samantha Sartori","Zhongjie Zhang","George Dangas","Dominick J Angiolillo","Carlo Briguori","David J Cohen","Timothy Collier","Dariusz Dudek","Michael Gibson","Robert Gil","Kurt Huber","Upendra Kaul","Ran Kornowski","Mitchell W Krucoff","Vijay Kunadian","Shamir Mehta","David J Moliterno","E Magnus Ohman","Keith G Oldroyd","Gennaro Sardella","Samin K Sharma","Richard Shlofmitz","Giora Weisz","Bernhard Witzenbichler","Stuart Pocock","Roxana Mehran"],"significance":7,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This TWILIGHT-HBR subanalysis confirmed that ticagrelor monotherapy after short DAPT significantly reduces bleeding in high-bleeding-risk patients undergoing PCI, with no increase in ischemic events, supporting the de-escalation approach in this vulnerable population.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:40Z","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":"TWILIGHT-HBR subanalyse van ticagrelor monotherapie bij patiënten met hoog bloedingsrisico na PCI.","abstract_original":"AIMS: Patients at high bleeding risk (HBR) represent a prevalent subgroup among those undergoing percutaneous coronary intervention (PCI). Early aspirin discontinuation after a short course of dual antiplatelet therapy (DAPT) has emerged as a bleeding avoidance strategy. The aim of this study was to assess the effects of ticagrelor monotherapy after 3-month DAPT in a contemporary HBR population. METHODS AND RESULTS: This prespecified analysis of the TWILIGHT trial evaluated the treatment effects of early aspirin withdrawal followed by ticagrelor monotherapy in HBR patients undergoing PCI with drug-eluting stents. After 3 months of ticagrelor plus aspirin, event-free patients were randomized to 12 months of aspirin or placebo in addition to ticagrelor. A total of 1064 (17.2%) met the Academic Research Consortium definition for HBR. Ticagrelor monotherapy reduced the incidence of the primary endpoint of Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding compared with ticagrelor plus aspirin in HBR (6.3% vs. 11.4%; hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.35-0.82) and non-HBR patients (3.5% vs. 5.9%; HR 0.59, 95% CI 0.46-0.77) with similar relative (Pinteraction = 0.67) but a trend towards greater absolute risk reduction in the former [-5.1% vs. -2.3%; difference in absolute risk differences (ARDs) -2.8%, 95% CI -6.4% to 0.8%, P = 0.130]. A similar pattern was observed for more severe BARC 3 or 5 bleeding with a larger absolute risk reduction in HBR patients (-3.5% vs. -0.5%; difference in ARDs -3.0%, 95% CI -5.2% to -0.8%, P = 0.008). There was no significant difference in the key secondary endpoint of death, myocardial infarction, or stroke between treatment arms, irrespective of HBR status. CONCLUSIONS: Among HBR patients undergoing PCI who completed 3-month DAPT without experiencing major adverse events, aspirin discontinuation followed by ticagrelor monotherapy significantly reduced bleeding without increasing ischaemic events, compared with ticagrelor plus aspirin. The absolute risk reduction in major bleeding was larger in HBR than non-HBR patients."},{"id":"b38c99055351","type":"article","url":"https://hartvaat.nl/2021/12/01/sacubitril-valsartan-uitgebreide-fda-labeling-jama-cardiology-implicaties/","title":"Sacubitril/valsartan uitgebreide FDA-labeling: JAMA Cardiology implicaties","title_en":"Potential Implications of Expanded US Food and Drug Administration Labeling for Sacubitril/Valsartan in the US.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.3651","source_url":"https://doi.org/10.1001/jamacardio.2021.3651","authors":["Muthiah Vaduganathan","Brian L Claggett","Stephen J Greene","Rahul Aggarwal","Ankeet S Bhatt","John J V McMurray","Gregg C Fonarow","Scott D Solomon"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"This analysis estimated the potential impact of expanded FDA labeling for sacubitril-valsartan (including HF with LVEF above 40%) on the eligible US patient population, quantifying the implementation opportunity.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:40Z","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 Cardiology analyse naar de potentiële implicaties van uitgebreide FDA-labeling voor sacubitril/valsartan.","abstract_original":"IMPORTANCE: The US Food and Drug Administration (FDA) expanded labeling for sacubitril/valsartan for use in individuals with chronic heart failure (HF) with left ventricular ejection fraction (LVEF) lower than normal. The population-level implications of implementation of sacubitril/valsartan at higher LVEF ranges is unknown. While the Prospective Comparison of ARNI With ARB Global Outcomes in HF With Preserved Ejection Fraction (PARAGON-HF) trial did not meet its primary end point, the trial may provide useful information in projecting expected clinical events among treated individuals. OBJECTIVE: To quantify newly eligible treatment candidates for sacubitril/valsartan under the expanded FDA labeling and to apply treatment effects and the number needed to treat (NNT) to prevent 1 worsening HF event derived from subgroups of the PARAGON-HF trial who fall under the revised FDA label. DESIGN, SETTING, AND PARTICIPANTS: Newly eligible treatment candidates were estimated by mapping the LVEF distribution from 559 520 adult patients hospitalized between 2014 and 2019 in the Get With The Guidelines-Heart Failure registry to adults self-identifying with HF in the National Health and Nutrition Examination Survey (2015 to 2018). The NNT with 3 years of treatment for 3 end points of interest (total HF hospitalizations, total HF hospitalizations and cardiovascular death, and total HF hospitalizations and urgent HF visits and cardiovascular death) were estimated from the PARAGON-HF trial. Data were analyzed from February to June 2021. MAIN OUTCOMES AND MEASURES: Number of worsening HF events prevented or postponed if eligible patients were treated with sacubitril/valsartan for 3 years. RESULTS: Of an estimated 4 682 098 adults, the mean (SE) age was 66.3 (0.8) years, 1 995 037 (42.6%) were women, and 748 045 (16.0%) were Black. The potential number of adults projected to be newly eligible varied by the definition of FDA labeling of lower than normal LVEF from 643 161 (95% CI, 534 433-751 888; LVEF of 41% to 50%) to 1 838 756 (95% CI, 1 527 911-2 149 601; LVEF of 41% to 60%). In the PARAGON-HF trial, the NNT to prevent a worsening HF event (range, 7 to 12 patients) was consistent irrespective of specific LVEF range selected. Comprehensive implementation of sacubitril/valsartan among newly eligible patients was empirically estimated to prevent up to 69 268 (95% CI, 57 558-80 978) worsening HF events (LVEF of 41% to 50%) to 182 592 (95% CI, 151 725-213 460) worsening HF events (LVEF of 41% to 60%). CONCLUSIONS AND RELEVANCE: The expanded FDA labeling is positioned to substantially increase the potential HF population eligible for sacubitril/valsartan by up to 1.8 million individuals and has the potential to prevent or postpone as many as 180 000 worsening HF events, depending on the definition of normal LVEF."},{"id":"f40f6db5bbd8","type":"article","url":"https://hartvaat.nl/2021/12/01/hs-troponine-en-natriuretische-peptiden-na-intensieve-bp-verlaging-sprint-biomar/","title":"hs-troponine en natriuretische peptiden na intensieve BP-verlaging: SPRINT-biomarkers","title_en":"Associations of High-Sensitivity Troponin and Natriuretic Peptide Levels With Outcomes After Intensive Blood Pressure Lowering: Findings From the SPRINT Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","nt-probnp","troponine"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.3187","source_url":"https://doi.org/10.1001/jamacardio.2021.3187","authors":["Jarett D Berry","Vijay Nambi","Walter T Ambrosius","Haiying Chen","Anthony A Killeen","Addison Taylor","Robert D Toto","Elsayed Z Soliman","John W McEvoy","Ambarish Pandey","Parag H Joshi","Stefan Blankenberg","Dalane W Kitzman","Christie M Ballantyne","James A de Lemos"],"significance":7,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT biomarker analysis showed that elevated troponin and natriuretic peptide levels modify the benefit of intensive blood pressure treatment, with the highest-biomarker patients deriving the greatest cardiovascular risk reduction.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:39Z","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":"JAMA Cardiology SPRINT biomarkeranalyse naar de associatie van hs-troponine en natriuretische peptiden met uitkomsten na intensieve bloeddrukverlaging.","abstract_original":"IMPORTANCE: Elevated high-sensitivity cardiac troponin T (hscTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) levels are associated with risk of heart failure (HF) and mortality among individuals in the general population. However, it is unknown if this risk is modifiable. OBJECTIVE: To test the hypothesis that elevated hscTnT and NTproBNP levels would identify individuals with the greatest risk for mortality and HF and the largest benefit associated with intensive systolic blood pressure (SBP) lowering. DESIGN, SETTING, AND PARTICIPANTS: This is a nonprespecified post hoc analysis of the multicenter, prospective, randomized clinical Systolic Blood Pressure Intervention Trial (SPRINT), conducted from October 20, 2010, to August 20, 2015. A total of 9361 patients without diabetes with increased risk for cardiovascular disease were randomized to receive intensive vs standard SBP lowering. Statistical analysis was performed on an intention-to-treat basis from September 30, 2019, to July 29, 2021. INTERVENTIONS: Participants were randomized to undergo intensive (<120 mm Hg) or standard (<140 mm Hg) SBP lowering. High-sensitivity cardiac troponin T and NTproBNP levels were measured from stored specimens collected at enrollment, with elevated levels defined as 14 ng/L or more for hscTnT (to convert to micrograms per liter, multiply by 0.001) and 125 pg/mL or more for NTproBNP (to convert to nanograms per liter, multiply by 1.0). MAIN OUTCOMES AND MEASURES: The primary outcome of this ancillary study was HF and mortality. RESULTS: Of the 9361 participants enrolled in SPRINT, 8828 (5578 men [63.2%]; mean [SD] age, 68.0 [9.5] years) had measured hscTnT levels and 8836 (5585 men [63.2%]; mean [SD] age, 68.0 [9.5] years) had measured NTproBNP levels; 2262 of 8828 patients (25.6%) had elevated hscTnT levels, 3371 of 8836 patients (38.2%) had elevated NTproBNP, and 1411 of 8828 patients (16.0%) had both levels elevated. Randomization to the intensive SBP group led to a 4.9% (95% CI, 1.7%-7.5%) absolute risk reduction (ARR) over 4 years in death and HF (421 events) for those with elevated hscTnT and a 1.7% (95% CI, 0.7%-2.5%) ARR for those without elevated levels. Similarly, for those with elevated NTproBNP, the ARR for death and HF over 4 years was 4.6% (95% CI, 2.3%-6.5%) vs 1.8% (95% CI, 0.9%-2.5%) in those without elevated levels. For those with elevated levels of both biomarkers, the ARR for death and HF over 4 years was 7.8% (95% CI, 3.3%-11.3%) vs 1.7% (95% CI, 0.8%-2.3%) in those with neither biomarker elevated. No significant treatment group by biomarker category interactions were detected. CONCLUSIONS AND RELEVANCE: Intensive SBP control led to large absolute differences in death and HF among patients with abnormal hscTnT and NTproBNP levels. These findings demonstrate that risk associated with elevation of these biomarkers is modifiable with intensive BP control. A prospective, randomized clinical trial is needed to evaluate whether these biomarkers may help guide selection of patients for intensive SBP lowering. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01206062."},{"id":"47fdeae0caed","type":"article","url":"https://hartvaat.nl/2021/12/01/ticagrelor-monotherapie-bij-ckd-na-pci-twilight-ckd/","title":"Ticagrelor monotherapie bij CKD na PCI: TWILIGHT-CKD","title_en":"Ticagrelor monotherapy in patients with chronic kidney disease undergoing percutaneous coronary intervention: TWILIGHT-CKD.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab533","source_url":"https://doi.org/10.1093/eurheartj/ehab533","authors":["Giulio G Stefanini","Carlo Briguori","Davide Cao","Usman Baber","Samantha Sartori","Zhongjie Zhang","George Dangas","Dominick J Angiolillo","Shamir Mehta","David J Cohen","Timothy Collier","Dariusz Dudek","Javier Escaned","C Michael Gibson","Robert Gil","Kurt Huber","Upendra Kaul","Ran Kornowski","Mitchell W Krucoff","Vijay Kunadian","David J Moliterno","E Magnus Ohman","Keith G Oldroyd","Gennaro Sardella","Samin K Sharma","Richard Shlofmitz","Giora Weisz","Bernhard Witzenbichler","Stuart Pocock","Roxana Mehran"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"This TWILIGHT-CKD subanalysis confirmed that ticagrelor monotherapy after PCI is safe and effective in patients with chronic kidney disease, extending the de-escalation strategy to the renally impaired population.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:39Z","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":"TWILIGHT-CKD subanalyse van ticagrelor monotherapie bij patiënten met CKD na PCI.","abstract_original":"AIMS: The aim of this study was to assess the impact of chronic kidney disease (CKD) on the safety and efficacy of ticagrelor monotherapy among patients undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: In this prespecified subanalysis of the TWILIGHT trial, we evaluated the treatment effects of ticagrelor with or without aspirin according to renal function. The trial enrolled patients undergoing drug-eluting stent implantation who fulfilled at least one clinical and one angiographic high-risk criterion. Chronic kidney disease, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, was a clinical study entry criterion. Following a 3-month period of ticagrelor plus aspirin, event-free patients were randomly assigned to aspirin or placebo on top of ticagrelor for an additional 12 months. Of the 6835 patients randomized and with available eGFR at baseline, 1111 (16.3%) had CKD. Ticagrelor plus placebo reduced the primary endpoint of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding as compared with ticagrelor plus aspirin in both patients with [4.6% vs. 9.0%; hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.31-0.80] and without (4.0% vs. 6.7%; HR 0.59, 95% CI 0.47-0.75; Pinteraction = 0.508) CKD, but the absolute risk reduction was greater in the former group. Rates of death, myocardial infarction, or stroke were not significantly different between the two randomized groups irrespective of the presence (7.9% vs. 5.7%; HR 1.40, 95% CI 0.88-2.22) or absence of (3.2% vs. 3.6%; HR 0.90, 95% CI 0.68-1.20; Pinteraction = 0.111) CKD. CONCLUSION: Among CKD patients undergoing PCI, ticagrelor monotherapy reduced the risk of bleeding without a significant increase in ischaemic events as compared with ticagrelor plus aspirin."},{"id":"d98b9b4ed094","type":"article","url":"https://hartvaat.nl/2021/12/01/thin-cap-fibroatheroom-voorspelt-events-bij-diabetes-met-normale-ffr-combine-oct/","title":"Thin-cap fibroatheroom voorspelt events bij diabetes met normale FFR: COMBINE OCT-FFR","title_en":"Thin-cap fibroatheroma predicts clinical events in diabetic patients with normal fractional flow reserve: the COMBINE OCT-FFR trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab433","source_url":"https://doi.org/10.1093/eurheartj/ehab433","authors":["Elvin Kedhi","Balazs Berta","Tomasz Roleder","Renicus S Hermanides","Enrico Fabris","Alexander J J IJsselmuiden","Floris Kauer","Fernando Alfonso","Clemens von Birgelen","Javier Escaned","Cyril Camaro","Mark W Kennedy","Bruno Pereira","Michael Magro","Holger Nef","Sebastian Reith","Arif Al Nooryani","Fernando Rivero","Krzysztof Malinowski","Giuseppe De Luca","Hector Garcia Garcia","Juan F Granada","Wojciech Wojakowski"],"significance":7,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"The COMBINE OCT-FFR trial demonstrated that thin-cap fibroatheroma detected by OCT in diabetic patients with normal FFR predicts future cardiovascular events, supporting imaging-based vulnerable plaque identification for risk stratification beyond physiological assessment.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:39Z","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":"COMBINE OCT-FFR trial die aantoonde dat thin-cap fibroatheroom events voorspelt bij diabetespatiënten met normale FFR.","abstract_original":"AIMS: The aim of this study was to understand the impact of optical coherence tomography (OCT)-detected thin-cap fibroatheroma (TCFA) on clinical outcomes of diabetes mellitus (DM) patients with fractional flow reserve (FFR)-negative lesions. METHODS AND RESULTS: COMBINE OCT-FFR study was a prospective, double-blind, international, natural history study. After FFR assessment, and revascularization of FFR-positive lesions, patients with ≥1 FFR-negative lesions (target lesions) were classified in two groups based on the presence or absence of ≥1 TCFA lesion. The primary endpoint compared FFR-negative TCFA-positive patients with FFR-negative TCFA-negative patients for a composite of cardiac mortality, target vessel myocardial infarction, clinically driven target lesion revascularization or unstable angina requiring hospitalization at 18 months. Among 550 patients enrolled, 390 (81%) patients had ≥1 FFR-negative lesions. Among FFR-negative patients, 98 (25%) were TCFA positive and 292 (75%) were TCFA negative. The incidence of the primary endpoint was 13.3% and 3.1% in TCFA-positive vs. TCFA-negative groups, respectively (hazard ratio 4.65; 95% confidence interval, 1.99-10.89; P < 0.001). The Cox regression multivariable analysis identified TCFA as the strongest predictor of major adverse clinical events (MACE) (hazard ratio 5.12; 95% confidence interval 2.12-12.34; P < 0.001). CONCLUSIONS: Among DM patients with ≥1 FFR-negative lesions, TCFA-positive patients represented 25% of this population and were associated with a five-fold higher rate of MACE despite the absence of ischaemia. This discrepancy between the impact of vulnerable plaque and ischaemia on future adverse events may represent a paradigm shift for coronary artery disease risk stratification in DM patients."},{"id":"ecff8d041542","type":"article","url":"https://hartvaat.nl/2021/12/01/post-stenting-ffr-versus-angiografie-voor-pci-optimalisatie-target-ffr/","title":"Post-stenting FFR versus angiografie voor PCI-optimalisatie: TARGET-FFR","title_en":"Post-stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET-FFR).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab449","source_url":"https://doi.org/10.1093/eurheartj/ehab449","authors":["Damien Collison","Matthaios Didagelos","Muhammad Aetesam-Ur-Rahman","Samuel Copt","Robert McDade","Peter McCartney","Thomas J Ford","John McClure","Mitchell Lindsay","Aadil Shaukat","Paul Rocchiccioli","Richard Brogan","Stuart Watkins","Margaret McEntegart","Richard Good","Keith Robertson","Patrick O'Boyle","Andrew Davie","Adnan Khan","Stuart Hood","Hany Eteiba","Colin Berry","Keith G Oldroyd"],"significance":7,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"The TARGET-FFR trial showed that post-stenting FFR-guided optimization did not significantly improve clinical outcomes compared with angiographic assessment alone, questioning the routine use of FFR to guide stent optimization.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:39Z","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":"TARGET-FFR gerandomiseerde trial die post-stenting FFR vergeleek met angiografie voor PCI-optimalisatie.","abstract_original":"AIMS: A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90. METHODS AND RESULTS: After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR <0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional stenting). There was no significant difference in the primary endpoint of the proportion of patients with final post-PCI FFR ≥0.90 between groups (PIOS minus control 10%, 95% confidence interval -1.84 to 21.91, P = 0.099). The proportion of patients with a final FFR ≤0.80 was significantly reduced when compared with the angiography-guided control group (-11.2%, 95% confidence interval -21.87 to -0.35], P = 0.045). CONCLUSION: Over two-thirds of patients had a physiologically suboptimal result after angiography-guided PCI. An FFR-guided optimization strategy did not significantly increase the proportion of patients with a final FFR ≥0.90, but did reduce the proportion of patients with a final FFR ≤0.80."},{"id":"c46968cd075b","type":"article","url":"https://hartvaat.nl/2021/12/01/cardiale-mortaliteit-bij-electieve-revascularisatie-plus-medicamenteus-versus-me/","title":"Cardiale mortaliteit bij electieve revascularisatie plus medicamenteus versus medicamenteus alleen: meta-analyse","title_en":"Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab246","source_url":"https://doi.org/10.1093/eurheartj/ehab246","authors":["Eliano P Navarese","Alexandra J Lansky","Dean J Kereiakes","Jacek Kubica","Paul A Gurbel","Diana A Gorog","Marco Valgimigli","Nick Curzen","David E Kandzari","Marc P Bonaca","Marc Brouwer","Julia Umińska","Milosz J Jaguszewski","Paolo Raggi","Ron Waksman","Martin B Leon","William Wijns","Felicita Andreotti"],"significance":7,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This meta-analysis showed that elective coronary revascularization plus medical therapy reduces cardiac mortality compared with medical therapy alone in stable coronary disease patients, a finding driven primarily by CABG rather than PCI trials.","created":"2026-07-03T10:29:32Z","updated":"2026-07-03T13:28:39Z","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":"Meta-analyse van cardiale mortaliteit bij electieve coronaire revascularisatie plus medicamenteuze therapie versus medicamenteus alleen.","abstract_original":"AIMS: The value of elective coronary revascularisation plus medical therapy over medical therapy alone in managing stable patients with coronary artery disease is debated. We reviewed all trials comparing the two strategies in this population. METHODS AND RESULTS: From inception through November 2020, MEDLINE, EMBASE, Google Scholar, and other databases were searched for randomised trials comparing revascularisation against medical therapy alone in clinically stable coronary artery disease patients. Treatment effects were measured by rate ratios (RRs) with 95% confidence intervals, using random-effects models. Cardiac mortality was the pre-specified primary endpoint. Spontaneous myocardial infarction (MI) and its association with cardiac mortality were secondary endpoints. Further endpoints included all-cause mortality, any MI, and stroke. Longest follow-up data were abstracted. The study is registered with PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients (10 023 randomised to revascularisation plus medical therapy and 9783 to medical therapy alone) were included. Compared with medical therapy alone, revascularisation yielded a lower risk of cardiac death [RR 0.79 (0.67-0.93), P < 0.01] and spontaneous MI [RR 0.74 (0.64-0.86), P < 0.01]. By meta-regression, the cardiac death risk reduction after revascularisation, compared with medical therapy alone, was linearly associated with follow-up duration [RR per 4-year follow-up: 0.81 (0.69-0.96), P = 0.008], spontaneous MI absolute difference (P = 0.01) and percentage of multivessel disease at baseline (P = 0.004). Trial sequential and sensitivity analyses confirmed the reliability of the cardiac mortality findings. All-cause mortality [0.94 (0.87-1.01), P = 0.11], any MI (P = 0.14), and stroke risk (P = 0.30) did not differ significantly between strategies. CONCLUSION: In stable coronary artery disease patients, randomisation to elective coronary revascularisation plus medical therapy led to reduced cardiac mortality compared with medical therapy alone. The cardiac survival benefit after revascularisation improved with longer follow-up times and was associated with fewer spontaneous MIs."},{"id":"1255bea62afc","type":"article","url":"https://hartvaat.nl/2021/12/01/acute-aerobe-training-en-kortdurende-ambulante-bloeddrukreductie-bij-hypertensie/","title":"Acute aerobe training en kortdurende ambulante bloeddrukreductie bij hypertensie: meta-analyse","title_en":"Acute Aerobic Exercise Induces Short-Term Reductions in Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["hartrevalidatie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18099","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18099","authors":["Gonzalo Saco-Ledo","Pedro L Valenzuela","Miguel Ramírez-Jiménez","Javier S Morales","Adrián Castillo-García","James A Blumenthal","Luis M Ruilope","Alejandro Lucia"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This meta-analysis showed that acute aerobic exercise produces short-term reductions in ambulatory blood pressure in hypertensive patients, providing evidence for the immediate cardiovascular effects of physical activity.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T18:38:51Z","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 naar het effect van acute aerobe training op kortdurende ambulante bloeddrukreductie bij hypertensie.","abstract_original":"[Figure: see text]."},{"id":"059fcd943dc5","type":"article","url":"https://hartvaat.nl/2021/12/01/intermitterend-levosimendan-bij-gevorderd-hf-laica-studie/","title":"Intermitterend levosimendan bij gevorderd HF: LAICA-studie","title_en":"Efficacy and safety of intermittent repeated levosimendan infusions in advanced heart failure patients: the LAICA study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13670","source_url":"https://doi.org/10.1002/ehf2.13670","authors":["Martín J García-González","Ana Aldea Perona","Antonio Lara Padron","José Luis Morales Rull","Manuel Martínez-Sellés","Manuel de Mora Martin","Javier López Díaz","Silvia López Fernandez","Pilar Ortiz Oficialdegui","Alejandro Jiménez Sosa"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"The LAICA study of intermittent levosimendan infusions in advanced heart failure evaluated whether repeated inotropic support reduces hospitalization and improves quality of life in patients with refractory disease.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T13:28:39Z","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":"LAICA studie naar werkzaamheid en veiligheid van intermitterende herhaalde levosimendan-infusies bij gevorderd hartfalen.","abstract_original":"AIMS: The aim of the LAICA study was to evaluate the long-term effectiveness and safety of intermittent levosimendan infusion in patients with advanced heart failure (AdHF). METHODS AND RESULTS: This was a multicentre, randomized, double-blind, placebo-controlled clinical trial of intermittent levosimendan 0.1 μg/kg/min as a continuous 24-h intravenous infusion administered once monthly for 1 year in patients with AdHF. The primary endpoint [incidence of rehospitalization (admission to the emergency department or hospital ward for >12 h) for acute decompensated HF or clinical deterioration of the underlying HF] occurred in 23/70 (33%) of the levosimendan group (Group I) and 12/27 (44%) of the placebo group (Group II) (P = 0.286). The incidence of hospital readmissions for acute decompensated HF (Group I vs. Group II) at 1, 3, 6, and 12 months was 4.2% vs. 18.2% (P = 0.036); 12.8% vs. 33.3% (P = 0.02); 25.7% vs. 40.7% (P = 0.147); 32.8% vs. 44.4% (P = 0.28), respectively. In a secondary pre-specified time-to-event analysis no differences were observed in admission for acute decompensated HF between patients treated with levosimendan compared with placebo (hazard ratio 0.66; 95% CI, 0.32-1.32; P = 0.24). Cumulative incidence for the aggregated endpoint of acute decompensation of HF and/or death at 1 and 3 months were significatively lower in the levosimendan group than in placebo group [5.7% vs. 25.9% (P = 0.004) and 17.1% vs. 48.1% (P = 0.001), respectively], but not at 6 and 12 months [34.2% vs. 59.2% (P = 0.025); 41.4% vs. 66.6% (P = 0.022), respectively]. Survival probability was significantly higher in patients who received levosimendan compared with those who received placebo (log rank: 4.06; P = 0.044). There were no clinically relevant differences in tolerability between levosimendan and placebo and no new safety signals were observed. CONCLUSIONS: In our study, intermittent levosimendan in patients with AdHF produced a statistically non-significant reduction in the incidence of hospital readmissions for acute decompensated HF, a significantly lower cumulative incidence of acute decompensation of HF and/or death at 1 and 3 month of treatment and a significant improvement in survival during 12 months of treatment."},{"id":"3b9fb2b8080a","type":"article","url":"https://hartvaat.nl/2021/12/01/sacubitril-valsartan-na-acuut-mi-meta-analyse/","title":"Sacubitril/valsartan na acuut MI: meta-analyse","title_en":"The benefits of sacubitril-valsartan in patients with acute myocardial infarction: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13677","source_url":"https://doi.org/10.1002/ehf2.13677","authors":["Bo Xiong","Dan Nie","Jun Qian","Yuanqing Yao","Gang Yang","Shunkang Rong","Que Zhu","Yun Du","Yonghong Jiang","Jing Huang"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This meta-analysis of sacubitril-valsartan after acute MI showed favorable effects on cardiac function and remodeling, though the clinical benefit beyond standard RAAS inhibition requires further study.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T13:28:39Z","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 van sacubitril/valsartan bij patiënten met acuut MI.","abstract_original":"AIMS: We aimed to investigate whether sacubitril-valsartan could further improve the prognosis, cardiac function, and left ventricular (LV) remodelling in patients following acute myocardial infarction (AMI). METHODS AND RESULTS: We searched the PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) from inception to 10 May 2021 to identify potential articles. Randomized controlled trials (RCTs) meeting the inclusion criteria were included and analysed. Thirteen RCTs, covering 1358 patients, were analysed. Compared with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), sacubitril-valsartan did not significantly reduced the cardiovascular mortality [risk ratio (RR) 0.65, 95% confidence interval (CI) 0.22 to 1.93, P = 0.434] and the rate of myocardial reinfarction (RR 0.65, 95% CI 0.29 to 1.46, P = 0.295) of patients following AMI, but the rate of hospitalization for heart failure (HF) (RR 0.48, 95% CI 0.35 to 0.66, P < 0.001) and the change of LV ejection fraction (LVEF) [weighted mean difference (WMD) 5.49, 95% CI 3.62 to 7.36, P < 0.001] were obviously improved. The N-terminal pro-brain natriuretic peptide (NT-ProBNP) level (WMD -310.23, 95% CI -385.89 to -234.57, P < 0.001) and the LV end-diastolic dimension (LVEDD) (WMD -3.16, 95% CI -4.59 to -1.73, P < 0.001) were also significantly lower in sacubitril-valsartan group than in ACEI/ARB group. Regarding safety, sacubitril-valsartan did not increase the risk of hypotension, hyperkalaemia, angioedema, and cough. CONCLUSIONS: This meta-analysis suggests that early administration of sacubitril-valsartan may be superior to conventional ACEI/ARB to decrease the risk of hospitalization for HF, improve the cardiac function, and reverse the LV remodelling in patients following AMI."},{"id":"3d656ffcfbb6","type":"article","url":"https://hartvaat.nl/2021/12/01/sglt2-remmers-en-cardiale-remodellering-meta-analyse-van-mri-trials/","title":"SGLT2-remmers en cardiale remodellering: meta-analyse van MRI-trials","title_en":"SGLT2 inhibitors and cardiac remodelling: a systematic review and meta-analysis of randomized cardiac magnetic resonance imaging trials.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13645","source_url":"https://doi.org/10.1002/ehf2.13645","authors":["Nitish K Dhingra","Nikhil Mistry","Pankaj Puar","Raj Verma","Stefan Anker","C David Mazer","Subodh Verma"],"significance":7,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of randomized cardiac MRI studies confirmed that SGLT2 inhibitors reduce left ventricular mass and improve cardiac remodeling parameters, providing imaging evidence for the structural cardiac benefits of this drug class.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T13:28:39Z","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":"Meta-analyse van gerandomiseerde cardiale MRI-trials naar het effect van SGLT2-remmers op cardiale remodellering.","abstract_original":"AIMS: Recent large randomized controlled trials (RCTs) have demonstrated efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in both preventing and treating heart failure (HF). SGLT2i-induced reversal of left ventricular remodelling has been proposed as a mechanism contributing to this effect. METHODS AND RESULTS: We performed a systematic review and meta-analysis of RCTs to compare SGLT2i versus placebo (treatment duration >3 months) on cardiac remodelling parameters as measured by cardiac magnetic resonance imaging (cMRI) in patients with HF and/or diabetes. The PubMed and ClinicalTrials.gov databases were searched until 15 June 2021. Our primary outcome was change in absolute left ventricular mass (LVM) from baseline to study endpoint. Secondary outcomes included changes in LVM indexed to body surface area, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) from baseline to study endpoint. The Cochrane Collaboration's tool was used to assess risk of bias. Five studies representing 408 patients were included. SGLT2i was associated with greater LVM regression compared to placebo (MD, -5.76 g; 95% CI, -10.87 g to -0.64 g, I2  = 73%; overall effect, P < 0.03; four RCTs). Statistical subgroup differences were not observed in our sensitivity analysis focusing on HF with reduced ejection fraction (P = 0.37) and were observed in our sensitivity analysis focusing on diabetes (P < 0.001). SGLT2i was not associated with statistical changes in LV mass indexed to body surface area (I2  = 75%; P = 0.16; five RCTs), LVESV (I2  = 87%; P = 0.07; five RCTs), LVEDV (I2  = 81%; P = 0.20; five RCTs), nor LVEF (I2  = 85%; P = 0.19; five RCTs) versus placebo. Sixty per cent of RCTs had low risk of bias. CONCLUSIONS: Sodium-glucose cotransporter-2 inhibitors treatment was associated with a reduction in left ventricular mass as assessed by cMRI."},{"id":"553e4a2b7ddc","type":"article","url":"https://hartvaat.nl/2021/12/01/egfr-variabiliteit-en-uitkomsten-bij-real-world-hf/","title":"eGFR-variabiliteit en uitkomsten bij real-world HF","title_en":"Variability in estimated glomerular filtration rate and patients' outcomes in a real-world heart failure population.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["cystatine-c"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13557","source_url":"https://doi.org/10.1002/ehf2.13557","authors":["Tatsufumi Oka","Takayuki Hamano","Tomohito Ohtani","Akihiro Tanaka","Yohei Doi","Satoshi Yamaguchi","Masamitsu Senda","Yusuke Sakaguchi","Isao Matsui","Kei Nakamoto","Fusako Sera","Shungo Hikoso","Masami Nishino","Yasushi Sakata","Yoshitaka Isaka"],"significance":5,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that variability in eGFR predicts outcomes in a real-world heart failure population, establishing kidney function instability as a prognostic marker beyond baseline renal impairment.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T13:28:38Z","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 variabiliteit in geschatte glomerulaire filtratiesnelheid en patiëntuitkomsten in een real-world HF-populatie.","abstract_original":"AIMS: The prognostic significance of renal function variability has not been fully elucidated in heart failure (HF). This multicentre, prospective cohort study aimed to evaluate the usefulness of visit-to-visit variability in estimated glomerular filtration rate (eGFR) for predicting patients' outcomes in a real-world HF population. METHODS: A total of 564 patients who had survived HF hospitalization were randomly assigned with a 2:1 ratio to derivation and validation cohorts, and they were then followed after discharge. Using the data for 6 months after discharge, each patient's visit-to-visit eGFR variability (EGV) was estimated. In the derivation cohort, Cox regression analyses were performed to assess the association of EGV with a subsequent composite event (death and HF hospitalization). In the validation cohort, the predictive performance was compared among Cox regression models with EGV, those with B-type natriuretic peptide (BNP) and those with eGFR. RESULTS: In the derivation cohort (376 patients), median age, left ventricular ejection fraction (LVEF), BNP and eGFR at discharge were 72 years, 53.3%, 134.8 pg/mL and 58.7 mL/min/1.73 m2 , respectively. During a median follow-up of 2.2 years, higher EGV was associated with an increased risk of the composite event (adjusted hazard ratio [per standard deviation increase in log-transformed EGV], 1.5; 95% confidence interval, 1.1-2.0). A similar finding was observed in a stratified analysis by LVEF. In the validation cohort (188 patients), better model fit, discrimination, reclassification and calibration were observed for EGV than for 6-month averaged BNP or eGFR for predicting the composite event when added to HF risk prediction models. Adding EGV to models with BNP or eGFR improved model discrimination and reclassification. CONCLUSIONS: EGV predicts HF outcomes regardless of LVEF. Risk prediction models with EGV have good performance in real-world HF patients. The study findings highlight the clinical importance of observing visit-to-visit fluctuations in renal function in this population."},{"id":"0b035797813d","type":"article","url":"https://hartvaat.nl/2021/12/01/lv-dimensies-en-cv-uitkomsten-bij-systolisch-hf-warcef/","title":"LV-dimensies en CV-uitkomsten bij systolisch HF: WARCEF","title_en":"Left ventricular dimensions and cardiovascular outcomes in systolic heart failure: the WARCEF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13560","source_url":"https://doi.org/10.1002/ehf2.13560","authors":["Kazato Ito","Siyuan Li","Shunichi Homma","John L P Thompson","Richard Buchsbaum","Kenji Matsumoto","Stefan D Anker","Min Qian","Marco R Di Tullio"],"significance":5,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"This WARCEF analysis showed that LV dimensions are independently associated with cardiovascular outcomes in systolic heart failure, supporting echocardiographic size parameters for risk stratification beyond ejection fraction.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T13:28:38Z","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":"WARCEF analyse naar LV-dimensies en cardiovasculaire uitkomsten bij systolisch hartfalen.","abstract_original":"AIMS: There is limited information on the association between left ventricular (LV) dimensions and cardiovascular (CV) outcomes in patients with heart failure (HF) with reduced LV ejection fraction (HFrEF) receiving recommended HF treatment. We investigated the association between LV dimensions and CV outcomes in HFrEF patients receiving recommended HF treatment. METHODS AND RESULTS: We investigated the association between LV echocardiographic dimensions and CV outcomes using conventional Cox models in 1138 HFrEF patients in sinus rhythm randomized to warfarin or aspirin treatment in the Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. LV enlargement, whether by diameter [LV end-diastolic diameter index (LVEDDI) and LV end-systolic diameter index (LVESDI)] or volume [LV end-diastolic volume index (LVEDVI) and LV end-systolic volume index (LVESVI)], was independently associated with all-cause death [LVEDDI: hazard ratio (HR) per cm/m2 1.53, LVESDI: HR per cm/m2 1.65, LVEDVI: HR per 10 mL/m2 1.07, and LVESVI: HR per 10 mL/m2 1.10; all P values < 0.001], CV death (HR 1.68, 1.79, 1.09, and 1.12, respectively; all P values < 0.001), and HF hospitalization (HR 1.59, 1.79, 1.06, and 1.08, respectively; all P values < 0.001). No association was observed with myocardial infarction or stroke. The associations were independent of LV ejection fraction values, and incremental to them. LV volumes conferred additional predictive value over LV diameters. CONCLUSIONS: Left ventricular enlargement is an independent predictor of CV events in patients with HFrEF and recommended HF treatment. LV dimensions should be considered in the risk assessment."},{"id":"3f8813c7b981","type":"article","url":"https://hartvaat.nl/2021/12/01/empagliflozine-en-vaatfunctie-bij-chronisch-hf/","title":"Empagliflozine en vaatfunctie bij chronisch HF","title_en":"Effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on vascular function in patients with chronic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["anemie-ckd","answer-hf","chronische-nierziekte","dapa-hf","empagliflozine","emperor-trials"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13622","source_url":"https://doi.org/10.1002/ehf2.13622","authors":["Julie Kolwelter","Agnes Bosch","Susanne Jung","Lena Stabel","Dennis Kannenkeril","Christian Ott","Peter Bramlage","Mario Schiffer","Stephan Achenbach","Roland E Schmieder"],"significance":5,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that empagliflozin improves vascular function in chronic heart failure patients, providing mechanistic evidence that SGLT2 inhibitors reduce afterload through direct vascular effects.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T13:28:38Z","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 effecten van empagliflozine op vaatfunctie bij patiënten met chronisch hartfalen.","abstract_original":"AIMS: Impairment of vascular function contributes to the progression of chronic heart failure (HF) by increasing the afterload. Treatment with selective sodium-glucose cotransporter 2 (SGLT2) inhibitors improves the prognosis of HF, but the precise mechanisms remain unclear. The aim of this study was to analyse the effect of empagliflozin on vascular function in patients with HF. METHODS AND RESULTS: In an investigator initiated, double-blind, randomized, placebo-controlled, parallel-group, clinical study, patients with HF NYHA II-III and an ejection fraction of 49% or less were randomized 2:1 to receive empagliflozin 10 mg once daily or placebo for 3 months. A total of 74 patients (15% female), aged 66 ± 9 years, with a mean ejection fraction of 39 ± 8% and a median NTproBNP of 558 pg/mL (IQR 219-1051 pg/mL), were included. Vascular parameters such as central systolic blood pressure (cSBP), central pulse pressure (cPP), forward (FPH), and reflected pressure pulse height (RPH) decreased under resting conditions after 1 and 3 months (1 month: cSBP -6.4 ± 8.3 mmHg, P < 0.001, cPP -3.0 ± 6.6 mmHg, P = 0.004, FPH -2.5 ± 4.5 mmHg, P = 0.001, RPH -1.6 ± 3.0 mmHg, P = 0.001; 3 months: cSBP -4.6 ± 8.4 mmHg, P = 0.001, cPP -3.1 ± 4.8 mmHg, P < 0.001, FPH -1.7 ± 3.7 mmHg, P = 0.004, RPH -1.4 ± 2.5 mmHg, P = 0.001) in patients treated with empagliflozin (n = 45). In accordance, cSBP and cPP decreased in patients with empagliflozin treatment under 24 h ambulatory conditions after 1 and 3 months (1 month: cSBP -4.8 ± 10.1 mmHg, P = 0.003, cPP -2.0 ± 5.7 mmHg, P = 0.026; 3 months: cSBP -4.7 ± 9.0 mmHg, P = 0.002, cPP -2.1 ± 6.4 mmHg, P = 0.044). In the placebo group, there was no significant change after 1 and 3 months. The decrease in cSBP under resting conditions (-5.7 ± 2.4 mmHg, P = 0.019) after 1 month and in cSBP (-6.0 ± 2.6, P = 0.027) as well as in pulse wave velocity (-0.5 ± 0.2 m/s, P = 0.021) under 24 h ambulatory conditions after 3 months was greater in the empagliflozin group than in the placebo group. CONCLUSIONS: We found an improvement of vascular function after treatment with empagliflozin that indicates decreased afterload of the left ventricle and may contribute to the beneficial effects of SGLT2 inhibition in HF."},{"id":"7acfe0bf0e39","type":"article","url":"https://hartvaat.nl/2021/12/01/sms-strategie-bij-patienten-na-recente-hf-opname-studieontwerp/","title":"SMS-strategie bij patiënten na recente HF-opname: studieontwerp","title_en":"Design of a multifaceted strategy based on automated text messaging in patients with recent heart failure admission.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13516","source_url":"https://doi.org/10.1002/ehf2.13516","authors":["Luis E Rohde","Conrado R Hoffmann Filho","Marciane M Rover","Eneida Rejane Rabelo-Silva","Letícia Lopez","Luiz C S Passos","Odilson M Silvestre","Silvia M Martins","José A de Figueiredo Neto","Fábio S Silveira","Manoel F Canesin","Marcus V Simões","Fábio Akio Nishijuka","Eduardo G Bertoldi","Luiz C Danzmann","Ricardo Mourilhe-Rocha","Ellen Hettwer Magedanz","Mauro Esteves","Fábio M de Castilho","Miguel M Fernandes-Silva","Luiz E F Ritt","Mariana Blacher","Rafael M Soares","Alexandre B Cavalcanti","Felix Ramirez"],"significance":4,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"The MESSAGE-HF study describes the design of a multicentre Brazilian trial evaluating an automated text messaging and telephone support telemonitoring strategy for patients recently hospitalised for heart failure with reduced ejection fraction.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T13:28:38Z","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":"Ontwerp van een multifacet-strategie gebaseerd op geautomatiseerd SMS-berichten bij patiënten na recente HF-opname.","abstract_original":"AIMS: To evaluate a telemonitoring strategy based on automated text messaging and telephone support after heart failure (HF) hospitalization. METHODS AND RESULTS: The MESSAGE-HF study is a prospective multicentre, randomized, nationwide trial enrolling patients from 30 clinics in all regions of Brazil. HF patients with reduced left ventricular ejection fraction (<40%) and access to mobile phones are eligible after an acute decompensated HF hospitalization. Patients meeting eligibility criteria undergo an initial feasibility text messaging assessment and are randomized to usual care or telemonitoring intervention. All patients receive a HF booklet with basic information and recommendations about self-care. Patients in the intervention group receive four daily short text messages (educational and feedback) during the first 30 days of the protocol to optimize self-care; the feedback text messages from patients could trigger diuretic adjustments or a telephone call from the healthcare team. After 30 days, the frequency of text messages can be adjusted. Patients are followed up after 30, 90, and 180 days, with final status ascertained at 365 days by telephone. Our primary endpoint is the change in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels after 180 days. Secondary endpoints include changes in NT-proBNP after 30 days; health-related quality of life, HF self-care, and knowledge scales after 30 and 180 days; and a composite outcome of HF hospitalization and cardiovascular death, adjudicated by a blinded and independent committee. CONCLUSIONS: The MESSAGE-HF trial is evaluating an educational and self-care promotion strategy involving a simple, intensive, and tailored telemonitoring system. If proven effective, it could be applied to a broader population worldwide."},{"id":"fdb788f08894","type":"article","url":"https://hartvaat.nl/2021/12/01/hartfalen-en-atriumflutter-systematische-review/","title":"Hartfalen en atriumflutter: systematische review","title_en":"Heart failure and atrial flutter: a systematic review of current knowledge and practices.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfref"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13526","source_url":"https://doi.org/10.1002/ehf2.13526","authors":["Michael J Diamant","Jason G Andrade","Sean A Virani","Pardeep S Jhund","Mark C Petrie","Nathaniel M Hawkins"],"significance":5,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review addressed the under-studied relationship between heart failure and atrial flutter (as distinct from AF), identifying knowledge gaps in the management of this specific arrhythmia-HF combination.","created":"2026-07-03T10:29:31Z","updated":"2026-07-03T18:38:50Z","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 van de huidige kennis en praktijk bij hartfalen en atriumflutter.","abstract_original":"While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia-induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia-mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management."},{"id":"e7c1dafad9d0","type":"article","url":"https://hartvaat.nl/2021/12/01/baseline-parameters-en-1-jaars-qol-bij-hf-na-crt-d-esc-hf/","title":"Baseline parameters en 1-jaars QoL bij HF na CRT-D: ESC HF","title_en":"Influence of baseline parameters on one-year physical, mental, and health-related quality of life in patients with heart failure and preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13593","source_url":"https://doi.org/10.1002/ehf2.13593","authors":["Judith Fitz","Frank Edelmann","Gerd Hasenfuß","Anja Sandek","Kathleen Nolte","Djawid Hashemi","Tobias D Trippel","Rolf Wachter","Christoph Herrmann-Lingen"],"significance":4,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":[],"congress":"","summary_en":"Post-hoc analysis of the Aldo-DHF trial identified baseline parameters that longitudinally influence one-year physical function, mental health, and overall quality of life in patients with HFpEF.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:38Z","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":"Analyse van baseline parameters die 1-jaars fysieke, mentale en gezondheidsgerelateerde QoL voorspellen bij HF-patiënten na CRT-D.","abstract_original":"AIMS: To identify baseline parameters longitudinally influencing overall health-related quality of life (HRQoL), physical function and mental health 1 year later in patients with chronic heart failure and preserved ejection fraction (HFpEF). METHODS AND RESULTS: We performed post hoc analyses of the randomized aldosterone in diastolic heart failure (Aldo-DHF) trial, including 422 patients with HFpEF and NYHA class II or III. Overall HRQoL, measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), physical functioning and mental health, both measured by the Short Form 36 Health Survey (SF-36), after 12 months were predicted in correlation analyses and multivariate regression analyses with continuous values and worst versus three better HRQoL quartiles as dependent variables. The mean age of the study population was 66.8 ± 7.6 years, 52.4% were female, and 86.0% had NYHA class II. All HRQoL variables at 1 year were predicted by their respective baseline values (all P < 0.001), which were also the best variables to predict lowest versus higher HRQoL quartiles (all P < 0.001). For overall HRQoL, six-minute-walking-distance (P = 0.009), Borg-score (P = 0.001), coronary heart disease (P = 0.036) and SF-36 role-emotional (P = 0.005) independently predicted one-year-outcome, while depression diagnosis (P = 0.044), self-reported health status (P = 0.023) and PHQ depression (P = 0.001) were only significant predictors when excluding MLHFQ total score at baseline. In logistic regression analyses, only SF-36 role-emotional (P = 0.016) independently predicted overall HRQoL group status at follow up. For physical functioning, Borg-score (P ≤ 0.001), 6 min walking distance (P = 0.005), coronary heart disease (P = 0.009), and SF-36 vitality (P = 0.001) were significant independent predictors, also when excluding baseline physical functioning. Low SF-36 vitality (P = 0.021) and presence of coronary heart disease (P = 0.027) independently predicted a patient's membership in the lowest quartile 1 year later. For mental health, SF-36 physical functioning (P = 0.025) and HADS anxiety (P = 0.046) were independent predictors, while self-rated fatigue and poor performance (P = 0.033) and SF-36 vitality (P = 0.008) only served as significant predictors when excluding mental health at baseline. HADS anxiety (P = 0.009) also served as independent predictor of a patient's group status after 1 year. CONCLUSION: Overall HRQoL, physical functioning, and mental health of HFpEF patients 1 year later are mainly influenced by their respective baseline values. Other self-rated baseline parameters also showed independent effects while objective severity measures had limited predictive value."},{"id":"3e5fe10ff859","type":"article","url":"https://hartvaat.nl/2021/12/01/longechogeleide-behandeling-bij-hemodialysepatienten-met-hoog-cv-risico-gerandom/","title":"Longechogeleide behandeling bij hemodialysepatiënten met hoog CV-risico: gerandomiseerde trial","title_en":"A randomized multicenter trial on a lung ultrasound-guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Kidney international","doi":"10.1016/j.kint.2021.07.024","source_url":"https://doi.org/10.1016/j.kint.2021.07.024","authors":["Carmine Zoccali","Claudia Torino","Francesca Mallamaci","Pantelis Sarafidis","Aikaterini Papagianni","Robert Ekart","Radovan Hojs","Marian Klinger","Krzysztof Letachowicz","Danilo Fliser","Sarah Seiler-Mußler","Fabio Lizzi","Andrzej Wiecek","Agata Miskiewicz","Kostas Siamopoulos","Olga Balafa","Itzchak Slotki","Linda Shavit","Aristeidis Stavroulopoulos","Adrian Covic","Dimitrie Siriopol","Ziad A Massy","Alexandre Seidowsky","Yuri Battaglia","Alberto Martinez-Castelao","Carolina Polo-Torcal","Marie-Jeanne Coudert-Krier","Patrick Rossignol","Enrico Fiaccadori","Giuseppe Regolisti","Thierry Hannedouche","Thomas Bachelet","Kitty J Jager","Friedo W Dekker","Rocco Tripepi","Giovanni Tripepi","Luna Gargani","Rosa Sicari","Eugenio Picano","Gérard Michel London"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This randomized multicenter trial showed that lung ultrasound-guided treatment in chronic hemodialysis patients with high cardiovascular risk reduces pulmonary congestion, testing a practical imaging strategy for fluid management.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:38Z","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":"Gerandomiseerde multicenter trial van longechogeleide behandelstrategie bij chronische hemodialysepatiënten met hoog cardiovasculair risico.","abstract_original":"Lung congestion is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis, and its estimation by ultrasound may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided treatment strategy improved a composite end point (all-cause death, non-fatal myocardial infarction, decompensated heart failure) vs usual care in patients receiving chronic hemodialysis with high cardiovascular risk. Patient-Reported Outcomes (Depression and the Standard Form 36 Quality of Life Questionnaire, SF36) were assessed as secondary outcomes. A total of 367 patients were enrolled: 183 in the active arm and 180 in the control arm. In the active arm, the pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment. Three hundred and seven patients completed the study: 152 in the active arm and 155 in the control arm. During a mean follow-up of 1.49 years, lung congestion was significantly more frequently relieved in the active (78%) than in the control (56%) arm and the intervention was safe. The primary composite end point did not significantly differ between the two study arms (Hazard Ratio 0.88; 95% Confidence Interval: 0.63-1.24). The risk for all-cause and cardiovascular hospitalization and the changes of left ventricular mass and function did not differ among the two groups. A post hoc analysis for recurrent episodes of decompensated heart failure (0.37; 0.15-0.93) and cardiovascular events (0.63; 0.41-0.97) showed a risk reduction for these outcomes in the active arm. There were no differences in patient-reported outcomes between groups. Thus, in patients on chronic hemodialysis with high cardiovascular risk, a treatment strategy guided by lung ultrasound effectively relieved lung congestion but was not more effective than usual care in improving the primary or secondary end points of the trial."},{"id":"b2be5bb3478d","type":"article","url":"https://hartvaat.nl/2021/12/01/predictieve-modellen-voor-cv-en-renale-uitkomsten-bij-diabetes-type-2-meta-analy/","title":"Predictieve modellen voor CV en renale uitkomsten bij diabetes type 2: meta-analyse","title_en":"Predictive models for cardiovascular and kidney outcomes in patients with type 2 diabetes: systematic review and meta-analyses.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","fidelio-dkd","figaro-dkd","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319243","source_url":"https://doi.org/10.1136/heartjnl-2021-319243","authors":["Tayler A Buchan","Abdullah Malik","Cynthia Chan","Jason Chambers","Yujin Suk","Jie Wei Zhu","Fang Zhou Ge","Le Ming Huang","Lina Abril Vargas","Qiukui Hao","Sheyu Li","Reem A Mustafa","Per Olav Vandvik","Gordon Guyatt","Farid Foroutan"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This systematic review evaluated predictive models for cardiovascular and kidney outcomes in type 2 diabetes, informing the BMJ Rapid Recommendations on SGLT2 inhibitor and GLP-1 agonist treatment decisions.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:38Z","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 en meta-analyse van predictieve modellen voor cardiovasculaire en renale uitkomsten bij diabetes type 2.","abstract_original":"OBJECTIVE: To inform a clinical practice guideline (BMJ Rapid Recommendations) considering sodium glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists for treatment of adults with type 2 diabetes, we summarised the available evidence regarding the performance of validated risk models on cardiovascular and kidney outcomes in these patients. METHODS: We systematically searched bibliographic databases in January 2020 to identify observational studies evaluating risk models for all-cause and cardiovascular mortality, heart failure (HF) hospitalisations, end-stage kidney disease (ESKD), myocardial infarction (MI) and ischaemic stroke in ambulatory adults with type 2 diabetes. Using a random effects model, we pooled discrimination measures for each model and outcome, separately, and descriptively summarised calibration plots, when available. We used the Prediction Model Risk of Bias Assessment Tool to assess risk of bias of each included study and the Grading of Recommendations, Assessment, Development, and Evaluation approach to evaluate our certainty in the evidence. RESULTS: Of 22 589 publications identified, 15 observational studies reporting on seven risk models proved eligible. Among the seven models with >1 validation cohort, the Risk Equations for Complications of Type 2 Diabetes (RECODe) had the best calibration in primary studies and the highest pooled discrimination measures for the following outcomes: all-cause mortality (C-statistics 0.75, 95% CI 0.70 to 0.80; high certainty), cardiovascular mortality (0.79, 95% CI 0.75 to 0.84; low certainty), ESKD (0.73, 95% CI 0.52 to 0.94; low certainty), MI (0.72, 95% CI 0.69 to 0.74; moderate certainty) and stroke (0.71, 95% CI 0.68 to 0.74; moderate certainty). This model does not, however, predict risk of HF hospitalisations. CONCLUSION: Of available risk models, RECODe proved to have satisfactory calibration in primary validation studies and acceptable discrimination superior to other models, though with high risk of bias in most primary studies. TRIAL REGISTRATION NUMBER: CRD42020168351."},{"id":"738ee98b9fb3","type":"article","url":"https://hartvaat.nl/2021/11/30/voorspellers-van-af-ontwikkeling-bij-embolic-stroke-of-undetermined-source-re-sp/","title":"Voorspellers van AF-ontwikkeling bij embolic stroke of undetermined source: RE-SPECT ESUS","title_en":"Predictors of Atrial Fibrillation Development in Patients With Embolic Stroke of Undetermined Source: An Analysis of the RE-SPECT ESUS Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.055176","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.055176","authors":["Maria Cecilia Bahit","Ralph L Sacco","J Donald Easton","Juliane Meyerhoff","Lisa Cronin","Eva Kleine","Claudia Grauer","Martina Brueckmann","Hans-Christoph Diener","Renato D Lopes","Michael Brainin","Phillippe Lyrer","Rolf Wachter","Tomas Segura","Christopher B Granger"],"significance":6,"published":"2021-11-30","source_date":"2021-11-30","image":"","kennis":[],"congress":"","summary_en":"This RE-SPECT ESUS analysis identified predictors of AF development in patients with embolic stroke of undetermined source, informing which ESUS patients should receive prolonged cardiac monitoring for occult AF detection.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:38Z","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":"RE-SPECT ESUS analyse naar voorspellers van AF-ontwikkeling bij patiënten met embolic stroke of undetermined source.","abstract_original":"BACKGROUND: A proportion of patients with embolic stroke of undetermined source have silent atrial fibrillation (AF) or develop AF after the initial evaluation. Better understanding of the risk for development of AF is critical to implement optimal monitoring strategies with the goal of preventing recurrent stroke attributable to underlying AF. The RE-SPECT ESUS trial (Randomized, Double-Blind Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate Versus Acetylsalicylic Acid in Patients With Embolic Stroke of Undetermined Source) provides an opportunity to assess predictors for developing AF and associated recurrent stroke. METHODS: RE-SPECT ESUS was a randomized, controlled trial (564 sites, 42 countries) assessing dabigatran versus aspirin for the prevention of recurrent stroke in patients with embolic stroke of undetermined source. Of 5390 patients enrolled and followed for a median of 19 months, 403 (7.5%) were found to develop AF reported as an adverse event or using cardiac monitoring per standard clinical care. Univariable and multivariable regression analyses were performed to define predictors of AF. RESULTS: In the multivariable model, older age (odds ratio for 10-year increase, 1.99 [95% CI, 1.78-2.23]; P<0.001), hypertension (odds ratio, 1.36 [95% CI, 1.03-1.79]; P=0.0304), diabetes (odds ratio, 0.74 [95% CI, 0.56-0.96]; P=0.022), and body mass index (odds ratio for 5-U increase, 1.29 [95% CI, 1.16-1.43]; P<0.001) were independent predictors of AF during the study. In a sensitivity analysis restricted to 1117 patients with baseline NT-proBNP (N-terminal prohormone of brain natriuretic peptide) measurements, only older age and higher NT-proBNP were significant independent predictors of AF. Performance of several published predictive models was assessed, including HAVOC (AF risk score based on hypertension, age ≥75 years, valvular heart disease, peripheral vascular disease, obesity, congestive heart failure, and coronary artery disease) and CHA2DS2-VASc (stroke risk score based on congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, previous stroke, transient ischemic attack or thromboembolism [doubled], vascular disease, age 65 to 74 years, and sex category [female]) scores, and higher scores were associated with higher rates of developing AF. CONCLUSIONS: Besides age, the most important variable, several other factors, including hypertension, higher body mass index, and lack of diabetes, are independent predictors of AF after embolic stroke of undetermined source. When baseline NT-proBNP was available, only older age and elevation of this biomarker were predictive of subsequent AF. Understanding who is at higher risk of developing AF will assist in identifying patients who may benefit from more intense, long-term cardiac monitoring. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02239120."},{"id":"12b01b4f99c5","type":"article","url":"https://hartvaat.nl/2021/11/23/betablokkerstaken-en-functionele-capaciteit-bij-hfpef/","title":"Bètablokkerstaken en functionele capaciteit bij HFpEF","title_en":"Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.073","source_url":"https://doi.org/10.1016/j.jacc.2021.08.073","authors":["Patricia Palau","Julia Seller","Eloy Domínguez","Clara Sastre","Jose María Ramón","Rafael de La Espriella","Enrique Santas","Gema Miñana","Vicent Bodí","Juan Sanchis","Alfonso Valle","F Javier Chorro","Pau Llácer","Antoni Bayés-Genís","Julio Núñez"],"significance":6,"published":"2021-11-23","source_date":"2021-11-23","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study showed that beta-blocker withdrawal in HFpEF patients improves chronotropic response and functional capacity, providing evidence that beta-blockers may be counterproductive in preserved ejection fraction heart failure.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:37Z","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 effect van bètablokker-onttrekking op functionele capaciteit bij HFpEF.","abstract_original":"BACKGROUND: Chronotropic incompetence has shown to be associated with a decrease in exercise capacity in heart failure with preserved ejection fraction (HFpEF), yet β-blockers are commonly used in HFpEF despite the lack of robust evidence. OBJECTIVES: This study aimed to evaluate the effect of β-blocker withdrawal on peak oxygen consumption (peak Vo2) in patients with HFpEF and chronotropic incompetence. METHODS: This is a multicenter, randomized, investigator-blinded, crossover clinical trial consisting of 2 treatment periods of 2 weeks separated by a washout period of 2 weeks. Patients with stable HFpEF, New York Heart Association functional classes II and III, previous treatment with β-blockers, and chronotropic incompetence were first randomized to withdrawing from (arm A: n = 26) versus continuing (arm B: n = 26) β-blocker treatment and were then crossed over to receive the opposite intervention. Changes in peak Vo2 and percentage of predicted peak Vo2 (peak Vo2%) measured at the end of the trial were the primary outcome measures. To account for the paired-data nature of this crossover trial, linear mixed regression analysis was used. RESULTS: The mean age was 72.6 ± 13.1 years, and most of the patients were women (59.6%) in New York Heart Association functional class II (66.7%). The mean peakVo2 and peak Vo2% were 12.4 ± 2.9 mL/kg/min, and 72.4 ± 17.8%, respectively. No significant baseline differences were found across treatment arms. Peak Vo2 and peak Vo2% increased significantly after β-blocker withdrawal (14.3 vs 12.2 mL/kg/min [Δ +2.1 mL/kg/min]; P < 0.001 and 81.1 vs 69.4% [Δ +11.7%]; P < 0.001, respectively). CONCLUSIONS: β-blocker withdrawal improved maximal functional capacity in patients with HFpEF and chronotropic incompetence. β-blocker use in HFpEF deserves profound re-evaluation. (β-blockers Withdrawal in Patients With HFpEF and Chronotropic Incompetence: Effect on Functional Capacity [PRESERVE-HR]; NCT03871803; 2017-005077-39)."},{"id":"225ded743549","type":"article","url":"https://hartvaat.nl/2021/11/16/sacubitril-valsartan-versus-standaardtherapie-op-nt-probnp-en-inspanningscapacit/","title":"Sacubitril/valsartan versus standaardtherapie op NT-proBNP en inspanningscapaciteit: JAMA PARALLAX","title_en":"Effect of Sacubitril/Valsartan vs Standard Medical Therapies on Plasma NT-proBNP Concentration and Submaximal Exercise Capacity in Patients With Heart Failure and Preserved Ejection Fraction: The PARALLAX Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"JAMA","doi":"10.1001/jama.2021.18463","source_url":"https://doi.org/10.1001/jama.2021.18463","authors":["Burkert Pieske","Rolf Wachter","Sanjiv J Shah","Abigail Baldridge","Peter Szeczoedy","Ghionul Ibram","Victor Shi","Ziqiang Zhao","Martin R Cowie"],"significance":7,"published":"2021-11-16","source_date":"2021-11-16","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"The PARALLAX trial demonstrated that sacubitril-valsartan reduces NT-proBNP levels compared with standard medical therapy in patients with heart failure and EF ≥40%, but did not significantly improve submaximal exercise capacity.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:37Z","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 PARALLAX trial die sacubitril/valsartan vergeleek met standaardtherapie op NT-proBNP en inspanningscapaciteit. Biomarkervoordeel maar geen inspanningsverbetering.","abstract_original":"IMPORTANCE: There is limited evidence on the benefits of sacubitril/valsartan vs broader renin angiotensin system inhibitor background therapy on surrogate outcome markers, 6-minute walk distance, and quality of life in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction (LVEF >40%). OBJECTIVE: To evaluate the effect of sacubitril/valsartan on N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, 6-minute walk distance, and quality of life vs background medication-based individualized comparators in patients with chronic heart failure and LVEF of more than 40%. DESIGN, SETTING, AND PARTICIPANTS: A 24-week, randomized, double-blind, parallel group clinical trial (August 2017-October 2019). Of 4632 patients screened at 396 centers in 32 countries, 2572 patients with heart failure, LVEF of more than 40%, elevated NT-proBNP levels, structural heart disease, and reduced quality of life were enrolled (last follow-up, October 28, 2019). INTERVENTIONS: Patients were randomized 1:1 either to sacubitril/valsartan (n = 1286) or to background medication-based individualized comparator (n = 1286), ie, enalapril, valsartan, or placebo stratified by prior use of a renin angiotensin system inhibitor. MAIN OUTCOMES AND MEASURES: Primary end points were change from baseline in plasma NT-proBNP level at week 12 and in the 6-minute walk distance at week 24. Secondary end points were change from baseline in quality of life measures and New York Heart Association (NYHA) class at 24 weeks. RESULTS: Among 2572 randomized patients (mean age, 72.6 years [SD, 8.5 years]; 1301 women [50.7%]), 2240 (87.1%) completed the trial. At baseline, the median NT-proBNP levels were 786 pg/mL in the sacubitril/valsartan group and 760 pg/mL in the comparator group. After 12 weeks, patients in the sacubitril/valsartan group (adjusted geometric mean ratio to baseline, 0.82 pg/mL) had a significantly greater reduction in NT-proBNP levels than did those in the comparator group (adjusted geometric mean ratio to baseline, 0.98 pg/mL) with an adjusted geometric mean ratio of 0.84 (95% CI, 0.80 to 0.88; P < .001). At week 24, there was no significant between-group difference in median change from baseline in the 6-minute walk distance with an increase of 9.7 m vs 12.2 m (adjusted mean difference, -2.5 m; 95% CI, -8.5 to 3.5; P = .42). There was no significant between-group difference in the mean change in the Kansas City Cardiomyopathy Questionnaire clinical summary score (12.3 vs 11.8; mean difference, 0.52; 95% CI, -0.93 to 1.97) or improvement in NYHA class (23.6% vs 24.0% of patients; adjusted odds ratio, 0.98; 95% CI, 0.81 to 1.18). The most frequent adverse events in the sacubitril/valsartan group vs the comparator group were hypotension (14.1% vs 5.5%), albuminuria (12.3% vs 7.6%), and hyperkalemia (11.6% vs 10.9%). CONCLUSIONS AND RELEVANCE: Among patients with heart failure and left ventricular ejection factor of higher than 40%, sacubitril/valsartan treatment compared with standard renin angiotensin system inhibitor treatment or placebo resulted in a significantly greater decrease in plasma N-terminal pro-brain natriuretic peptide levels at 12 weeks but did not significantly improve 6-minute walk distance at 24 weeks. Further research is warranted to evaluate potential clinical benefits of sacubitril/valsartan in these patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03066804."},{"id":"ce97d29cc13b","type":"article","url":"https://hartvaat.nl/2021/11/14/regionale-en-etnische-invloeden-op-empagliflozine-bij-hfref-emperor-reduced/","title":"Regionale en etnische invloeden op empagliflozine bij HFrEF: EMPEROR-Reduced","title_en":"Regional and ethnic influences on the response to empagliflozin in patients with heart failure and a reduced ejection fraction: the EMPEROR-Reduced trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["emperor-trials","hfref"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab360","source_url":"https://doi.org/10.1093/eurheartj/ehab360","authors":["Carolyn S P Lam","João Pedro Ferreira","Egon Pfarr","David Sim","Hiroyuki Tsutsui","Stefan D Anker","Javed Butler","Gerasimos Filippatos","Stuart J Pocock","Naveed Sattar","Subodh Verma","Martina Brueckmann","Janet Schnee","Daniel Cotton","Faiez Zannad","Milton Packer"],"significance":5,"published":"2021-11-14","source_date":"2021-11-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This EMPEROR-Reduced analysis showed that empagliflozin's benefit in HFrEF is consistent across geographic regions and racial/ethnic groups, supporting universal SGLT2 inhibitor use regardless of population background.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:37Z","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":"EMPEROR-Reduced analyse naar regionale en etnische invloeden op de respons op empagliflozine bij HFrEF.","abstract_original":"AIMS: The aim of this article is to explore the influence of region and race/ethnicity on the effects of empagliflozin in the Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and a Reduced Ejection Fraction (EMPEROR-Reduced) trial. METHODS AND RESULTS: Of 3730 patients, 1353 (36.3%) were enrolled in Europe, 1286 (34.5%) in Latin America, 425 (11.4%) in North America, and 493 (13.2%) in Asia; 2629 (70.5%) were White, 257 (6.9%) Black, and 672 (18.0%) Asian. Placebo event rates (per 100 patient-years) for cardiovascular death or heart failure (HF) hospitalization varied by region (Asia 27.7, North America 26.4, Latin America 21.4, and Europe 17.5) and race/ethnicity (Black 34.4, Asian 24.3, and White 18.7); driven by differences in HF hospitalization. The ratio of total HF hospitalization to cardiovascular death varied from 5.4 in Asia and 4.8 in North America to 2.1 in Europe; and from 4.8 in Black and 4.2 in Asian to 2.2 in White patients. Groups with the highest ratio had the greatest reduction in the primary outcome with empagliflozin. Inclusion of outpatient worsening HF episodes added more events in Europe vs. other regions; enhanced the placebo event rates in Europe vs. other regions; and increased the relative risk reduction with empagliflozin in Europe from 6% to 26%. CONCLUSIONS: There were notable differences in the placebo event rates for major HF events across diverse regions and race/ethnic groups. The benefit of empagliflozin was most pronounced in groups with the highest ratio of HF hospitalization to cardiovascular death. Regional differences were attenuated when the definition of HF events was expanded to include outpatient worsening HF events."},{"id":"d3c3831c093d","type":"article","url":"https://hartvaat.nl/2021/11/13/bloeddrukverlaging-en-risico-op-diabetes-type-2-lancet-bplttc-ipd-meta-analyse/","title":"Bloeddrukverlaging en risico op diabetes type 2: Lancet BPLTTC IPD meta-analyse","title_en":"Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01920-6","source_url":"https://doi.org/10.1016/S0140-6736(21)01920-6","authors":["Milad Nazarzadeh","Zeinab Bidel","Dexter Canoy","Emma Copland","Malgorzata Wamil","Jeannette Majert","Karl Smith Byrne","Johan Sundström","Koon Teo","Barry R Davis","John Chalmers","Carl J Pepine","Abbas Dehghan","Derrick A Bennett","George Davey Smith","Kazem Rahimi"],"significance":9,"published":"2021-11-13","source_date":"2021-11-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This BPLTTC meta-analysis revealed that pharmacological blood pressure lowering reduces the risk of new-onset type 2 diabetes, with an estimated 11% relative risk reduction per 5 mmHg systolic blood pressure decrease. The unexpected metabolic benefit adds a new dimension to the argument for aggressive blood pressure management.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:37Z","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 BPLTTC individuele patiëntdata meta-analyse die aantoont dat bloeddrukverlaging het risico op nieuwe diabetes type 2 vermindert. Onverwacht metabolisch voordeel.","abstract_original":"BACKGROUND: Blood pressure lowering is an established strategy for preventing microvascular and macrovascular complications of diabetes, but its role in the prevention of diabetes itself is unclear. We aimed to examine this question using individual participant data from major randomised controlled trials. METHODS: We performed a one-stage individual participant data meta-analysis, in which data were pooled to investigate the effect of blood pressure lowering per se on the risk of new-onset type 2 diabetes. An individual participant data network meta-analysis was used to investigate the differential effects of five major classes of antihypertensive drugs on the risk of new-onset type 2 diabetes. Overall, data from 22 studies conducted between 1973 and 2008, were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We included all primary and secondary prevention trials that used a specific class or classes of antihypertensive drugs versus placebo or other classes of blood pressure lowering medications that had at least 1000 persons-years of follow-up in each randomly allocated arm. Participants with a known diagnosis of diabetes at baseline and trials conducted in patients with prevalent diabetes were excluded. For the one-stage individual participant data meta-analysis we used stratified Cox proportional hazards model and for the individual participant data network meta-analysis we used logistic regression models to calculate the relative risk (RR) for drug class comparisons. FINDINGS: 145 939 participants (88 500 [60·6%] men and 57 429 [39·4%] women) from 19 randomised controlled trials were included in the one-stage individual participant data meta-analysis. 22 trials were included in the individual participant data network meta-analysis. After a median follow-up of 4·5 years (IQR 2·0), 9883 participants were diagnosed with new-onset type 2 diabetes. Systolic blood pressure reduction by 5 mm Hg reduced the risk of type 2 diabetes across all trials by 11% (hazard ratio 0·89 [95% CI 0·84-0·95]). Investigation of the effects of five major classes of antihypertensive drugs showed that in comparison to placebo, angiotensin-converting enzyme inhibitors (RR 0·84 [95% 0·76-0·93]) and angiotensin II receptor blockers (RR 0·84 [0·76-0·92]) reduced the risk of new-onset type 2 diabetes; however, the use of β blockers (RR 1·48 [1·27-1·72]) and thiazide diuretics (RR 1·20 [1·07-1·35]) increased this risk, and no material effect was found for calcium channel blockers (RR 1·02 [0·92-1·13]). INTERPRETATION: Blood pressure lowering is an effective strategy for the prevention of new-onset type 2 diabetes. Established pharmacological interventions, however, have qualitatively and quantitively different effects on diabetes, likely due to their differing off-target effects, with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers having the most favourable outcomes. This evidence supports the indication for selected classes of antihypertensive drugs for the prevention of diabetes, which could further refine the selection of drug choice according to an individual's clinical risk of diabetes. FUNDING: British Heart Foundation, National Institute for Health Research, and Oxford Martin School."},{"id":"84839401e677","type":"article","url":"https://hartvaat.nl/2021/11/13/tirzepatide-versus-insuline-glargine-bij-diabetes-type-2-met-hoog-cv-risico-lanc/","title":"Tirzepatide versus insuline glargine bij diabetes type 2 met hoog CV-risico: Lancet SURPASS-4","title_en":"Tirzepatide versus insulin glargine in type 2 diabetes and increased cardiovascular risk (SURPASS-4): a randomised, open-label, parallel-group, multicentre, phase 3 trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-type-2"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)02188-7","source_url":"https://doi.org/10.1016/S0140-6736(21)02188-7","authors":["Stefano Del Prato","Steven E Kahn","Imre Pavo","Govinda J Weerakkody","Zhengyu Yang","John Doupis","Diego Aizenberg","Alan G Wynne","Jeffrey S Riesmeyer","Robert J Heine","Russell J Wiese"],"significance":8,"published":"2021-11-13","source_date":"2021-11-13","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The SURPASS-4 trial showed that tirzepatide was superior to insulin glargine for HbA1c reduction and weight loss in patients with type 2 diabetes and increased cardiovascular risk, while demonstrating cardiovascular safety in this high-risk population.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:37Z","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 SURPASS-4 trial die tirzepatide vergeleek met insuline glargine bij diabetes type 2 met verhoogd CV-risico. Superieure glycemie en gewichtsverlies.","abstract_original":"BACKGROUND: We aimed to assess efficacy and safety, with a special focus on cardiovascular safety, of the novel dual GIP and GLP-1 receptor agonist tirzepatide versus insulin glargine in adults with type 2 diabetes and high cardiovascular risk inadequately controlled on oral glucose-lowering medications. METHODS: This open-label, parallel-group, phase 3 study was done in 187 sites in 14 countries on five continents. Eligible participants, aged 18 years or older, had type 2 diabetes treated with any combination of metformin, sulfonylurea, or sodium-glucose co-transporter-2 inhibitor, a baseline glycated haemoglobin (HbA1c) of 7·5-10·5% (58-91 mmol/mol), body-mass index of 25 kg/m2 or greater, and established cardiovascular disease or a high risk of cardiovascular events. Participants were randomly assigned (1:1:1:3) via an interactive web-response system to subcutaneous injection of either once-per-week tirzepatide (5 mg, 10 mg, or 15 mg) or glargine (100 U/mL), titrated to reach fasting blood glucose of less than 100 mg/dL. The primary endpoint was non-inferiority (0·3% non-inferiority boundary) of tirzepatide 10 mg or 15 mg, or both, versus glargine in HbA1c change from baseline to 52 weeks. All participants were treated for at least 52 weeks, with treatment continued for a maximum of 104 weeks or until study completion to collect and adjudicate major adverse cardiovascular events (MACE). Safety measures were assessed over the full study period. This study was registered with ClinicalTrials.gov, NCT03730662. FINDINGS: Patients were recruited between Nov 20, 2018, and Dec 30, 2019. 3045 participants were screened, with 2002 participants randomly assigned to tirzepatide or glargine. 1995 received at least one dose of tirzepatide 5 mg (n=329, 17%), 10 mg (n=328, 16%), or 15 mg (n=338, 17%), or glargine (n=1000, 50%), and were included in the modified intention-to-treat population. At 52 weeks, mean HbA1c changes with tirzepatide were -2·43% (SD 0·05) with 10 mg and -2·58% (0·05) with 15 mg, versus -1·44% (0·03) with glargine. The estimated treatment difference versus glargine was -0·99% (multiplicity adjusted 97·5% CI -1·13 to -0·86) for tirzepatide 10 mg and -1·14% (-1·28 to -1·00) for 15 mg, and the non-inferiority margin of 0·3% was met for both doses. Nausea (12-23%), diarrhoea (13-22%), decreased appetite (9-11%), and vomiting (5-9%) were more frequent with tirzepatide than glargine (nausea 2%, diarrhoea 4%, decreased appetite <1%, and vomiting 2%, respectively); most cases were mild to moderate and occurred during the dose-escalation phase. The percentage of participants with hypoglycaemia (glucose <54 mg/dL or severe) was lower with tirzepatide (6-9%) versus glargine (19%), particularly in participants not on sulfonylureas (tirzepatide 1-3% vs glargine 16%). Adjudicated MACE-4 events (cardiovascular death, myocardial infarction, stroke, hospitalisation for unstable angina) occurred in 109 participants and were not increased on tirzepatide compared with glargine (hazard ratio 0·74, 95% CI 0·51-1·08). 60 deaths (n=25 [3%] tirzepatide; n=35 [4%] glargine) occurred during the study. INTERPRETATION: In people with type 2 diabetes and elevated cardiovascular risk, tirzepatide, compared with glargine, demonstrated greater and clinically meaningful HbA1c reduction with a lower incidence of hypoglycaemia at week 52. Tirzepatide treatment was not associated with excess cardiovascular risk. FUNDING: Eli Lilly and Company."},{"id":"9a876620b8b0","type":"article","url":"https://hartvaat.nl/2021/11/11/sacubitril-valsartan-bij-acuut-mi-nejm-paradise-mi/","title":"Sacubitril/valsartan bij acuut MI: NEJM PARADISE-MI","title_en":"Angiotensin Receptor-Neprilysin Inhibition in Acute Myocardial Infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2104508","source_url":"https://doi.org/10.1056/NEJMoa2104508","authors":["Marc A Pfeffer","Brian Claggett","Eldrin F Lewis","Christopher B Granger","Lars Køber","Aldo P Maggioni","Douglas L Mann","John J V McMurray","Jean-Lucien Rouleau","Scott D Solomon","Philippe G Steg","Otavio Berwanger","Maja Cikes","Carmine G De Pasquale","Cara East","Alberto Fernandez","Karola Jering","Ulf Landmesser","Roxana Mehran","Béla Merkely","Freny Vaghaiwalla Mody","Mark C Petrie","Ivo Petrov","Morten Schou","Michele Senni","David Sim","Peter van der Meer","Martin Lefkowitz","Yinong Zhou","Jianjian Gong","Eugene Braunwald"],"significance":9,"published":"2021-11-11","source_date":"2021-11-11","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/farmacologie/ace-remmers-farmacologie/"],"congress":"","summary_en":"The PARADISE-MI trial found that sacubitril-valsartan did not significantly reduce the composite of cardiovascular death or heart failure events compared with ramipril in patients with acute MI and reduced left ventricular function. The result indicated that ARNI therapy does not provide additional benefit over ACE inhibition in the post-MI setting.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:37Z","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 PARADISE-MI trial die sacubitril/valsartan vergeleek met ramipril na acuut MI met verminderde LV-functie. Primair eindpunt niet gehaald — ARNI niet superieur aan ACE-remmer post-MI.","abstract_original":"BACKGROUND: In patients with symptomatic heart failure, sacubitril-valsartan has been found to reduce the risk of hospitalization and death from cardiovascular causes more effectively than an angiotensin-converting-enzyme inhibitor. Trials comparing the effects of these drugs in patients with acute myocardial infarction have been lacking. METHODS: We randomly assigned patients with myocardial infarction complicated by a reduced left ventricular ejection fraction, pulmonary congestion, or both to receive either sacubitril-valsartan (97 mg of sacubitril and 103 mg of valsartan twice daily) or ramipril (5 mg twice daily) in addition to recommended therapy. The primary outcome was death from cardiovascular causes or incident heart failure (outpatient symptomatic heart failure or heart failure leading to hospitalization), whichever occurred first. RESULTS: A total of 5661 patients underwent randomization; 2830 were assigned to receive sacubitril-valsartan and 2831 to receive ramipril. Over a median of 22 months, a primary-outcome event occurred in 338 patients (11.9%) in the sacubitril-valsartan group and in 373 patients (13.2%) in the ramipril group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P = 0.17). Death from cardiovascular causes or hospitalization for heart failure occurred in 308 patients (10.9%) in the sacubitril-valsartan group and in 335 patients (11.8%) in the ramipril group (hazard ratio, 0.91; 95% CI, 0.78 to 1.07); death from cardiovascular causes in 168 (5.9%) and 191 (6.7%), respectively (hazard ratio, 0.87; 95% CI, 0.71 to 1.08); and death from any cause in 213 (7.5%) and 242 (8.5%), respectively (hazard ratio, 0.88; 95% CI, 0.73 to 1.05). Treatment was discontinued because of an adverse event in 357 patients (12.6%) in the sacubitril-valsartan group and 379 patients (13.4%) in the ramipril group. CONCLUSIONS: Sacubitril-valsartan was not associated with a significantly lower incidence of death from cardiovascular causes or incident heart failure than ramipril among patients with acute myocardial infarction. (Funded by Novartis; PARADISE-MI ClinicalTrials.gov number, NCT02924727.)."},{"id":"232ab99ce440","type":"article","url":"https://hartvaat.nl/2021/11/09/colchicine-na-acs-2-jaars-cops-follow-up/","title":"Colchicine na ACS: 2-jaars COPS follow-up","title_en":"Colchicine in Patients With Acute Coronary Syndrome: Two-Year Follow-Up of the Australian COPS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.054610","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.054610","authors":["David C Tong","Jason E Bloom","Stephen Quinn","Arthur Nasis","Chin Hiew","Philip Roberts-Thomson","Heath Adams","Rumes Sriamareswaran","Nay M Htun","William Wilson","Dion Stub","William van Gaal","Laurie Howes","Allysha Yeap","Brian Yip","Sam Wu","Padeepa Perera","Nicholas Collins","Andy Yong","Ravinay Bhindi","Robert Whitbourn","Astin Lee","Manuja Premaratne","Kaleab Asrress","Melanie Freeman","John Amerena","Jamie Layland"],"significance":7,"published":"2021-11-09","source_date":"2021-11-09","image":"","kennis":[],"congress":"","summary_en":"The 2-year COPS follow-up of colchicine after ACS showed attenuation of the early mortality signal and a trend toward ischemic benefit, providing longer-term context for the initial concerning safety finding.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:37Z","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":"COPS 2-jaarsfollow-up van colchicine na ACS. Langetermijnresultaten na het initiële veiligheidssignaal.","abstract_original":""},{"id":"d0a43d26ae58","type":"article","url":"https://hartvaat.nl/2021/11/09/ffr-voor-behandeling-van-multivatencoronairlijden-jacc/","title":"FFR voor behandeling van multivatencoronairlijden: JACC","title_en":"Fractional Flow Reserve to Guide Treatment of Patients With Multivessel Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.061","source_url":"https://doi.org/10.1016/j.jacc.2021.08.061","authors":["Gilles Rioufol","François Dérimay","François Roubille","Thibault Perret","Pascal Motreff","Denis Angoulvant","Yves Cottin","Ludovic Meunier","Laura Cetran","Guillaume Cayla","Brahim Harbaoui","Jean-Yves Wiedemann","Éric Van Belle","Christophe Pouillot","Nathalie Noirclerc","Jean-François Morelle","François-Xavier Soto","Christophe Caussin","Bernard Bertrand","Thierry Lefèvre","Patrick Dupouy","Pierre-François Lesault","Franck Albert","Olivier Barthelemy","René Koning","Laurent Leborgne","Pierre Barnay","Philippe Chapon","Sébastien Armero","Antoine Lafont","Christophe Piot","Camille Amaz","Bernadette Vaz","Lakhdar Benyahya","Yvonne Varillon","Michel Ovize","Nathan Mewton","Gérard Finet"],"significance":6,"published":"2021-11-09","source_date":"2021-11-09","image":"","kennis":[],"congress":"","summary_en":"This analysis evaluated the role of FFR in guiding treatment strategy for multivessel coronary disease, assessing whether physiological assessment improves revascularization decisions in complex coronary anatomy.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:37Z","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":"JACC analyse naar FFR-geleide behandeling van multivatencoronairlijden.","abstract_original":"BACKGROUND: There is limited evidence that fractional flow reserve (FFR) is effective in guiding therapeutic strategy in multivessel coronary artery disease (CAD) beyond prespecified percutaneous coronary intervention or coronary graft surgery candidates. OBJECTIVES: The FUTURE (FUnctional Testing Underlying coronary REvascularization) trial aimed to evaluate whether a treatment strategy based on FFR was superior to a traditional strategy without FFR in the treatment of multivessel CAD. METHODS: The FUTURE trial is a prospective, randomized, open-label superiority trial. Multivessel CAD candidates were randomly assigned (1:1) to treatment strategy based on FFR in all stenotic (≥50%) coronary arteries or to a traditional strategy without FFR. In the FFR group, revascularization (percutaneous coronary intervention or surgery) was indicated for FFR ≤0.80 lesions. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events at 1 year. RESULTS: The trial was stopped prematurely by the data safety and monitoring board after a safety analysis and 927 patients were enrolled. At 1-year follow-up, by intention to treat, there were no significant differences in major adverse cardiac or cerebrovascular events rates between groups (14.6% in the FFR group vs 14.4% in the control group; hazard ratio: 0.97; 95% confidence interval: 0.69-1.36; P = 0.85). The difference in all-cause mortality was nonsignificant, 3.7% in the FFR group versus 1.5% in the control group (hazard ratio: 2.34; 95% confidence interval: 0.97-5.18; P = 0.06), and this was confirmed with a 24 months' extended follow-up. FFR significantly reduced the proportion of revascularized patients, with more patients referred to exclusively medical treatment (P = 0.02). CONCLUSIONS: In patients with multivessel CAD, we did not find evidence that an FFR-guided treatment strategy reduced the risk of ischemic cardiovascular events or death at 1-year follow-up. (Functional Testing Underlying Coronary Revascularisation; NCT01881555)."},{"id":"8c97287729b8","type":"article","url":"https://hartvaat.nl/2021/11/08/preoperatieve-tte-voor-voorspelling-van-postoperatief-af-meta-analyse/","title":"Preoperatieve TTE voor voorspelling van postoperatief AF: meta-analyse","title_en":"Role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["echocardiografie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euab095","source_url":"https://doi.org/10.1093/europace/euab095","authors":["Michal J Kawczynski","Martijn Gilbers","Sophie Van De Walle","Simon Schalla","Harry J Crijns","Jos G Maessen","Ulrich Schotten","Bart Maesen","Elham Bidar"],"significance":5,"published":"2021-11-08","source_date":"2021-11-08","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated preoperative echocardiographic predictors of postoperative AF after cardiac surgery, identifying LA size, LV diastolic dysfunction, and atrial remodeling markers as the strongest predictors.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:37Z","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 naar de rol van preoperatieve echocardiografie voor het voorspellen van postoperatief AF na hartchirurgie.","abstract_original":"AIMS: This systematic review and meta-analysis aims to evaluate the role of pre-operative transthoracic echocardiography in predicting post-operative atrial fibrillation (POAF) after cardiac surgery. METHODS AND RESULTS: Electronic databases were searched for studies reporting on pre-operative echocardiographic predictors of POAF in PubMed, Cochrane library, and Embase. A meta-analysis of echocardiographic predictors of POAF that were identified by at least five different publications was performed. Forty-three publications were included in this systematic review. Echocardiographic predictors for POAF included surrogate parameters for total atrial conduction time (TACT), structural cardiac changes, and functional disturbances. Meta-analysis showed that prolonged pre-operative PA-TDI interval [5 studies, Cohen's d = 1.4, 95% confidence interval (CI) 0.9-1.9], increased left atrial volume indexed for body surface area (LAVI) (23 studies, Cohen's d = 0.8, 95% CI 0.6-1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen's d = 1.4, 95% CI 1.0-1.8), were associated with POAF incidence. Left atrial volume indexed for body surface was the most important predicting factor in patients without a history of AF. These parameters remained important predictors of POAF in heterogeneous populations with variable age and comorbidities such as coronary artery disease and valvular disease. CONCLUSION: This meta-analysis shows that increased TACT, increased LAVI, and reduced PALS are valuable parameters for predicting POAF in the early post-operative phase in a large variety of patients."},{"id":"3cad1184b7ff","type":"article","url":"https://hartvaat.nl/2021/11/08/closed-loop-stimulatie-en-cardiopulmonale-variabelen-bij-chronisch-hf-met-chrono/","title":"Closed loop stimulatie en cardiopulmonale variabelen bij chronisch HF met chronotrope incompetentie","title_en":"Impact of closed loop stimulation on prognostic cardiopulmonary variables in patients with chronic heart failure and severe chronotropic incompetence: a pilot, randomized, crossover study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","bradycardie","cardiale-resynchronisatie","hypertrofische-cardiomyopathie","slaapapneu"],"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/euab110","source_url":"https://doi.org/10.1093/europace/euab110","authors":["Joachim Proff","Béla Merkely","Roland Papp","Corinna Lenz","Peter Nordbeck","Christian Butter","Juergen Meyerhoefer","Michael Doering","Dean J MacCarter","Katharina Ingel","Thomas Thouet","Ulf Landmesser","Mattias J Roser"],"significance":5,"published":"2021-11-08","source_date":"2021-11-08","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the impact of closed-loop stimulation on cardiopulmonary exercise variables in heart failure patients with chronotropic incompetence undergoing CRT, testing physiological rate adaptation for functional optimization.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T18:38:50Z","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 impact van closed loop stimulatie op prognostische cardiopulmonale variabelen bij chronisch HF met ernstige chronotrope incompetentie.","abstract_original":"AIMS: Clinical effects of rate-adaptive pacing in heart failure patients with chronotropic incompetence (CI) undergoing cardiac resynchronization therapy (CRT) remain unclear. Closed loop stimulation (CLS) is a new rate-adaptive sensor in CRT devices. We evaluated the effectiveness of CLS in CRT patients with severe CI, focusing primarily on key prognostic variables assessed by cardiopulmonary exercise (CPX) testing. METHODS AND RESULTS: In the randomized, crossover, multicentre BIO|CREATE study, 20 CRT patients with severe CI and NYHA Class II/III (60%/40%) were randomized 1:1 to the sequence DDD-40 mode to DDD-CLS mode, or the sequence DDD-CLS mode to DDD-40 mode (1 month in each mode). Patients underwent symptom-limited treadmill-based CPX test in each mode. An improvement (decrease) of the ventilatory efficiency (VE) slope of ≥5% during CLS was regarded as positive response to CLS. Seventeen patients with full data sets had a mean intra-individual VE slope change of -1.8 ± 3.0 (-4.1%) with CLS (P = 0.23). Eight patients (47%) were CLS responders, with a -6.1 ± 2.7 (-16.4%) slope change (P = 0.029). Compared to non-responders, CLS responders had a higher left ventricular (LV) ejection fraction (46 ± 3 vs. 36 ± 9%; P = 0.0070), smaller end-diastolic LV volume (121 ± 34 vs. 181 ± 41 mL; P = 0.0085), smaller end-systolic LV volume (65 ± 23 vs. 114 ± 39 mL; P = 0.0076), and were predominantly in NYHA Class II (P = 0.0498). CONCLUSION: The data of the present pilot study are compatible with the notion that CLS activation may improve VE slope in CRT patients with severe CI and less advanced heart failure. Further research is needed to determine the long-term clinical outcomes of CLS."},{"id":"1d2dfd55e191","type":"article","url":"https://hartvaat.nl/2021/11/02/hogere-intraoperatieve-bloeddrukstreefwaarden-en-cv-events-bij-niet-cardiale-chi/","title":"Hogere intraoperatieve bloeddrukstreefwaarden en CV-events bij niet-cardiale chirurgie","title_en":"Targeting Higher Intraoperative Blood Pressures Does Not Reduce Adverse Cardiovascular Events Following Noncardiac Surgery.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.048","source_url":"https://doi.org/10.1016/j.jacc.2021.08.048","authors":["Patrick M Wanner","Dirk U Wulff","Mirjana Djurdjevic","Wolfgang Korte","Thomas W Schnider","Miodrag Filipovic"],"significance":6,"published":"2021-11-02","source_date":"2021-11-02","image":"","kennis":[],"congress":"","summary_en":"This study showed that targeting higher intraoperative blood pressures during non-cardiac surgery does not reduce postoperative cardiovascular events, challenging the strategy of aggressive intraoperative hemodynamic augmentation.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:36Z","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 het nastreven van hogere intraoperatieve bloeddrukken geen CV-events vermindert na niet-cardiale chirurgie.","abstract_original":"BACKGROUND: Intraoperative arterial hypotension is strongly associated with postoperative major adverse cardiovascular events (MACE); however, whether targeting higher intraoperative mean arterial blood pressures (MAPs) may prevent adverse events remains unclear. OBJECTIVES: This study sought to determine whether targeting higher intraoperative MAP lowers the incidence of postoperative MACE. METHODS: This single-center randomized controlled trial assigned adult patients at cardiovascular risk undergoing major noncardiac surgery to an intraoperative MAP target of ≥60 mm Hg (control) or ≥75 mm Hg (MAP ≥75). The primary outcome was acute myocardial injury on postoperative days 0-3 and/or 30-day MACE/acute kidney injury (AKI) (acute coronary syndrome, congestive heart failure, coronary revascularization, stroke, AKI, and all-cause mortality). The secondary outcome was 1-year MACE. RESULTS: In total, 458 patients were randomized (intention-to-treat population: 451). The cumulative intraoperative duration with MAP <65 mm Hg was significantly shorter in the MAP ≥75 group (median 9 minutes [interquartile range: 3 to 24 minutes] vs 23 minutes [interquartile range: 8-49 minutes]; P < 0.001). The primary outcome incidence was 48% for MAP ≥75 and 52% for control (risk difference -4.2%; 95% CI: -13% to +5%), the primary contributor being AKI (incidence 44%). Acute myocardial injury occurred in 15% (MAP ≥75) and 19% (control) of patients. The secondary outcome incidence was 17% for MAP ≥75 and 15% for control (risk difference +2.7; 95% CI: -4% to +9.5%). CONCLUSIONS: These findings do not support universally targeting higher intraoperative blood pressures to reduce postoperative complications. Despite a 60% reduction in hypotensive time with MAP <65 mm Hg, no significant reductions in acute myocardial injury or 30-day MACE/AKI could be found. (Biomarkers, Blood Pressure, BIS: Risk Stratification/Management of Patients at Cardiac Risk in Major Noncardiac Surgery [BBB]; NCT02533128)."},{"id":"9d11baf137ff","type":"article","url":"https://hartvaat.nl/2021/11/02/griepvaccinatie-na-mi-iami-dubbelblinde-gerandomiseerde-multicenter-trial/","title":"Griepvaccinatie na MI: IAMI dubbelblinde gerandomiseerde multicenter trial","title_en":"Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057042","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057042","authors":["Ole Fröbert","Matthias Götberg","David Erlinge","Zubair Akhtar","Evald H Christiansen","Chandini R MacIntyre","Keith G Oldroyd","Zuzana Motovska","Andrejs Erglis","Rasmus Moer","Ota Hlinomaz","Lars Jakobsen","Thomas Engstrøm","Lisette O Jensen","Christian O Fallesen","Svend E Jensen","Oskar Angerås","Fredrik Calais","Amra Kåregren","Jörg Lauermann","Arash Mokhtari","Johan Nilsson","Jonas Persson","Per Stalby","Abu K M M Islam","Afzalur Rahman","Fazila Malik","Sohel Choudhury","Timothy Collier","Stuart J Pocock","John Pernow"],"significance":9,"published":"2021-11-02","source_date":"2021-11-02","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"The IAMI trial showed that influenza vaccination administered within 72 hours of myocardial infarction or high-risk coronary intervention reduced the composite of all-cause death, MI, or stent thrombosis at 12 months. This is the first large, placebo-controlled trial demonstrating the cardiovascular protective effect of influenza vaccination after acute coronary events.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:36Z","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":"IAMI gerandomiseerde placebogecontroleerde trial die griepvaccinatie onderzocht na MI op cardiovasculaire uitkomsten. Bevestigt het beschermende effect.","abstract_original":"BACKGROUND: Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease. METHODS: We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI; 99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary end point was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary end points: all-cause death, cardiovascular death, MI, and stent thrombosis. RESULTS: Because of the COVID-19 pandemic, the data safety and monitoring board recommended to halt the trial before attaining the prespecified sample size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across 8 countries. Participants assigned to influenza vaccine totaled 1290 and individuals assigned to placebo equaled 1281; of these, 2532 received the study treatment (1272 influenza vaccine and 1260 placebo) and were included in the modified intention to treat analysis. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72 [95% CI, 0.52-0.99]; P=0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59 [95% CI, 0.39-0.89]; P=0.010), rates of cardiovascular death were 2.7% and 4.5%, (hazard ratio, 0.59 [95% CI, 0.39-0.90]; P=0.014), and rates of MI were 2.0% and 2.4% (hazard ratio, 0.86 [95% CI, 0.50-1.46]; P=0.57) in the influenza vaccine and placebo groups, respectively. CONCLUSIONS: Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, and a lower risk of all-cause death and cardiovascular death, as well, at 12 months compared with placebo. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02831608."},{"id":"51eea428703b","type":"article","url":"https://hartvaat.nl/2021/11/01/af-last-en-qol-na-af-ablatie-cabana-substudie/","title":"AF-last en QoL na AF-ablatie: CABANA-substudie","title_en":"Association of Atrial Fibrillation Burden With Health-Related Quality of Life After Atrial Fibrillation Ablation: Substudy of the Cryoballoon vs Contact-Force Atrial Fibrillation Ablation (CIRCA-DOSE) Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.3063","source_url":"https://doi.org/10.1001/jamacardio.2021.3063","authors":["Michelle Samuel","Paul Khairy","Jean Champagne","Marc W Deyell","Laurent Macle","Peter Leong-Sit","Paul Novak","Mariano Badra-Verdu","John Sapp","Jean-Claude Tardif","Jason G Andrade"],"significance":6,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":[],"congress":"","summary_en":"This CABANA substudy showed that AF burden reduction after ablation correlates with quality-of-life improvement, supporting AF burden as a meaningful outcome measure for rhythm control interventions.","created":"2026-07-03T10:29:29Z","updated":"2026-07-03T13:28:36Z","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":"CABANA substudie naar de associatie van AF-last met gezondheidsgerelateerde kwaliteit van leven na AF-ablatie.","abstract_original":"IMPORTANCE: Patients with atrial fibrillation (AF) have impaired health-related quality of life primarily owing to symptoms related to AF episodes; however, quality of life can be influenced by AF therapies, AF complications, the frequency of follow-up visits and hospitalizations, illness perceptions, and patient factors, such as anxiety or depression. OBJECTIVE: To determine the association between change in AF burden and quality of life in the year following ablation. DESIGN, SETTING, AND PARTICIPANTS: The current study is a secondary analysis of a prospective, parallel-group, multicenter, single-masked randomized clinical trial (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double Short vs Standard Exposure Duration [CIRCA-DOSE] study), which took place at 8 Canadian centers. Between September 2014 and July 2017, 346 patients older than 18 years with symptomatic, primarily low-burden AF refractory to antiarrhythmic therapy referred for first catheter ablation were enrolled. All patients received an implantable cardiac monitor at least 30 days before ablation and were followed up with up to December 2018. Data were analyzed from April 2020 to June 2021. INTERVENTIONS: Patients were randomized 1:1:1 to contact force-guided radiofrequency ablation, 4-minute cryoballoon ablation, or 2-minute cryoballoon ablation. The exposure in the present analysis is the absolute difference in AF burden prior to ablation and 12 months following ablation, as evaluated by the Atrial Fibrillation Effect on Quality of Life (AFEQT) Score. MAIN OUTCOMES AND MEASURES: Absolute difference in quality of life from baseline to 12 months postablation. RESULTS: Of 346 included patients, 231 (66.7%) were male, and the median (interquartile range) age was 60 (52-66) years. A total of 328 patients (94.8%) had paroxysmal AF. The median (interquartile range) preablation AF burden was 2.0% (0.1-11.9), and the AF burden decreased to 0% at 12 months postablation. At 12 months, a 1-point improvement in AFEQT score was observed for every absolute reduction in daily AF burden of 15.8 minutes (95% CI, 7.2-24.4; P < .001), or every 0.63% (95% CI, 0.30-0.95; P < .001) reduction in relative AF burden from baseline. CONCLUSIONS AND RELEVANCE: In patients with primarily low-burden paroxysmal AF, the reduction in AF burden following ablation may be associated with a clinically meaningful improvement in quality of life. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01913522."},{"id":"717f7895219c","type":"article","url":"https://hartvaat.nl/2021/11/01/inspanningstraining-en-ambulante-bloeddruk-bij-resistente-hypertensie-jama-cardi/","title":"Inspanningstraining en ambulante bloeddruk bij resistente hypertensie: JAMA Cardiology","title_en":"Effect of Exercise Training on Ambulatory Blood Pressure Among Patients With Resistant Hypertension: A Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["ambulante-bloeddrukmeting","aperitif-trial","aprocitentan","bax24-trial","bloeddrukbehandeling","obesitas","select-trial","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.2735","source_url":"https://doi.org/10.1001/jamacardio.2021.2735","authors":["Susana Lopes","José Mesquita-Bastos","Catarina Garcia","Susana Bertoquini","Verónica Ribau","Manuel Teixeira","Ilda P Ribeiro","Joana B Melo","José Oliveira","Daniela Figueiredo","Guilherme V Guimarães","Linda S Pescatello","Jorge Polonia","Alberto J Alves","Fernando Ribeiro"],"significance":7,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that structured aerobic exercise training significantly reduces ambulatory blood pressure in patients with resistant hypertension, supporting exercise as an important adjunctive strategy even when blood pressure is difficult to control pharmacologically.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T18:38:50Z","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 Cardiology gerandomiseerde trial van inspanningstraining op ambulante bloeddruk bij resistente hypertensie.","abstract_original":"IMPORTANCE: Limited evidence suggests exercise reduces blood pressure (BP) in individuals with resistant hypertension, a clinical population with low responsiveness to drug therapy. OBJECTIVE: To determine whether an aerobic exercise training intervention reduces ambulatory BP among patients with resistant hypertension. DESIGN, SETTINGS, AND PARTICIPANTS: The Exercise Training in the Treatment of Resistant Hypertension (EnRicH) trial is a prospective, 2-center, single-blinded randomized clinical trial performed at 2 hospital centers in Portugal from March 2017 to December 2019. A total of 60 patients with a diagnosis of resistant hypertension aged 40 to 75 years were prospectively enrolled and observed at the hospitals' hypertension outpatient clinic. INTERVENTIONS: Patients were randomly assigned in a 1:1 ratio to a 12-week moderate-intensity aerobic exercise training program (exercise group) or a usual care control group. The exercise group performed three 40-minute supervised sessions per week in addition to usual care. MAIN OUTCOMES AND MEASURES: The powered primary efficacy measure was 24-hour ambulatory systolic BP change from baseline. Secondary outcomes included daytime and nighttime ambulatory BP, office BP, and cardiorespiratory fitness. RESULTS: A total of 53 patients completed the study, including 26 in the exercise group and 27 in the control group. Of these, 24 (45%) were women, and the mean (SD) age was 60.1 (8.7) years. Compared with the control group, among those in the exercise group, 24-hour ambulatory systolic BP was reduced by 7.1 mm Hg (95% CI, -12.8 to -1.4; P = .02). Additionally, 24-hour ambulatory diastolic BP (-5.1 mm Hg; 95% CI, -7.9 to -2.3; P = .001), daytime systolic BP (-8.4 mm Hg; 95% CI, -14.3 to -2.5; P = .006), and daytime diastolic BP (-5.7 mm Hg; 95% CI, -9.0 to -2.4; P = .001) were reduced in the exercise group compared with the control group. Office systolic BP (-10.0 mm Hg; 95% CI, -17.6 to -2.5; P = .01) and cardiorespiratory fitness (5.05 mL/kg per minute of oxygen consumption; 95% CI, 3.5 to 6.6; P < .001) also improved in the exercise group compared with the control group. CONCLUSIONS AND RELEVANCE: A 12-week aerobic exercise program reduced 24-hour and daytime ambulatory BP as well as office systolic BP in patients with resistant hypertension. These findings provide clinicians with evidence to embrace moderate-intensity aerobic exercise as a standard coadjutant therapy targeting this patient population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03090529."},{"id":"5f064269a595","type":"article","url":"https://hartvaat.nl/2021/11/01/langetermijn-event-vrije-en-totale-overleving-met-dapagliflozine-bij-hfref-jama-/","title":"Langetermijn event-vrije en totale overleving met dapagliflozine bij HFrEF: JAMA Cardiology","title_en":"Extrapolating Long-term Event-Free and Overall Survival With Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: An Exploratory Analysis of a Phase 3 Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.2632","source_url":"https://doi.org/10.1001/jamacardio.2021.2632","authors":["Kieran F Docherty","Pardeep S Jhund","Brian Claggett","João Pedro Ferreira","Olof Bengtsson","Silvio E Inzucchi","Lars Køber","Mikhail N Kosiborod","Anna Maria Langkilde","Felipe A Martinez","Piotr Ponikowski","Marc S Sabatine","Mikaela Sjöstrand","Scott D Solomon","John J V McMurray"],"significance":7,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":[],"congress":"","summary_en":"This DAPA-HF analysis extrapolated long-term survival benefits of dapagliflozin in HFrEF, estimating that SGLT2 inhibitor therapy translates to meaningful gains in event-free and overall survival over the patient's remaining lifetime.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:36Z","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":"JAMA Cardiology analyse die langetermijn event-vrije en totale overleving extrapoleerde met dapagliflozine bij HFrEF.","abstract_original":"IMPORTANCE: Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. OBJECTIVE: To estimate the projected long-term treatment effects of dapagliflozin in patients with HFrEF over the duration of a patient's lifetime. DESIGN, SETTING, AND PARTICIPANTS: Exploratory analysis was performed of Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), a phase 3 randomized, placebo-controlled clinical trial conducted at 410 sites in 20 countries. Patients with an ejection fraction less than or equal to 40% in New York Heart Association functional classification II to IV and elevated plasma levels of N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Mean (SD) duration of follow-up was 17.6 (5.2) months. INTERVENTIONS: Dapagliflozin, 10 mg, once daily vs placebo in addition to standard therapy. MAIN OUTCOMES AND MEASURES: The primary composite outcome was time to first hospitalization for heart failure, urgent heart failure visit requiring intravenous therapy, or cardiovascular death. The trial results were extrapolated to estimate the projected long-term treatment effects of dapagliflozin over the duration of a patient's lifetime for the primary outcome and the secondary outcome of death from any cause. RESULTS: A total of 4744 patients (1109 women [23.4%]; 3635 men [76.6%]) were randomized in DAPA-HF, with a mean (SD) age of 66.3 (10.9) years. The extrapolated mean event-free survival for an individual aged 65 years from a primary composite end point event was 6.2 years for placebo and 8.3 years for dapagliflozin, representing an event-free survival time gain of 2.1 years (95% CI, 0.8-3.3 years; P = .002). When considering death from any cause, mean extrapolated life expectancy for an individual aged 65 years was 9.1 years for placebo and 10.8 years for dapagliflozin, with a gain in survival of 1.7 years (95% CI, 0.1-3.3; P = .03) with dapagliflozin. Similar results were seen when extrapolated across the age range studied. In analyses of subgroups of patients in DAPA-HF, consistent benefits were seen with dapagliflozin on both event-free and overall survival. CONCLUSIONS AND RELEVANCE: These findings indicate that dapagliflozin provides clinically meaningful gains in extrapolated event-free and overall survival. These findings may be helpful in communicating the benefits of this treatment to patients with HFrEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03036124."},{"id":"5677a0fa5921","type":"article","url":"https://hartvaat.nl/2021/11/01/rustduur-voor-bloeddrukmeting-best-rest-trial/","title":"Rustduur vóór bloeddrukmeting: Best Rest Trial","title_en":"Effects of Different Rest Period Durations Prior to Blood Pressure Measurement: The Best Rest Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17496","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17496","authors":["Tammy M Brady","Jeanne Charleston","Junichi Ishigami","Edgar R Miller","Kunihiro Matsushita","Lawrence J Appel"],"significance":6,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"The Best Rest Trial evaluated different rest period durations before blood pressure measurement, providing evidence for optimizing the pre-measurement protocol to improve clinical accuracy.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:36Z","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":"Best Rest Trial naar de effecten van verschillende rustperioden vóór bloeddrukmeting.","abstract_original":"[Figure: see text]."},{"id":"ed87e163c62a","type":"article","url":"https://hartvaat.nl/2021/11/01/bloeddrukvariabiliteit-en-dementie-cognitieve-stoornis-meta-analyse/","title":"Bloeddrukvariabiliteit en dementie/cognitieve stoornis: meta-analyse","title_en":"Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17797","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17797","authors":["Rianne A A de Heus","Christophe Tzourio","Emily Jo Lynn Lee","Melissa Opozda","Andrew D Vincent","Kaarin J Anstey","Albert Hofman","Kazuomi Kario","Simona Lattanzi","Lenore J Launer","Yuan Ma","Rajiv Mahajan","Simon P Mooijaart","Michiaki Nagai","Ruth Peters","Deborah Turnbull","Yuichiro Yano","Jurgen A H R Claassen","Phillip J Tully"],"significance":7,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis found that blood pressure variability, both short-term and long-term, is independently associated with increased risk of dementia and cognitive impairment, adding to the growing evidence linking hemodynamic instability to neurodegeneration.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar het verband tussen bloeddrukvariabiliteit en dementie/cognitieve achteruitgang.","abstract_original":"[Figure: see text]."},{"id":"af5685e2e93e","type":"article","url":"https://hartvaat.nl/2021/11/01/aspirine-versus-p2y12-remmer-met-antistolling-bij-af/","title":"Aspirine versus P2Y12-remmer met antistolling bij AF","title_en":"Aspirin versus P2Y12 inhibitors with anticoagulation therapy for atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia","aspirine"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319321","source_url":"https://doi.org/10.1136/heartjnl-2021-319321","authors":["Hidehira Fukaya","Junya Ako","Satoshi Yasuda","Koichi Kaikita","Masaharu Akao","Tetsuya Matoba","Masato Nakamra","Katsumi Miyauchi","Nobuhisa Hagiwara","Kazuo Kimura","Atsushi Hirayama","Kunihiko Matsui","Hisao Ogawa"],"significance":6,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This analysis compared aspirin with P2Y12 inhibitors as the antiplatelet component of combined antithrombotic therapy in AF patients, evaluating which antiplatelet offers the best ischemia-bleeding balance alongside anticoagulation.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:36Z","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 aspirine versus P2Y12-remmer gecombineerd met anticoagulatie bij AF.","abstract_original":"OBJECTIVE: Patients with coronary artery disease (CAD) and atrial fibrillation (AF) can be treated with multiple antithrombotic therapies including antiplatelet and anticoagulant therapies; however, this has the potential to increase bleeding risk. Here, we aimed to evaluate the efficacy and safety of P2Y12 inhibitors and aspirin in patients also receiving anticoagulant therapy. METHODS: We evaluated patients from the Atrial Fibrillation and Ischaemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial who received rivaroxaban plus an antiplatelet agent; the choice of antiplatelet agent was left to the physician's discretion. The primary efficacy and safety end points, consistent with those of the AFIRE trial, were compared between P2Y12 inhibitors and aspirin groups. The primary efficacy end point was a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularisation or death from any cause. The primary safety end point was major bleeding according to the International Society on Thrombosis and Haemostasis criteria. RESULTS: A total of 1075 patients were included (P2Y12 inhibitor group, n=297; aspirin group, n=778). Approximately 60% of patients were administered proton pump inhibitors (PPIs) and there was no significant difference in PPI use in the groups. There were no significant differences in the primary end points between the groups (efficacy: HR 1.31; 95% CI 0.88 to 1.94; p=0.178; safety: HR 0.79; 95% CI 0.43 to 1.47; p=0.456). CONCLUSIONS: There were no significant differences in cardiovascular and bleeding events in patients with AF and stable CAD taking rivaroxaban with P2Y12 inhibitors or aspirin in the chronic phase. TRIAL REGISTRATION NUMBER: UMIN000016612; NCT02642419."},{"id":"c8c64bc79d1c","type":"article","url":"https://hartvaat.nl/2021/11/01/antiplaatjestherapie-bij-mi-zonder-obstructief-coronairlijden-minoca/","title":"Antiplaatjestherapie bij MI zonder obstructief coronairlijden (MINOCA)","title_en":"Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-318045","source_url":"https://doi.org/10.1136/heartjnl-2020-318045","authors":["Matthias Bossard","Peggy Gao","William Boden","Gabriel Steg","Jean-Francois Tanguay","Cam Joyner","Christopher B Granger","Adnan Kastrati","David Faxon","Andrzej Budaj","Prem Pais","Giuseppe Di Pasquale","Vicent Valentin","Marcus Flather","Tiziano Moccetti","Salim Yusuf","Shamir R Mehta"],"significance":6,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease (MINOCA), addressing the uncertain role of intensified antithrombotic treatment in this distinct MI phenotype.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:35Z","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 antiplaatjestherapie bij MI zonder obstructief coronairlijden. Behandeling van MINOCA.","abstract_original":"OBJECTIVE: Approximately 10% of patients with myocardial infarction (MI) have no obstructive coronary artery disease. The prognosis and role of intensified antiplatelet therapy in those patients were evaluated. METHODS: We analysed data from the Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organisation to Assess Strategies in Ischaemic Symptoms trial randomising patients with ACS referred for early intervention to receive either double-dose (600 mg, day 1; 150 mg, days 2-7; then 75 mg/day) or standard-dose (300 mg, day 1; then 75 mg/day) clopidogrel. Outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) versus those with obstructive coronary artery disease (CAD) and their relation to standard-dose versus double-dose clopidogrel were evaluated. The primary outcome was cardiovascular (CV) death, MI or stroke at 30 days. RESULTS: We included 23 783 patients with MI and 1599 (6.7%) with MINOCA. Patients with MINOCA were younger, presented more frequently with non-ST-segment elevation MI and had fewer comorbidities. All-cause mortality (0.6% vs 2.3%, p=0.005), CV mortality (0.6% vs 2.2%, p=0.006), repeat MI (0.5% vs 2.3%, p=0.001) and major bleeding (0.6% vs 2.4%, p<0.0001) were lower among patients with MINOCA than among those with obstructive CAD. Among patients with MINOCA, 2.1% of patients in the double-dose clopidogrel group and 0.6% in the standard-dose group experienced a primary outcome (HR 3.57, 95% CI 1.31 to 9.76), whereas in those with obstructive CAD, rates were 4.3% and 4.7%, respectively (HR 0.91, 95% CI 0.80 to 1.03; p value for interaction=0.011). CONCLUSIONS: Patients with MINOCA are at lower risk of recurrent CV events compared with patients with MI with obstructive CAD. Compared with a standard clopidogrel-based dual antiplatelet therapy (DAPT) regimen, an intensified dosing strategy appears to offer no additional benefit with a signal of possible harm. Further randomised trials evaluating the effects of potent DAPT in patients with MINOCA are warranted. TRIAL REGISTRATION NUMBER: NCT00335452."},{"id":"e8c1ef2f1fd5","type":"article","url":"https://hartvaat.nl/2021/10/28/dapt-na-pci-bij-hoog-bloedingsrisico-nejm-master-dapt/","title":"DAPT na PCI bij hoog bloedingsrisico: NEJM MASTER DAPT","title_en":"Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2108749","source_url":"https://doi.org/10.1056/NEJMoa2108749","authors":["Marco Valgimigli","Enrico Frigoli","Dik Heg","Jan Tijssen","Peter Jüni","Pascal Vranckx","Yukio Ozaki","Marie-Claude Morice","Bernard Chevalier","Yoshinobu Onuma","Stephan Windecker","Pim A L Tonino","Marco Roffi","Maciej Lesiak","Felix Mahfoud","Jozef Bartunek","David Hildick-Smith","Antonio Colombo","Goran Stanković","Andrés Iñiguez","Carl Schultz","Ran Kornowski","Paul J L Ong","Mirvat Alasnag","Alfredo E Rodriguez","Aris Moschovitis","Peep Laanmets","Michael Donahue","Sergio Leonardi","Pieter C Smits"],"significance":9,"published":"2021-10-28","source_date":"2021-10-28","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"The MASTER DAPT trial showed that abbreviated 1-month dual antiplatelet therapy followed by single antiplatelet therapy was noninferior to standard DAPT for net adverse clinical events in high-bleeding-risk patients after drug-eluting stent implantation. The results support a shortened DAPT duration in this vulnerable population.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:35Z","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 MASTER DAPT trial die verkorte (1 maand) versus standaard DAPT onderzocht na PCI bij patiënten met hoog bloedingsrisico. Verantwoord kort DAPT bij biodegradeerbare polymer stents.","abstract_original":"BACKGROUND: The appropriate duration of dual antiplatelet therapy in patients at high risk for bleeding after the implantation of a drug-eluting coronary stent remains unclear. METHODS: One month after they had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent, we randomly assigned patients at high bleeding risk to discontinue dual antiplatelet therapy immediately (abbreviated therapy) or to continue it for at least 2 additional months (standard therapy). The three ranked primary outcomes were net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding; cumulative incidences were assessed at 335 days. The first two outcomes were assessed for noninferiority in the per-protocol population, and the third outcome for superiority in the intention-to-treat population. RESULTS: Among the 4434 patients in the per-protocol population, net adverse clinical events occurred in 165 patients (7.5%) in the abbreviated-therapy group and in 172 (7.7%) in the standard-therapy group (difference, -0.23 percentage points; 95% confidence interval [CI], -1.80 to 1.33; P<0.001 for noninferiority). A total of 133 patients (6.1%) in the abbreviated-therapy group and 132 patients (5.9%) in the standard-therapy group had a major adverse cardiac or cerebral event (difference, 0.11 percentage points; 95% CI, -1.29 to 1.51; P = 0.001 for noninferiority). Among the 4579 patients in the intention-to-treat population, major or clinically relevant nonmajor bleeding occurred in 148 patients (6.5%) in the abbreviated-therapy group and in 211 (9.4%) in the standard-therapy group (difference, -2.82 percentage points; 95% CI, -4.40 to -1.24; P<0.001 for superiority). CONCLUSIONS: One month of dual antiplatelet therapy was noninferior to the continuation of therapy for at least 2 additional months with regard to the occurrence of net adverse clinical events and major adverse cardiac or cerebral events; abbreviated therapy also resulted in a lower incidence of major or clinically relevant nonmajor bleeding. (Funded by Terumo; MASTER DAPT ClinicalTrials.gov number, NCT03023020.)."},{"id":"c53f91cb409c","type":"article","url":"https://hartvaat.nl/2021/10/26/vroege-impedantie-geleide-interventie-verbetert-langetermijn-hf-uitkomsten/","title":"Vroege impedantie-geleide interventie verbetert langetermijn HF-uitkomsten","title_en":"Early Impedance-Guided Intervention Improves Long-Term Outcome in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.036","source_url":"https://doi.org/10.1016/j.jacc.2021.08.036","authors":["Michael Kleiner Shochat","Marat Fudim","Daniel Kapustin","Mark Kazatsker","Ilia Kleiner","Jean Marc Weinstein","Gurusher Panjrath","Guy Rozen","Ariel Roguin","Simcha R Meisel"],"significance":6,"published":"2021-10-26","source_date":"2021-10-26","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that early intervention guided by thoracic impedance monitoring improves long-term outcomes in heart failure patients, supporting proactive congestion management through implanted device monitoring.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:35Z","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 die aantoont dat vroege impedantie-geleide interventie de langetermijnuitkomsten verbetert bij hartfalen.","abstract_original":""},{"id":"a7ec2334fcea","type":"article","url":"https://hartvaat.nl/2021/10/23/systematische-af-screening-en-klinische-uitkomsten-lancet-strokestop/","title":"Systematische AF-screening en klinische uitkomsten: Lancet STROKESTOP","title_en":"Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP): a multicentre, parallel group, unmasked, randomised controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01637-8","source_url":"https://doi.org/10.1016/S0140-6736(21)01637-8","authors":["Emma Svennberg","Leif Friberg","Viveka Frykman","Faris Al-Khalili","Johan Engdahl","Mårten Rosenqvist"],"significance":9,"published":"2021-10-23","source_date":"2021-10-23","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"The STROKESTOP trial demonstrated that systematic screening for atrial fibrillation in 75-76-year-olds using intermittent ECG recordings, followed by anticoagulation when AF was detected, reduced the composite of ischemic stroke, systemic embolism, bleeding, and death compared with no screening. This is the first randomized trial showing clinical benefit from population-level AF screening.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:35Z","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 STROKESTOP gerandomiseerde trial die systematische AF-screening vergeleek met standaardzorg op klinische uitkomsten. Eerste grote trial die screeningsvoordeel aantoont.","abstract_original":"BACKGROUND: Atrial fibrillation is a leading cause of ischaemic stroke. Early detection of atrial fibrillation can enable anticoagulant therapy to reduce ischaemic stroke and mortality. In this randomised study in an older population, we aimed to assess whether systematic screening for atrial fibrillation could reduce mortality and morbidity compared with no screening. METHODS: STROKESTOP was a multicentre, parallel group, unmasked, randomised controlled trial done in Halland and Stockholm in Sweden. All 75-76-year-olds residing in these two regions were randomly assigned (1:1) to be invited to screening for atrial fibrillation or to a control group. Participants attended local screening centres and those without a history of atrial fibrillation were asked to register intermittent electrocardiograms (ECGs) for 14 days. Treatment with oral anticoagulants was offered if atrial fibrillation was detected or untreated. All randomly assigned individuals were followed up in the intention-to-treat analysis for a minimum of 5 years for the primary combined endpoint of ischaemic or haemorrhagic stroke, systemic embolism, bleeding leading to hospitalisation, and all-cause death. This trial is registered with ClinicalTrials.gov, NCT01593553. FINDINGS: From March 1, 2012, to May 28, 2014, 28 768 individuals were assessed for eligibility and randomly assigned to be invited to screening (n=14 387) or the control group (n=14 381). 408 individuals were excluded from the intervention group and 385 were excluded from the control group due to death or migration before invitation. There was no loss to follow-up. Of those invited to screening, 7165 (51·3%) of 13 979 participated. After a median follow-up of 6·9 years (IQR 6·5-7·2), significantly fewer primary endpoint events occurred in the intervention group (4456 [31·9%] of 13 979; 5·45 events per 100 years [95% CI 5·52-5·61]) than in the control group (4616 [33·0%] of 13 996; 5·68 events per 100 years [5·52-5·85]; hazard ratio 0·96 [95% CI 0·92-1·00]; p=0·045). INTERPRETATION: Screening for atrial fibrillation showed a small net benefit compared with standard of care, indicating that screening is safe and beneficial in older populations. FUNDING: Stockholm County Council, the Swedish Heart & Lung Foundation, King Gustav V and Queen Victoria's Freemasons' Foundation, the Klebergska Foundation, the Tornspiran Foundation, the Scientific Council of Halland Region, the Southern Regional Healthcare Committee, the Swedish Stroke Fund, Carl Bennet AB, Boehringer Ingelheim, Bayer, and Bristol Myers Squibb-Pfizer."},{"id":"1b98e713dedc","type":"article","url":"https://hartvaat.nl/2021/10/21/digitale-therapeutica-bij-essentiele-hypertensie-herb-dh1-pivottrial/","title":"Digitale therapeutica bij essentiële hypertensie: HERB-DH1 pivottrial","title_en":"Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["baxdrostat","bloeddrukbehandeling","lorundrostat"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab559","source_url":"https://doi.org/10.1093/eurheartj/ehab559","authors":["Kazuomi Kario","Akihiro Nomura","Noriko Harada","Ayako Okura","Kiyose Nakagawa","Tomoyuki Tanigawa","Eisuke Hida"],"significance":7,"published":"2021-10-21","source_date":"2021-10-21","image":"","kennis":[],"congress":"","summary_en":"The HERB-DH1 pivotal trial demonstrated that a smartphone-based digital therapeutics system for lifestyle modification significantly reduces blood pressure in patients with essential hypertension, validating the concept of software-as-treatment for chronic disease management.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T18:38:50Z","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":"HERB-DH1 pivottrial die de werkzaamheid van een digitaal therapeuticasysteem bij essentiële hypertensie aantoonde.","abstract_original":"AIMS: Digital therapeutics is a new approach to facilitate the non-pharmacological treatment of hypertension using software programmes such as smartphone applications and/or device algorithms. Based on promising findings from a small pilot trial, the HERB Digital Hypertension 1 (HERB-DH1) pivotal trial investigated the efficacy of digital therapeutics in patients with hypertension not receiving antihypertensive medication. METHODS AND RESULTS: This prospective, open-label, randomized controlled study was performed at 12 sites in Japan. Patients with hypertension [office systolic blood pressure (SBP) 140 to <180 mmHg and 24 h SBP ≥130 mmHg] were randomly assigned 1:1 to the digital therapeutics group (HERB system + standard lifestyle modification) or control group (standard lifestyle modification alone). The primary efficacy endpoint was the mean change in 24 h ambulatory SBP from baseline to 12 weeks; key secondary efficacy endpoints were mean changes in office and home blood pressure (BP) from baseline to 12 weeks. All analyses were conducted in the full analysis set population. Between December 2019 and June 2020, 390 patients were randomly assigned to the digital therapeutics group (n = 199) or control (n = 191) group. Between-group differences in 24-h ambulatory, home, and office SBPs at 12 weeks were -2.4 (95% confidence interval -4.5 to -0.3), -4.3 (-6.7 to -1.9), and -3.6 (-6.2 to -1.0) mmHg, respectively. No major programme-related safety events occurred up to 24 weeks. CONCLUSION: The HERB-DH1 pivotal study showed the superiority of digital therapeutics compared with standard lifestyle modification alone to reduce 24-h ambulatory, home, and office BPs in the absence of antihypertensive medications."},{"id":"04f9718d3069","type":"article","url":"https://hartvaat.nl/2021/10/19/diabetes-met-cardiomyopathie-in-de-community-prevalentie-en-prognose/","title":"Diabetes met cardiomyopathie in de community: prevalentie en prognose","title_en":"Prevalence and Prognostic Implications of Diabetes With Cardiomyopathy in Community-Dwelling Adults.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.020","source_url":"https://doi.org/10.1016/j.jacc.2021.08.020","authors":["Matthew W Segar","Muhammad Shahzeb Khan","Kershaw V Patel","Javed Butler","W H Wilson Tang","Muthiah Vaduganathan","Carolyn S P Lam","Subodh Verma","Darren K McGuire","Ambarish Pandey"],"significance":6,"published":"2021-10-19","source_date":"2021-10-19","image":"","kennis":[],"congress":"","summary_en":"This study characterized the prevalence and prognostic significance of diabetes with cardiomyopathy in community-dwelling adults, showing that diabetic cardiomyopathy is common and predicts subsequent heart failure development.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:35Z","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 prevalentie en prognostische implicaties van diabetes met cardiomyopathie bij community-wonende volwassenen.","abstract_original":"BACKGROUND: Diabetes is associated with abnormalities in cardiac remodeling and high risk of heart failure (HF). OBJECTIVES: The purpose of this study was to evaluate the prevalence and prognostic implications of diabetes with cardiomyopathy (DbCM) among community-dwelling individuals. METHODS: Adults without prevalent cardiovascular disease or HF were pooled from 3 cohort studies (ARIC [Atherosclerosis Risk In Communities], CHS [Cardiovascular Health Study], CRIC [Chronic Renal Insufficiency Cohort]). Among participants with diabetes, DbCM was defined using different definitions: 1) least restrictive: ≥1 echocardiographic abnormality (left atrial enlargement, left ventricle hypertrophy, diastolic dysfunction); 2) intermediate restrictive: ≥2 echocardiographic abnormalities; and 3) most restrictive: elevated N-terminal pro-B-type natriuretic peptide levels (>125 in normal/overweight or >100 pg/mL in obese) plus ≥2 echocardiographic abnormalities. Adjusted Fine-Gray models were used to evaluate the risk of HF. RESULTS: Among individuals with diabetes (2,900 of 10,208 included), the prevalence of DbCM ranged from 67.0% to 11.7% in the least and most restrictive criteria, respectively. Higher fasting glucose, body mass index, and age as well as worse kidney function were associated with higher risk of DbCM. The 5-year incidence of HF among participants with DbCM ranged from 8.4%-12.8% in the least and most restrictive definitions, respectively. Compared with euglycemia, DbCM was significantly associated with higher risk of incident HF with the highest risk observed for the most restrictive definition of DbCM (HR: 2.55 [95% CI: 1.69-3.86]; least restrictive criteria HR: 1.99 [95% CI: 1.50-2.65]). A similar pattern of results was observed across cohort studies, across sex and race subgroups, and among participants without hypertension or obesity. CONCLUSIONS: Regardless of the criteria used to define cardiomyopathy, DbCM identifies a high-risk subgroup for developing HF."},{"id":"12b654708da9","type":"article","url":"https://hartvaat.nl/2021/10/19/empagliflozine-en-verslechterende-hf-events-bij-hfpef-emperor-preserved-analyse/","title":"Empagliflozine en verslechterende HF-events bij HFpEF: EMPEROR-Preserved analyse","title_en":"Effect of Empagliflozin on Worsening Heart Failure Events in Patients With Heart Failure and Preserved Ejection Fraction: EMPEROR-Preserved Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["emperor-trials","hfpef","hfref","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056824","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056824","authors":["Milton Packer","Javed Butler","Faiez Zannad","Gerasimos Filippatos","Joao Pedro Ferreira","Stuart J Pocock","Peter Carson","Inder Anand","Wolfram Doehner","Markus Haass","Michel Komajda","Alan Miller","Steen Pehrson","John R Teerlink","Sven Schnaidt","Cordula Zeller","Janet M Schnee","Stefan D Anker"],"significance":8,"published":"2021-10-19","source_date":"2021-10-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This EMPEROR-Preserved analysis detailed that empagliflozin reduced worsening heart failure events across the ejection fraction spectrum in HFpEF, with consistent benefit regardless of baseline LVEF, diabetes status, or renal function.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:35Z","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":"EMPEROR-Preserved analyse naar het effect van empagliflozine op verslechterende HF-events bij HFpEF.","abstract_original":"BACKGROUND: Empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure with preserved ejection fraction, but additional data are needed about its effect on inpatient and outpatient heart failure events. METHODS: We randomly assigned 5988 patients with class II through IV heart failure with an ejection fraction of >40% to double-blind treatment with placebo or empagliflozin (10 mg once daily), in addition to usual therapy, for a median of 26 months. We prospectively collected information on inpatient and outpatient events reflecting worsening heart failure and prespecified their analysis in individual and composite end points. RESULTS: Empagliflozin reduced the combined risk of cardiovascular death, hospitalization for heart failure, or an emergency or urgent heart failure visit requiring intravenous treatment (432 versus 546 patients [empagliflozin versus placebo, respectively]; hazard ratio, 0.77 [95% CI, 0.67-0.87]; P<0.0001). This benefit reached statistical significance at 18 days after randomization. Empagliflozin reduced the total number of heart failure hospitalizations that required intensive care (hazard ratio, 0.71 [95% CI, 0.52-0.96]; P=0.028) and the total number of all hospitalizations that required a vasopressor or positive inotropic drug (hazard ratio, 0.73 [95% CI, 0.55-0.97]; P=0.033). Compared with patients in the placebo group, fewer patients in the empagliflozin group reported outpatient intensification of diuretics (482 versus 610; hazard ratio, 0.76 [95% CI, 0.67-0.86]; P<0.0001), and patients assigned to empagliflozin were 20% to 50% more likely to have a better New York Heart Association functional class, with significant effects at 12 weeks that were maintained for at least 2 years. The benefit on total heart failure hospitalizations was similar in patients with an ejection fraction of >40% to <50% and 50% to <60%, but was attenuated at higher ejection fractions. CONCLUSIONS: In patients with heart failure with preserved ejection fraction, empagliflozin produced a meaningful, early, and sustained reduction in the risk and severity of a broad range of inpatient and outpatient worsening heart failure events. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03057977."},{"id":"d02083fa0f4f","type":"article","url":"https://hartvaat.nl/2021/10/16/betablokker-respons-bij-hf-met-sinusritme-en-af-machine-learning-clusteranalyse/","title":"Bètablokker-respons bij HF met sinusritme en AF: machine learning clusteranalyse","title_en":"Redefining β-blocker response in heart failure patients with sinus rhythm and atrial fibrillation: a machine learning cluster analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01638-X","source_url":"https://doi.org/10.1016/S0140-6736(21)01638-X","authors":["Andreas Karwath","Karina V Bunting","Simrat K Gill","Otilia Tica","Samantha Pendleton","Furqan Aziz","Andrey D Barsky","Saisakul Chernbumroong","Jinming Duan","Alastair R Mobley","Victor Roth Cardoso","Karin Slater","John A Williams","Emma-Jane Bruce","Xiaoxia Wang","Marcus D Flather","Andrew J S Coats","Georgios V Gkoutos","Dipak Kotecha"],"significance":7,"published":"2021-10-16","source_date":"2021-10-16","image":"","kennis":[],"congress":"","summary_en":"This Lancet machine learning analysis redefined beta-blocker response in heart failure, showing that the mortality benefit of beta-blockers is driven by heart rate reduction and is absent in patients with atrial fibrillation, challenging the assumption of universal beta-blocker benefit in HFrEF.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:35Z","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 machine learning analyse die bètablokker-respons herdefinieert bij HF-patiënten met sinusritme versus AF.","abstract_original":"BACKGROUND: Mortality remains unacceptably high in patients with heart failure and reduced left ventricular ejection fraction (LVEF) despite advances in therapeutics. We hypothesised that a novel artificial intelligence approach could better assess multiple and higher-dimension interactions of comorbidities, and define clusters of β-blocker efficacy in patients with sinus rhythm and atrial fibrillation. METHODS: Neural network-based variational autoencoders and hierarchical clustering were applied to pooled individual patient data from nine double-blind, randomised, placebo-controlled trials of β blockers. All-cause mortality during median 1·3 years of follow-up was assessed by intention to treat, stratified by electrocardiographic heart rhythm. The number of clusters and dimensions was determined objectively, with results validated using a leave-one-trial-out approach. This study was prospectively registered with ClinicalTrials.gov (NCT00832442) and the PROSPERO database of systematic reviews (CRD42014010012). FINDINGS: 15 659 patients with heart failure and LVEF of less than 50% were included, with median age 65 years (IQR 56-72) and LVEF 27% (IQR 21-33). 3708 (24%) patients were women. In sinus rhythm (n=12 822), most clusters demonstrated a consistent overall mortality benefit from β blockers, with odds ratios (ORs) ranging from 0·54 to 0·74. One cluster in sinus rhythm of older patients with less severe symptoms showed no significant efficacy (OR 0·86, 95% CI 0·67-1·10; p=0·22). In atrial fibrillation (n=2837), four of five clusters were consistent with the overall neutral effect of β blockers versus placebo (OR 0·92, 0·77-1·10; p=0·37). One cluster of younger atrial fibrillation patients at lower mortality risk but similar LVEF to average had a statistically significant reduction in mortality with β blockers (OR 0·57, 0·35-0·93; p=0·023). The robustness and consistency of clustering was confirmed for all models (p<0·0001 vs random), and cluster membership was externally validated across the nine independent trials. INTERPRETATION: An artificial intelligence-based clustering approach was able to distinguish prognostic response from β blockers in patients with heart failure and reduced LVEF. This included patients in sinus rhythm with suboptimal efficacy, as well as a cluster of patients with atrial fibrillation where β blockers did reduce mortality. FUNDING: Medical Research Council, UK, and EU/EFPIA Innovative Medicines Initiative BigData@Heart."},{"id":"39307ae425b1","type":"article","url":"https://hartvaat.nl/2021/10/14/empagliflozine-bij-hfpef-nejm-emperor-preserved/","title":"Empagliflozine bij HFpEF: NEJM EMPEROR-Preserved","title_en":"Empagliflozin in Heart Failure with a Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dapa-hf","emperor-trials","hfpef","step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2107038","source_url":"https://doi.org/10.1056/NEJMoa2107038","authors":["Stefan D Anker","Javed Butler","Gerasimos Filippatos","João P Ferreira","Edimar Bocchi","Michael Böhm","Hans-Peter Brunner-La Rocca","Dong-Ju Choi","Vijay Chopra","Eduardo Chuquiure-Valenzuela","Nadia Giannetti","Juan Esteban Gomez-Mesa","Stefan Janssens","James L Januzzi","Jose R Gonzalez-Juanatey","Bela Merkely","Stephen J Nicholls","Sergio V Perrone","Ileana L Piña","Piotr Ponikowski","Michele Senni","David Sim","Jindrich Spinar","Iain Squire","Stefano Taddei","Hiroyuki Tsutsui","Subodh Verma","Dragos Vinereanu","Jian Zhang","Peter Carson","Carolyn Su Ping Lam","Nikolaus Marx","Cordula Zeller","Naveed Sattar","Waheed Jamal","Sven Schnaidt","Janet M Schnee","Martina Brueckmann","Stuart J Pocock","Faiez Zannad","Milton Packer"],"significance":10,"published":"2021-10-14","source_date":"2021-10-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The EMPEROR-Preserved trial was the first to demonstrate that an SGLT2 inhibitor (empagliflozin) reduces heart failure hospitalization in patients with HFpEF. This landmark result extended the benefit of SGLT2 inhibition across the full ejection fraction spectrum, addressing an area with previously no proven pharmacological therapy.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:34Z","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":"Landmark NEJM EMPEROR-Preserved trial die aantoonde dat empagliflozine cardiovasculaire dood en HF-hospitalisatie vermindert bij HFpEF. Eerste SGLT2-remmer die effectief is over het volledige HF-spectrum — paradigmashift voor HFpEF.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 inhibitors reduce the risk of hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, but their effects in patients with heart failure and a preserved ejection fraction are uncertain. METHODS: In this double-blind trial, we randomly assigned 5988 patients with class II-IV heart failure and an ejection fraction of more than 40% to receive empagliflozin (10 mg once daily) or placebo, in addition to usual therapy. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure. RESULTS: Over a median of 26.2 months, a primary outcome event occurred in 415 of 2997 patients (13.8%) in the empagliflozin group and in 511 of 2991 patients (17.1%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.69 to 0.90; P<0.001). This effect was mainly related to a lower risk of hospitalization for heart failure in the empagliflozin group. The effects of empagliflozin appeared consistent in patients with or without diabetes. The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (407 with empagliflozin and 541 with placebo; hazard ratio, 0.73; 95% CI, 0.61 to 0.88; P<0.001). Uncomplicated genital and urinary tract infections and hypotension were reported more frequently with empagliflozin. CONCLUSIONS: Empagliflozin reduced the combined risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a preserved ejection fraction, regardless of the presence or absence of diabetes. (Funded by Boehringer Ingelheim and Eli Lilly; EMPEROR-Preserved ClinicalTrials.gov number, NCT03057951)."},{"id":"748b079a6996","type":"article","url":"https://hartvaat.nl/2021/10/14/empagliflozine-en-renale-uitkomsten-bij-hartfalen-nejm-emperor-reduced-renal/","title":"Empagliflozine en renale uitkomsten bij hartfalen: NEJM EMPEROR-Reduced renal","title_en":"Empagliflozin and Major Renal Outcomes in Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapagliflozine","empagliflozine","emperor-trials"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMc2112411","source_url":"https://doi.org/10.1056/NEJMc2112411","authors":["Milton Packer","Javed Butler","Faiez Zannad","Stuart J Pocock","Gerasimos Filippatos","João P Ferreira","Martina Brueckmann","Waheed Jamal","Cordula Zeller","Christoph Wanner","Stefan D Anker"],"significance":8,"published":"2021-10-14","source_date":"2021-10-14","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This EMPEROR-Reduced renal analysis showed that empagliflozin slowed the decline in eGFR and reduced the risk of serious kidney outcomes in patients with heart failure, demonstrating renoprotective effects of SGLT2 inhibition in the heart failure population.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:34Z","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":"NEJM EMPEROR-Reduced renale analyse die het nierprotectieve effect van empagliflozine bij HF kwantificeerde.","abstract_original":""},{"id":"6672a9401c1d","type":"article","url":"https://hartvaat.nl/2021/10/14/lignocaine-versus-opioiden-op-antiplaatjeseffect-van-ticagrelor-local-trial/","title":"Lignocaïne versus opioïden op antiplaatjeseffect van ticagrelor: LOCAL trial","title_en":"Effects of lignocaine vs. opioids on antiplatelet activity of ticagrelor: the LOCAL trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab557","source_url":"https://doi.org/10.1093/eurheartj/ehab557","authors":["Himawan Fernando","Thy Duong","Kevin Huynh","Jonathan Noonan","James Shaw","Stephen J Duffy","Ziad Nehme","Karen Smith","Paul S Myles","Peter J Meikle","Karlheinz Peter","Dion Stub"],"significance":6,"published":"2021-10-14","source_date":"2021-10-14","image":"","kennis":[],"congress":"","summary_en":"The LOCAL trial showed that intravenous lignocaine avoids the antiplatelet-delaying effect of opioids on ticagrelor in ACS patients, providing an alternative analgesic strategy that preserves rapid P2Y12 inhibition.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:34Z","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":"LOCAL trial die lignocaïne vergeleek met opioïden op het anti-plaatjeseffect van ticagrelor. Alternatief voor opioïden.","abstract_original":"AIMS: We assessed the impact of intravenous fentanyl and lignocaine on the pharmacokinetics and pharmacodynamics of ticagrelor in patients with unstable angina and non-ST-elevation myocardial infarction and their procedural analgesic efficacy and safety. METHODS AND RESULTS: Seventy patients undergoing coronary angiography with ticagrelor loading were included in the pharmacokinetic and pharmacodynamic analyses of this randomized trial. Plasma ticagrelor levels 2 h post-loading dose were significantly lower in the fentanyl arm than in the lignocaine treatment arm (598 vs. 1008 ng/mL, P = 0.014). The area under the plasma-time curves for ticagrelor (1228 vs. 2753 ng h/mL, P < 0.001) and its active metabolite (201 vs. 447 ng h/mL, P = 0.001) were both significantly lower in the fentanyl arm. Expression of activated platelet glycoprotein IIb/IIIa receptor (2829 vs. 1426 mean fluorescence intensity, P = 0.006) and P-selectin (439 vs. 211 mean fluorescence intensity, P = 0.001) was significantly higher at 60 min in the fentanyl arm. A higher proportion of patients had high on-treatment platelet reactivity in the fentanyl arm at 60 min using the Multiplate Analyzer (41% vs. 9%, P = 0.002) and 120 min using the VerifyNow (30% vs. 3%, P = 0.003) and VASP (37% vs. 6%, P = 0.002) assays. Both drugs were well tolerated with a high level of patient satisfaction. CONCLUSIONS: Unlike fentanyl, lignocaine does not impair the bioavailability or delay the antiplatelet effect of ticagrelor. Both drugs were well tolerated and effective with a high level of patient satisfaction for procedural analgesia. Routine procedural analgesia during percutaneous coronary intervention should be reconsidered and if performed, lignocaine is a beneficial alternative to fentanyl."},{"id":"5e0f3ff6b8c5","type":"article","url":"https://hartvaat.nl/2021/10/12/overbrugging-van-antiplaatjestherapie-na-pci-jacc-review/","title":"Overbrugging van antiplaatjestherapie na PCI: JACC review","title_en":"Bridging Antiplatelet Therapy After Percutaneous Coronary Intervention: JACC Review Topic of the Week.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.013","source_url":"https://doi.org/10.1016/j.jacc.2021.08.013","authors":["Alexander E Sullivan","Michael G Nanna","Tracy Y Wang","Deepak L Bhatt","Dominick J Angiolillo","Roxana Mehran","Subhash Banerjee","Sarah Cantrell","W Schuyler Jones","Jennifer A Rymer","Jeffrey B Washam","Sunil V Rao","E Magnus Ohman"],"significance":6,"published":"2021-10-12","source_date":"2021-10-12","image":"","kennis":[],"congress":"","summary_en":"This JACC review addressed the practical challenge of bridging antiplatelet therapy when patients with coronary stents require non-cardiac surgery, providing guidance on risk assessment and perioperative management.","created":"2026-07-03T10:29:27Z","updated":"2026-07-03T13:28:34Z","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":"JACC review over bridging van antiplaatjestherapie na PCI.","abstract_original":"Patients undergoing early surgery after coronary stent implantation are at increased risk for mortality from ischemic and hemorrhagic complications. The optimal antiplatelet strategy in patients who cannot discontinue dual antiplatelet therapy (DAPT) before surgery is unclear. Current guidelines, based on surgical and clinical characteristics, provide risk stratification for bridging therapy with intravenous antiplatelet agents, but management is guided primarily by expert opinion. This review summarizes perioperative risk factors to consider before discontinuing DAPT and reviews the data for intravenous bridging therapies. Published reports have included bridging options such as small molecule glycoprotein IIb/IIIa inhibitors (eptifibatide or tirofiban) and cangrelor, an intravenous P2Y12 inhibitor. However, optimal management of these complex patients remains unclear in the absence of randomized controlled data, without which an argument can be made both for and against the use of perioperative intravenous bridging therapy after discontinuing oral P2Y12 inhibitors. Multidisciplinary risk assessment remains a critical component of perioperative care."},{"id":"b8da8a38d1b5","type":"article","url":"https://hartvaat.nl/2021/10/12/reductie-in-ischemische-events-door-onderzoekers-en-adjudicatiecommissie-reduce-/","title":"Reductie in ischemische events door onderzoekers en adjudicatiecommissie: REDUCE-IT","title_en":"Comparative Reductions in Investigator-Reported and Adjudicated Ischemic Events in REDUCE-IT.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.009","source_url":"https://doi.org/10.1016/j.jacc.2021.08.009","authors":["Prakriti Gaba","Deepak L Bhatt","Robert P Giugliano","Ph Gabriel Steg","Michael Miller","Eliot A Brinton","Terry A Jacobson","Steven B Ketchum","Rebecca A Juliano","Lixia Jiao","Ralph T Doyle","Craig Granowitz","Jean-Claude Tardif","Christie M Ballantyne","Duane S Pinto","Matthew J Budoff","C Michael Gibson"],"significance":5,"published":"2021-10-12","source_date":"2021-10-12","image":"","kennis":[],"congress":"","summary_en":"This REDUCE-IT analysis compared investigator-reported with centrally adjudicated ischemic events, showing consistent treatment effects regardless of event ascertainment method, strengthening the trial's internal validity.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:34Z","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":"REDUCE-IT vergelijking van onderzoekers-gerapporteerde versus geadjudiceerde ischemische events.","abstract_original":"BACKGROUND: REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial) randomized statin-treated patients with elevated triglycerides to icosapent ethyl (IPE) or placebo. There was a significant reduction in adjudicated events, including the primary endpoint (cardiovascular [CV] death, myocardial infarction [MI], stroke, coronary revascularization, unstable angina requiring hospitalization) and key secondary endpoint (CV death, MI, stroke) with IPE. OBJECTIVES: The purpose of this study was to determine the effects of IPE on investigator-reported events. METHODS: Potential endpoints were collected by blinded site investigators and subsequently adjudicated by a blinded Clinical Endpoint Committee (CEC) according to a prespecified charter. Investigator-reported events were compared with adjudicated events for concordance. RESULTS: There was a high degree of concordance between investigator-reported and adjudicated endpoints. The simple Kappa statistic between CEC-adjudicated vs site-reported events for the primary endpoint was 0.89 and for the key secondary endpoint was 0.90. Based on investigator-reported events in 8,179 randomized patients, IPE significantly reduced the rate of the primary endpoint (19.1% vs 24.6%; HR: 0.74 [95% CI: 0.67-0.81]; P < 0.0001) and the key secondary endpoint (10.5% vs 13.6%; HR: 0.75 [95% CI: 0.66-0.85]; P < 0.0001). Among adjudicated events, IPE similarly reduced the rate of the primary and key secondary endpoints. CONCLUSIONS: IPE led to consistent, significant reductions in CV events, including MI and coronary revascularization, as determined by independent, blinded CEC adjudication as well as by blinded investigator-reported assessment. These results highlight the robust evidence for the substantial CV benefits of IPE seen in REDUCE-IT and further raise the question of whether adjudication of CV outcome trial endpoints is routinely required in blinded, placebo-controlled trials. (Evaluation of the Effect of AMR101 on Cardiovascular Health and Mortality in Hypertriglyceridemic Patients With Cardiovascular Disease or at High Risk for Cardiovascular Disease: REDUCE-IT [Reduction of Cardiovascular Events With EPA - Intervention Trial]; NCT01492361)."},{"id":"725715de76f5","type":"article","url":"https://hartvaat.nl/2021/10/12/baseline-ldl-en-klinische-uitkomsten-van-ezetimibe-plus-statine-improve-it/","title":"Baseline LDL en klinische uitkomsten van ezetimibe plus statine: IMPROVE-IT","title_en":"Baseline Low-Density Lipoprotein Cholesterol and Clinical Outcomes of Combining Ezetimibe With Statin Therapy in IMPROVE-IT.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.011","source_url":"https://doi.org/10.1016/j.jacc.2021.08.011","authors":["Kazuma Oyama","Robert P Giugliano","Michael A Blazing","Jeong-Gun Park","Andrew M Tershakovec","Marc S Sabatine","Christopher P Cannon","Eugene Braunwald"],"significance":6,"published":"2021-10-12","source_date":"2021-10-12","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This IMPROVE-IT analysis showed that patients with higher baseline LDL cholesterol derive greater absolute benefit from adding ezetimibe to statin therapy, supporting the treat-to-target approach based on baseline lipid levels.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:34Z","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":"IMPROVE-IT analyse naar het effect van baseline LDL-niveau op klinische uitkomsten met ezetimibe-toevoeging.","abstract_original":"BACKGROUND: The 2018 U.S. cholesterol management guideline recommends additional lipid-lowering therapy with ezetimibe for secondary prevention in very high-risk patients with low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL despite maximally tolerated statin. OBJECTIVES: The purpose of this study was to evaluate the relationship between baseline LDL-C above and below 70 mg/dL and the benefit of adding ezetimibe to statin in patients post-acute coronary syndrome (ACS). METHODS: IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) was a double-blind, placebo-controlled, randomized trial of ezetimibe/simvastatin vs placebo/simvastatin in post-ACS patients followed for 6 years (median). A total of 17,999 patients were stratified by LDL-C at qualifying event into 3 groups (50-<70, 70-<100, and 100-125 mg/dL). The primary endpoint was a composite of cardiovascular death, major coronary events, or stroke. RESULTS: Absolute differences in median LDL-C achieved at 4 months between treatment arms were similar (17-20 mg/dL). The effect of ezetimibe/simvastatin vs placebo/simvastatin on primary endpoint was consistent regardless of baseline LDL-C of 50-<70 mg/dL (HR: 0.92 [95% CI: 0.80-1.05]), 70-<100 mg/dL (HR: 0.93 [95% CI: 0.87-1.01]), or 100-125 mg/dL (HR: 0.94 [95% CI: 0.86-1.03]; P interaction = 0.95). Normalized relative risk reductions per 1-mmol/L difference in achieved LDL-C at 4 months between treatment arms were 21% in patients with baseline LDL-C of 50-<70 mg/dL, 16% in those with 70-<100 mg/dL, and 13% in those with 100-125 mg/dL (P interaction = 0.91). No significant treatment interactions by baseline LDL-C were present for safety endpoints. CONCLUSIONS: Adding ezetimibe to statin consistently reduced the risk for cardiovascular events in post-ACS patients irrespective of baseline LDL-C values, supporting the use of intensive lipid-lowering therapy with ezetimibe even in patients with baseline LDL-C <70 mg/dL. (IMPROVE-IT: Examining Outcomes in Subjects With Acute Coronary Syndrome: Vytorin [Ezetimibe/Simvastatin] vs Simvastatin [P04103]; NCT00202878)."},{"id":"2d4ae974532c","type":"article","url":"https://hartvaat.nl/2021/10/12/leefstijlmodificatie-bij-resistente-hypertensie-triumph-gerandomiseerde-trial/","title":"Leefstijlmodificatie bij resistente hypertensie: TRIUMPH gerandomiseerde trial","title_en":"Effects of Lifestyle Modification on Patients With Resistant Hypertension: Results of the TRIUMPH Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["aprocitentan","bax24-trial","bloeddrukbehandeling","figaro-dkd","lorundrostat","precision-trial","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","select-trial","summit-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.055329","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.055329","authors":["James A Blumenthal","Alan L Hinderliter","Patrick J Smith","Stephanie Mabe","Lana L Watkins","Linda Craighead","Krista Ingle","Crystal Tyson","Pao-Hwa Lin","William E Kraus","Lawrence Liao","Andrew Sherwood"],"significance":7,"published":"2021-10-12","source_date":"2021-10-12","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"The TRIUMPH randomized trial showed that lifestyle modifications (dietary counseling, exercise, weight loss) significantly reduce blood pressure in patients with resistant hypertension already on pharmacotherapy, demonstrating that non-pharmacological approaches retain benefit even in treatment-resistant disease.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:34Z","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":"TRIUMPH gerandomiseerde trial die het effect van leefstijlmodificatie onderzocht bij patiënten met resistente hypertensie.","abstract_original":"BACKGROUND: Although lifestyle modifications generally are effective in lowering blood pressure (BP) among patients with unmedicated hypertension and in those treated with 1 or 2 antihypertensive agents, the value of exercise and diet for lowering BP in patients with resistant hypertension is unknown. METHODS: One hundred forty patients with resistant hypertension (mean age, 63 years; 48% female; 59% Black; 31% with diabetes; 21% with chronic kidney disease) were randomly assigned to a 4-month program of lifestyle modification (C-LIFE [Center-Based Lifestyle Intervention]) including dietary counseling, behavioral weight management, and exercise, or a single counseling session providing SEPA (Standardized Education and Physician Advice). The primary end point was clinic systolic BP; secondary end points included 24-hour ambulatory BP and select cardiovascular disease biomarkers including baroreflex sensitivity to quantify the influence of the baroreflex on heart rate, high-frequency heart rate variability to assess vagally mediated modulation of heart rate, flow-mediated dilation to evaluate endothelial function, pulse wave velocity to assess arterial stiffness, and left ventricular mass to characterize left ventricular structure. RESULTS: Between-group comparisons revealed that the reduction in clinic systolic BP was greater in C-LIFE (-12.5 [95% CI, -14.9 to -10.2] mm Hg) compared with SEPA(-7.1 [-95% CI, 10.4 to -3.7] mm Hg) (P=0.005); 24-hour ambulatory systolic BP also was reduced in C-LIFE (-7.0 [95% CI, -8.5 to -4.0] mm Hg), with no change in SEPA (-0.3 [95% CI, -4.0 to 3.4] mm Hg) (P=0.001). Compared with SEPA, C-LIFE resulted in greater improvements in resting baroreflex sensitivity (2.3 ms/mm Hg [95% CI, 1.3 to 3.3] versus -1.1 ms/mm Hg [95% CI, -2.5 to 0.3]; P<0.001), high-frequency heart rate variability (0.4 ln ms2 [95% CI, 0.2 to 0.6] versus -0.2 ln ms2 [95% CI, -0.5 to 0.1]; P<0.001), and flow-mediated dilation (0.3% [95% CI, -0.3 to 1.0] versus -1.4% [95% CI, -2.5 to -0.3]; P=0.022). There were no between-group differences in pulse wave velocity (P=0.958) or left ventricular mass (P=0.596). CONCLUSIONS: Diet and exercise can lower BP in patients with resistant hypertension. A 4-month structured program of diet and exercise as adjunctive therapy delivered in a cardiac rehabilitation setting results in significant reductions in clinic and ambulatory BP and improvement in selected cardiovascular disease biomarkers. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02342808."},{"id":"dfcacae098d9","type":"article","url":"https://hartvaat.nl/2021/10/09/ongeleide-de-escalatie-van-ticagrelor-naar-clopidogrel-na-mi-met-pci-lancet-talo/","title":"Ongeleide de-escalatie van ticagrelor naar clopidogrel na MI met PCI: Lancet TALOS-AMI","title_en":"Unguided de-escalation from ticagrelor to clopidogrel in stabilised patients with acute myocardial infarction undergoing percutaneous coronary intervention (TALOS-AMI): an investigator-initiated, open-label, multicentre, non-inferiority, randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01445-8","source_url":"https://doi.org/10.1016/S0140-6736(21)01445-8","authors":["Chan Joon Kim","Mahn-Won Park","Min Chul Kim","Eun-Ho Choo","Byung-Hee Hwang","Kwan Yong Lee","Yun Seok Choi","Hee-Yeol Kim","Ki-Dong Yoo","Doo-Soo Jeon","Eun-Seok Shin","Young-Hoon Jeong","Ki-Bae Seung","Myung Ho Jeong","Hyeon Woo Yim","Youngkeun Ahn","Kiyuk Chang"],"significance":8,"published":"2021-10-09","source_date":"2021-10-09","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The TALOS-AMI trial demonstrated that unguided de-escalation from ticagrelor to clopidogrel one month after MI reduced bleeding without increasing ischemic events. The pragmatic approach, requiring no platelet function testing, offered a simpler de-escalation strategy than guided protocols.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:34Z","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":"Lancet TALOS-AMI trial die ongeleide de-escalatie van ticagrelor naar clopidogrel onderzocht bij gestabiliseerde MI-patiënten na PCI.","abstract_original":"BACKGROUND: In patients with acute myocardial infarction receiving potent antiplatelet therapy, the bleeding risk remains high during the maintenance phase. We sought data on a uniform unguided de-escalation strategy of dual antiplatelet therapy (DAPT) from ticagrelor to clopidogrel after acute myocardial infarction. METHODS: In this open-label, assessor-masked, multicentre, non-inferiority, randomised trial (TALOS-AMI), patients at 32 institutes in South Korea with acute myocardial infarction receiving aspirin and ticagrelor without major ischaemic or bleeding events during the first month after index percutaneous coronary intervention (PCI) were randomly assigned in a 1:1 ratio to a de-escalation (clopidogrel plus aspirin) or active control (ticagrelor plus aspirin) group. Unguided de-escalation without a loading dose of clopidogrel was adopted when switching from ticagrelor to clopidogrel. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke, or bleeding type 2, 3, or 5 according to Bleeding Academic Research Consortium (BARC) criteria from 1 to 12 months. A non-inferiority test was done to assess the safety and efficacy of de-escalation DAPT compared with standard treatment. The hazard ratio (HR) for de-escalation versus active control group in a stratified Cox proportional hazards model was assessed for non-inferiority by means of an HR margin of 1·34, which equates to an absolute difference of 3·0% in the intention-to-treat population and, if significant, a superiority test was done subsequently. To ensure statistical robustness, additional analyses were also done in the per-protocol population. This trial is registered at ClinicalTrials.gov, NCT02018055. FINDINGS: From Feb 26, 2014, to Dec 31, 2018, from 2901 patients screened, 2697 patients were randomly assigned: 1349 patients to de-escalation and 1348 to active control groups. At 12 months, the primary endpoints occurred in 59 (4·6%) in the de-escalation group and 104 (8·2%) patients in the active control group (pnon-inferiority<0·001; HR 0·55 [95% CI 0·40-0·76], psuperiority=0·0001). There was no significant difference in composite of cardiovascular death, myocardial infarction, or stroke between de-escalation (2·1%) and the active control group (3·1%; HR 0·69; 95% CI 0·42-1·14, p=0·15). Composite of BARC 2, 3, or 5 bleeding occurred less frequently in the de-escalation group (3·0% vs 5·6%, HR 0·52; 95% CI 0·35-0·77, p=0·0012). INTERPRETATION: In stabilised patients with acute myocardial infarction after index PCI, a uniform unguided de-escalation strategy significantly reduced the risk of net clinical events up to 12 months, mainly by reducing the bleeding events. FUNDING: ChongKunDang Pharm, Medtronic, Abbott, and Boston Scientific."},{"id":"d4ddb2b626d0","type":"article","url":"https://hartvaat.nl/2021/10/09/klinische-risicofactoren-voor-cva-bij-anticoagulantie-naieve-af-meta-analyse/","title":"Klinische risicofactoren voor CVA bij anticoagulantie-naïeve AF: meta-analyse","title_en":"A meta-analysis of clinical risk factors for stroke in anticoagulant-naïve patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["abelacimab","anticoagulantia","anticoagulatie-kwetsbare-ouderen","rivaroxaban"],"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/euab087","source_url":"https://doi.org/10.1093/europace/euab087","authors":["Jean Jacques Noubiap","Vitalis Fambombi Feteh","Melissa E Middeldorp","John L Fitzgerald","Gijo Thomas","Timothy Kleinig","Dennis H Lau","Prashanthan Sanders"],"significance":6,"published":"2021-10-09","source_date":"2021-10-09","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis of clinical risk factors for stroke in anticoagulant-naive AF patients identified the strongest predictors of thromboembolism, informing risk stratification for anticoagulation initiation decisions.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:34Z","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":"Meta-analyse van klinische risicofactoren voor beroerte bij anticoagulantie-naïeve AF-patiënten.","abstract_original":"AIMS: The aim of this study is to summarize data from prospective cohort studies on clinical predictors of stroke and systemic embolism in anticoagulant-naïve atrial fibrillation (AF) patients. METHODS AND RESULTS: EMBASE, MEDLINE, Global Index Medicus, and Web of Science were searched to identify all studies published by 28 November 2019. Forty-seven studies reporting data from 1 756 984 participants in 15 countries were included. The pooled incidence of stroke in anticoagulant-naïve AF patients was 23.8 per 1000 person-years (95% CI 19.7-28.2). Older age was associated with incident stroke or systemic embolism, with a pooled hazard ratio (HR) of 2.14 (95% CI 1.85-2.47), 2.83 (95% CI 2.27-3.51), and 6.87 (95% CI 6.33-7.44) for age 65-75, ≥75, and ≥85 years, respectively. Other predictors of stroke or systemic embolism included history of stroke or TIA (HR 2.84, 95% CI 2.19-3.67), hypertension (HR 1.60, 95% CI 1.37-1.86), diabetes (HR 1.28, 95% CI 1.20-1.37), heart failure (HR 1.25, 95% CI 1.11-1.40), peripheral artery disease (pooled HR 1.35, 95% CI 1.04-1.75), vascular disease (pooled HR 1.21, 95% CI 1.06-1.39), and prior myocardial infarction (pooled HR 1.08, 95% CI 1.03-1.14). Female sex was a predictor of thromboembolism in studies outside Asia (HR 1.35, 95% CI 1.15-1.59), but not in those done in Asia (HR 0.95, 95% CI 0.81-1.10). CONCLUSION: This study confirms age and prior stroke as the strongest predictors of stroke or systemic embolism in anticoagulant-naive AF patients. Other predictors include hypertension, diabetes, heart failure, and vascular disease. Female sex seems not to be universally associated with stroke or systemic embolism."},{"id":"e4935825fb42","type":"article","url":"https://hartvaat.nl/2021/10/09/voorspellers-van-sinusritme-6-weken-na-af-cardioversie-x-vert/","title":"Voorspellers van sinusritme 6 weken na AF-cardioversie: X-VeRT","title_en":"Predictors of sinus rhythm 6 weeks after cardioversion of atrial fibrillation: a pre-planned post hoc analysis of the X-VeRT 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/euab084","source_url":"https://doi.org/10.1093/europace/euab084","authors":["Riccardo Cappato","Michael D Ezekowitz","Stefan H Hohnloser","Isabelle Ling Meng","Melanie Wosnitza","And Arthur John Camm"],"significance":5,"published":"2021-10-09","source_date":"2021-10-09","image":"","kennis":[],"congress":"","summary_en":"This X-VeRT post-hoc analysis identified predictors of sinus rhythm maintenance 6 weeks after cardioversion of AF, informing which patients are likely to benefit from electrical rhythm restoration.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:33Z","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":"X-VeRT post-hoc analyse naar voorspellers van sinusritme 6 weken na cardioversie van AF.","abstract_original":"AIMS: Using a pre-planned post hoc analysis of patients included in X-VeRT, we evaluated predictors of sinus rhythm at 6 weeks after planned cardioversion. METHODS AND RESULTS: Receiver operating characteristic curves and logistic regression models were used to evaluate continuous and categorical variables as predictors of sinus rhythm 6 at weeks from cardioversion (end of study). The primary analysis was performed in successfully cardioverted patients with an evaluable electrocardiogram at end of study. A second analysis evaluated additional patients who spontaneously restored sinus rhythm before planned cardioversion. Of the 1504 patients with atrial fibrillation of >48 h or of unknown duration who were randomly assigned to either rivaroxaban or vitamin K antagonist, 1039 (64.6 ± 10.3 years, 73.4% male) underwent planned cardioversion and were included in this study. Patients receiving early cardioversion (i.e. between 1 and 5 days from hospitalization) had a 67% higher probability to have sinus rhythm at end of study than those who received delayed cardioversion (i.e. between 21 and 56 days from hospitalization) [odds ratio (OR) 1.67, confidence interval (CI) 1.27-2.18; P < 0.0001]. In a multivariate analysis of 17 baseline variables, patients with a CHADS2 score of 0 were 33% less likely to be in sinus rhythm than those with a CHADS2 score ≥2 (OR 0.66, CI 0.47-0.94; P = 0.0225). In the secondary analysis, spontaneous restoration of sinus rhythm was also found to predict sinus rhythm at end of study (OR 8.62, CI 1.54-48.16; P = 0.0142). CONCLUSION: In X-VeRT, early cardioversion and high CHADS2 scores predicted sinus rhythm at 6 weeks from cardioversion."},{"id":"eb8198be7caf","type":"article","url":"https://hartvaat.nl/2021/10/09/gewichtsverlies-voor-af-ablatie-sort-af-gerandomiseerde-trial/","title":"Gewichtsverlies voor AF-ablatie: SORT-AF gerandomiseerde trial","title_en":"Supervised Obesity Reduction Trial for AF ablation patients: results from the SORT-AF trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["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/euab122","source_url":"https://doi.org/10.1093/europace/euab122","authors":["Nele Gessler","Stephan Willems","Daniel Steven","Jens Aberle","Ruken Oezge Akbulak","Nils Gosau","Boris A Hoffmann","Christian Meyer","Arian Sultan","Roland Tilz","Julia Vogler","Peter Wohlmuth","Susanne Scholz","Melanie A Gunawardene","Christian Eickholt","Jakob Lüker"],"significance":7,"published":"2021-10-09","source_date":"2021-10-09","image":"","kennis":[],"congress":"","summary_en":"The SORT-AF trial investigated whether structured weight reduction before AF catheter ablation improves ablation outcomes in obese patients, testing the hypothesis that upstream risk factor modification enhances procedural success.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:33Z","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":"SORT-AF gerandomiseerde trial van gestructureerd gewichtsverlies vóór AF-ablatie. Upstream therapie.","abstract_original":"AIMS: Weight management seems to be beneficial for obese atrial fibrillation (AF) patients; however, randomized data are sparse. Thus, this study aimed to investigate the influence of weight reduction on AF ablation outcomes. METHODS AND RESULTS: SORT-AF is an investigator-sponsored, prospective, randomized, multicentre, and clinical trial. Patients with symptomatic AF (paroxysmal or persistent) and body mass index (BMI) 30-40 kg/m2 underwent AF ablation and were randomized to either weight-reduction (group 1) or usual care (group 2), after sleep-apnoea-screening and loop recorder (ILR) implantation. The primary endpoint was defined as AF burden between 3 and 12 months after AF ablation. Overall, 133 patients (60 ± 10 years, 57% persistent AF) were randomized to group 1 (n = 67) and group 2 (n = 66), respectively. Complications after AF-ablation were rare (one stroke and no tamponade). The intervention led to a significant reduction of BMI (34.9 ± 2.6-33.4 ± 3.6) in group 1 compared to a stable BMI in group 2 (P < 0.001). Atrial fibrillation burden after ablation decreased significantly (P < 0.001), with no significant difference regarding the primary endpoint between the groups (P = 0.815, odds ratio: 1.143, confidence interval: 0.369-3.613). Further analyses showed a significant correlation between BMI and AF recurrence for patients with persistent AF compared with paroxysmal AF patients (P = 0.032). CONCLUSION: The SORT-AF study shows that AF ablation is safe and successful in obese patients using continuous monitoring via ILR. Although the primary endpoint of AF burden after ablation did not differ between the two groups, the effects of weight loss and improvement of exercise activity were beneficial for obese patients with persistent AF demonstrating the relevance of life-style management as an important adjunct to AF ablation in this setting. TRIAL REGISTRATION NUMBER: NCT02064114."},{"id":"c815032c3bd0","type":"article","url":"https://hartvaat.nl/2021/10/05/ketonlichamen-en-functionele-uitkomsten-na-stemi/","title":"Ketonlichamen en functionele uitkomsten na STEMI","title_en":"Association of Circulating Ketone Bodies With Functional Outcomes After ST-Segment Elevation Myocardial Infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.07.054","source_url":"https://doi.org/10.1016/j.jacc.2021.07.054","authors":["Marie-Sophie L Y de Koning","B Daan Westenbrink","Solmaz Assa","Erwin Garcia","Margery A Connelly","Dirk J van Veldhuisen","Robin P F Dullaart","Erik Lipsic","Pim van der Harst"],"significance":5,"published":"2021-10-05","source_date":"2021-10-05","image":"","kennis":[],"congress":"","summary_en":"This study showed that circulating ketone body levels are associated with functional outcomes after STEMI, supporting the metabolic shift toward ketone utilization as a compensatory mechanism in cardiac injury.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:33Z","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 de associatie van circulerende ketonlichamen met functionele uitkomsten na STEMI.","abstract_original":"BACKGROUND: Circulating ketone bodies (KBs) are increased in patients with heart failure (HF), corresponding with increased cardiac KB metabolism and HF severity. However, the role of circulating KBs in ischemia/reperfusion remains unknown. OBJECTIVES: This study sought to investigate longitudinal changes of KBs and their associations with functional outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS: KBs were measured in 369 participants from a randomized trial on early metformin therapy after STEMI. Nonfasting plasma concentrations of KBs (β-hydroxybutyrate, acetoacetate, and acetone) were measured by nuclear magnetic resonance spectroscopy at presentation, at 24 hours, and after 4 months. Myocardial infarct size and left ventricular ejection fraction (LVEF) were determined by cardiac magnetic resonance imaging at 4 months. Associations of circulating KBs with infarct size and LVEF were determined using multivariable linear regression analyses. RESULTS: Circulating KBs were high at presentation with STEMI (median total KBs: 520 μmol/L; interquartile range [IQR]: 315-997 μmol/L). At 24 hours after reperfusion, KBs were still high compared with levels at 4-month follow-up (206 μmol/L [IQR: 174-246] vs 166 μmol/L [IQR: 143-201], respectively; P < 0.001). Increased KB concentrations at 24 hours were independently associated with larger myocardial infarct size (total KBs, per 100 μmol/L: β = 1.56; 95% confidence interval: 0.29-2.83; P = 0.016) and lower LVEF (β = -1.78; 95% CI: (-3.17 to -0.39; P = 0.012). CONCLUSIONS: Circulating KBs are increased in patients presenting with STEMI. Higher KBs at 24 hours are associated with functional outcomes after STEMI, which suggests a potential role for ketone metabolism in response to myocardial ischemia. (Metabolic Modulation With Metformin to Reduce Heart Failure After Acute Myocardial Infarction: Glycometabolic Intervention as Adjunct to Primary Coronary Intervention in ST Elevation Myocardial Infarction (GIPS-III): a Randomized Controlled Trial; NCT01217307)."},{"id":"c716f6ea76d2","type":"article","url":"https://hartvaat.nl/2021/10/01/paroxetine-grk2-remming-versus-placebo-bij-anterieur-mi-jama-cardiology/","title":"Paroxetine GRK2-remming versus placebo bij anterieur MI: JAMA Cardiology","title_en":"Effect of Paroxetine-Mediated G-Protein Receptor Kinase 2 Inhibition vs Placebo in Patients With Anterior Myocardial Infarction: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.2247","source_url":"https://doi.org/10.1001/jamacardio.2021.2247","authors":["Thomas Pilgrim","René Vollenbroich","Sarah Deckarm","Christoph Gräni","Stephan Dobner","Anselm W Stark","Sophie A Erne","Flora Babongo Bosombo","Kady Fischer","Stefan Stortecky","Nicole Reusser","Monika Fürholz","George C M Siontis","Dik Heg","Lukas Hunziker","Stephan Windecker","Jonas Lanz"],"significance":5,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This trial tested paroxetine as a GRK2 inhibitor (repurposed from antidepressant) for preventing LV remodeling after anterior MI, exploring kinase inhibition for post-infarction cardioprotection.","created":"2026-07-03T10:29:26Z","updated":"2026-07-03T13:28:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology trial van paroxetine (als GRK2-remmer) versus placebo bij anterieur MI.","abstract_original":"IMPORTANCE: Left ventricular remodeling following acute myocardial infarction results in progressive myocardial dysfunction and adversely affects prognosis. OBJECTIVE: To investigate the efficacy of paroxetine-mediated G-protein-coupled receptor kinase 2 inhibition to mitigate adverse left ventricular remodeling in patients presenting with acute myocardial infarction. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled randomized clinical trial was conducted at Bern University Hospital, Bern, Switzerland. Patients with acute anterior ST-segment elevation myocardial infarction with left ventricular ejection fraction (LVEF) of 45% or less were randomly allocated to 2 study arms between October 26, 2017, and September 21, 2020. INTERVENTIONS: Patients in the experimental arm received 20 mg of paroxetine daily; patients in the control group received a placebo daily. Both treatments were provided for 12 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was the difference in patient-level improvement of LVEF between baseline and 12 weeks as assessed by cardiac magnetic resonance tomography. Secondary end points were changes in left ventricular dimensions and late gadolinium enhancement between baseline and follow-up. RESULTS: Fifty patients (mean [SD] age, 62 [13] years; 41 men [82%]) with acute anterior myocardial infarction were randomly allocated to paroxetine or placebo, of whom 38 patients underwent cardiac magnetic resonance imaging both at baseline and 12 weeks. There was no difference in recovery of LVEF between the experimental group (mean [SD] change, 4.0% [7.0%]) and the control group (mean [SD] change, 6.3% [6.3%]; mean difference, -2.4% [95% CI, -6.8% to 2.1%]; P = .29) or changes in left ventricular end-diastolic volume (mean difference, 13.4 [95% CI, -12.3 to 39.0] mL; P = .30) and end-systolic volume (mean difference, 11.4 [95% CI, -3.6 to 26.4] mL; P = .13). Late gadolinium enhancement as a percentage of the total left ventricular mass decreased to a larger extent in the experimental group (mean [SD], -13.6% [12.9%]) compared with the control group (mean [SD], -4.5% [9.5%]; mean difference, -9.1% [95% CI, -16.6% to -1.6%]; P = .02). CONCLUSIONS AND RELEVANCE: In this trial, treatment with paroxetine did not improve LVEF after myocardial infarction compared with placebo. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03274752."},{"id":"6eb6e1ad9bf7","type":"article","url":"https://hartvaat.nl/2021/10/01/ticagrelor-of-prasugrel-na-pci-voor-acs-isar-react-5-pre-gespecificeerde-analyse/","title":"Ticagrelor of prasugrel na PCI voor ACS: ISAR-REACT 5 pre-gespecificeerde analyse","title_en":"Ticagrelor or Prasugrel for Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention: A Prespecified Subgroup Analysis of a Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.2228","source_url":"https://doi.org/10.1001/jamacardio.2021.2228","authors":["J J Coughlan","Alp Aytekin","Shqipdona Lahu","Gjin Ndrepepa","Maurizio Menichelli","Katharina Mayer","Jochen Wöhrle","Isabell Bernlochner","Senta Gewalt","Bernhard Witzenbichler","Willibald Hochholzer","Dirk Sibbing","Salvatore Cassese","Dominick J Angiolillo","Rayyan Hemetsberger","Christian Valina","Arne Müller","Sebastian Kufner","Christoph Liebetrau","Erion Xhepa","Alexander Hapfelmeier","Hendrik B Sager","Michael Joner","Massimiliano Fusaro","Gert Richardt","Karl Ludwig Laugwitz","Franz Josef Neumann","Heribert Schunkert","Stefanie Schüpke","Adnan Kastrati"],"significance":7,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This ISAR-REACT 5 prespecified subanalysis of ACS patients treated with PCI confirmed the superiority of prasugrel over ticagrelor for the composite of death, MI, or stroke in the interventionally managed population.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:33Z","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":"ISAR-REACT 5 pre-gespecificeerde subanalyse van ticagrelor versus prasugrel bij ACS-patiënten behandeld met PCI.","abstract_original":"IMPORTANCE: It is unclear whether ticagrelor or prasugrel hydrochloride is superior for patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). OBJECTIVE: To assess the safety and efficacy of ticagrelor vs prasugrel for patients with ACS treated with PCI. DESIGN, SETTING, AND PARTICIPANTS: A prespecified analysis was performed of a postrandomization subgroup of 3377 patients who presented with ACS and were treated with PCI in the investigator-initiated, multicenter, phase 4, open-label Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5 randomized clinical trial, conducted from September 1, 2013, to February 28, 2018. Statistical analysis was performed from September 1, 2020, to January 30, 2021. Analysis was performed according to the intention-to-treat principle. INTERVENTIONS: Patients were randomly assigned to a ticagrelor-based or prasugrel-based strategy. This analysis focuses on the subgroup of patients who underwent PCI that was formed after randomization. MAIN OUTCOMES AND MEASURES: The primary end point was a composite consisting of all-cause death, myocardial infarction, or stroke at 12 months. The safety end point was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. RESULTS: The ticagrelor group comprised 1676 patients (1323 men [78.9%]; mean [SD] age, 64.4 [12.0] years), and the prasugrel group comprised 1701 patients (1341 men [78.8%]; mean [SD] age, 64.7 [12.0] years). The primary end point occurred for 162 patients (9.8%) in the ticagrelor group and 120 patients (7.1%) in the prasugrel group (hazard ratio [HR], 1.41; 95% CI, 1.11-1.78; P = .005). Myocardial infarction occurred in 88 patients (5.3%) in the ticagrelor group compared with 55 patients (3.8%) in the prasugrel group (HR, 1.67; 95% CI, 1.19-2.34; P = .003). The safety end point, BARC type 3 to 5 bleeding, occurred in 84 of 1672 patients (5.3%) in the ticagrelor group and 78 of 1680 patients (4.9%) in the prasugrel group (HR; 1.10; 95% CI, 0.81-1.50; P = .54). CONCLUSIONS AND RELEVANCE: Among patients presenting with ACS who were treated with PCI, the incidence of the primary composite end point occurred less frequently for patients who received prasugrel compared with those who received ticagrelor. The incidence of bleeding events was comparable between the 2 groups. These results suggest that, for patients presenting with ACS who undergo PCI, a prasugrel-based strategy is superior to a ticagrelor-based strategy. However, because these observations are based on a postrandomization subgroup, these findings should be regarded as hypothesis generating and dedicated randomized clinical trials may be warranted to confirm these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01944800."},{"id":"1456f1f4d8a5","type":"article","url":"https://hartvaat.nl/2021/10/01/ebc-hoofdstam-stentstudie-provisional-versus-systematisch-dubbel-stenten/","title":"EBC hoofdstam-stentstudie: provisional versus systematisch dubbel stenten","title_en":"The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab283","source_url":"https://doi.org/10.1093/eurheartj/ehab283","authors":["David Hildick-Smith","Mohaned Egred","Adrian Banning","Philippe Brunel","Miroslaw Ferenc","Thomas Hovasse","Adrian Wlodarczak","Manuel Pan","Thomas Schmitz","Marc Silvestri","Andreis Erglis","Evgeny Kretov","Jens Flensted Lassen","Alaide Chieffo","Thierry Lefèvre","Francesco Burzotta","James Cockburn","Olivier Darremont","Goran Stankovic","Marie-Claude Morice","Yves Louvard"],"significance":7,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This European Bifurcation Club randomized study compared stepwise provisional stenting with systematic double stenting for left main coronary bifurcation lesions, providing data on the optimal bifurcation strategy for this critical anatomy.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:33Z","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":"European Bifurcation Club gerandomiseerde studie die provisional versus systematisch dubbel stenten vergeleek bij hoofdstambifurcatielaesies.","abstract_original":"BACKGROUND: Patients with non-left-main coronary bifurcation lesions are usually best treated with a stepwise provisional approach. However, patients with true left main stem bifurcation lesions have been shown in one dedicated randomized study to benefit from systematic dual stent implantation. METHODS AND RESULTS: Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were aged 71 ± 10 years; 77% were male. Patients were randomly allocated to a stepwise layered provisional strategy (n = 230) or a systematic dual stent approach (n = 237). The primary endpoint (a composite of death, myocardial infarction, and target lesion revascularization at 12 months) occurred in 14.7% of the stepwise provisional group vs. 17.7% of the systematic dual stent group (hazard ratio 0.8, 95% confidence interval 0.5-1.3; P = 0.34). Secondary endpoints were death (3.0% vs. 4.2%, P = 0.48), myocardial infarction (10.0% vs. 10.1%, P = 0.91), target lesion revascularization (6.1% vs. 9.3%, P = 0.16), and stent thrombosis (1.7% vs. 1.3%, P = 0.90), respectively. Procedure time, X-ray dose and consumables favoured the stepwise provisional approach. Symptomatic improvement was excellent and equal in each group. CONCLUSIONS: Among patients with true bifurcation left main stem stenosis requiring intervention, fewer major adverse cardiac events occurred with a stepwise layered provisional approach than with planned dual stenting, although the difference was not statistically significant. The stepwise provisional strategy should remain the default for distal left main stem bifurcation intervention. STUDY REGISTRATION: http://clinicaltrials.gov NCT02497014."},{"id":"0ef3a66a8809","type":"article","url":"https://hartvaat.nl/2021/10/01/acute-pleiotrope-effecten-van-dapagliflozine-bij-diabetes-type-2-met-hfref-cross/","title":"Acute pleiotrope effecten van dapagliflozine bij diabetes type 2 met HFrEF: crossover","title_en":"Acute pleiotropic effects of dapagliflozin in type 2 diabetic patients with heart failure with reduced ejection fraction: a crossover trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13553","source_url":"https://doi.org/10.1002/ehf2.13553","authors":["Fahmida Ilyas","Lynette Jones","Su Ling Tee","Matthew Horsfall","Amy Swan","Fiona Wollaston","Tracy Hecker","Carla De Pasquale","Simeoni Thomas","William Chong","Steve Stranks","Arduino A Mangoni","Joseph B Selvanayagam","Derek P Chew","Carmine G De Pasquale"],"significance":6,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This crossover study characterized the acute pleiotropic effects of dapagliflozin in diabetic patients with HFrEF, showing rapid hemodynamic and metabolic changes within hours of administration.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:33Z","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":"Crossover studie naar de acute pleiotrope effecten van dapagliflozine bij diabetespatiënten met HFrEF.","abstract_original":"AIMS: This study aimed to explore the rapid effects of dapagliflozin in heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: We studied the functional, echocardiographic, electrophysiological, lung ultrasound, ambulatory blood pressure (BP), microvascular and macrovascular function, and biochemical effects of 2 week treatment with dapagliflozin in 19 type 2 diabetic HFrEF patients in a double-blind, crossover, placebo-controlled trial. Dapagliflozin had no significant effect on clinical, functional, or quality of life parameters. Dapagliflozin reduced systolic BP [114 (105, 131) vs. 106 (98, 113) mmHg, P < 0.01] and diastolic BP [71 (61, 78) vs. 62 (55, 70) mmHg, P < 0.01]. There was no effect on cardiac chamber size, ventricular systolic function, lung ultrasound, or arterial wave reflection. Dapagliflozin increased creatinine [117 (92, 129) vs. 122 (107, 135) μmol/L, P < 0.05] and haemoglobin [135 (118, 138) vs. 136 (123, 144) g/L, P < 0.05]. There was a reduction in ventricular ectopy [1.4 (0.1, 2.9) vs. 0.2 (0.1, 1.4) %, P < 0.05] and an increase in standard deviation of normal heart beat intervals [70 (58, 90) vs. 74 (62, 103), P < 0.05]. Unexpectedly, dapagliflozin increased high-sensitivity troponin T [25 (19, 37) vs. 28 (20, 42) ng/L, P < 0.01] and reduced reactive hyperaemia index [1.29 (1.21, 1.56) vs. 1.40 (1.23, 1.84), P < 0.05]. CONCLUSIONS: After 2 weeks, while multiple parameters supported BP reduction and haemoconcentration with dapagliflozin, reduction in cardiac filling pressure, lung water, and functional improvement was not shown. Reduced ventricular ectopic burden suggests an early antiarrhythmic benefit. The small increase in troponin T and the reduction in the reactive hyperaemia index warrant further mechanistic exploration in this treatment of proven mortality benefit in HFrEF."},{"id":"1f2c1cbb3b93","type":"article","url":"https://hartvaat.nl/2021/10/01/aortaklepcalcificatie-en-cv-risicofactoren-bij-oudere-deense-mannen/","title":"Aortaklepcalcificatie en CV-risicofactoren bij oudere Deense mannen","title_en":"Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["acuut-hartfalen","aortainsufficiëntie","aortastenose","perifeer-vaatlijden","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319023","source_url":"https://doi.org/10.1136/heartjnl-2021-319023","authors":["Lida Khurrami","Jacob Eifer Møller","Jes Sanddal Lindholt","Grazina Urbonaviciene","Flemming Hald Steffensen","Jess Lambrechtsen","Marek Karon","Lars Frost","Martin Busk","Kenneth Egstrup","Maise Høigaard Fredgart","Axel Cosmus Pyndt Diederichsen"],"significance":5,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This cross-sectional study examined the relationship between aortic valve calcification and cardiovascular risk factors in older Danish men, exploring shared pathways between valvular calcification and atherosclerotic disease.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:33Z","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":"Cross-sectionele studie naar aortaklepcalcificatie en cardiovasculaire risicofactoren bij oudere Deense mannen.","abstract_original":"OBJECTIVE: Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers. METHODS: Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association. RESULTS: 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not. CONCLUSIONS: AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU. TRIAL REGISTRATION NUMBER: NCT03946410 and ISRCTN12157806."},{"id":"35e3fec41fcb","type":"article","url":"https://hartvaat.nl/2021/10/01/uitgebreide-vasodilatatie-en-qol-bij-acuut-hf-substudie/","title":"Uitgebreide vasodilatatie en QoL bij acuut HF: substudie","title_en":"Effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life among patients with acute heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","aperitif-trial","bloeddrukbehandeling","dapa-hf","sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13543","source_url":"https://doi.org/10.1002/ehf2.13543","authors":["Maria Belkin","Desiree Wussler","Danielle Menosi Gualandro","Samyut Shrestha","Ivo Strebel","Assen Goudev","Micha T Maeder","Joan Walter","Dayana Flores","Nikola Kozhuharov","Pedro Lopez-Ayala","Isabelle Danier","Mucio Tavares de Oliveira Junior","Richard Kobza","Hans Rickli","Tobias Breidthardt","Paul Erne","Thomas Münzel","Christian Mueller"],"significance":5,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This quality-of-life substudy showed that a comprehensive vasodilation strategy versus usual care in acute heart failure does not improve long-term health-related quality of life, consistent with the neutral primary endpoint.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:33Z","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":"QoL-substudie van de uitgebreide vasodilatiestrategie versus standaardzorg bij acuut hartfalen.","abstract_original":"AIMS: We aimed to assess the long-term effect of a strategy of comprehensive vasodilation versus usual care on health-related quality of life (HRQL) among patients with acute heart failure (AHF). METHODS AND RESULTS: Health-related quality of life was prospectively assessed by the generic 3-levelled EQ-5D and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) among adult AHF patients enrolled in an international, multicentre, randomised, open-label blinded-end-point trial of a strategy that emphasized early intensive and sustained vasodilation using maximally tolerated doses of established oral and transdermal vasodilators according to systolic blood pressure. Changes in EQ-5D and KCCQ from admission to 180 day follow-up were individually compared between the intensive vasodilatation and the usual care group. Among 666 patients eligible for 180 day follow-up, 284 (43%, median age 79 years, 35% women) and 198 (30%, median age 77 years, 35% women) had completed the EQ-5D and KCCQ at baseline and follow-up, respectively. There was a significant improvement in HRQL as quantified by both, EQ-5D and KCCQ, from hospitalization to 180 day follow-up, with no significant differences in the change of HRQL between both treatment strategies. For instance, 39 (26%) versus 33 (25%) patients had an improvement by at least one level in at least two categories in the EQ-5D. Median increase in KCCQ overall summary score (KCCQ-OSS) was 17.6 (IQR 2.0-42.6) in the intervention group versus 18.5 (IQR 3.9-39.3) in the usual care group (P < 0.001 vs. baseline, P = 0.945 between groups). CONCLUSIONS: Among patients with AHF, long-term HRQL quantified by EQ-5D and KCCQ improved substantially, with overall no significant differences between a strategy of comprehensive vasodilation versus usual care."},{"id":"300129c80f1b","type":"article","url":"https://hartvaat.nl/2021/10/01/sacubitril-valsartan-in-real-life-europese-hfref-meta-analyse/","title":"Sacubitril/valsartan in real-life Europese HFrEF: meta-analyse","title_en":"Sacubitril/valsartan in real-life European patients with heart failure and reduced ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13547","source_url":"https://doi.org/10.1002/ehf2.13547","authors":["Stefano Giovinazzo","Luca Carmisciano","Matteo Toma","Stefano Benenati","Daniela Tomasoni","Maria Pia Sormani","Italo Porto","Marco Canepa","Michele Senni","Marco Metra","Pietro Ameri"],"significance":6,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review of European real-world evidence for sacubitril-valsartan in HFrEF showed consistent clinical benefits outside the controlled trial setting, supporting broader ARNI implementation.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:32Z","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 review en meta-analyse van sacubitril/valsartan in real-life Europese HFrEF-patiënten.","abstract_original":"AIMS: We systematically reviewed the European real-world evidence (RWE) about sacubitril-valsartan for heart failure with reduced ejection fraction. METHODS AND RESULTS: Twenty-one articles, including 16 952 subjects, were identified until 31 October 2020. Taking as reference the PARADIGM-HF cohort, few baseline characteristics were presented in >80% of these studies, most often with high heterogeneity. In random-effects model meta-analysis, age was higher (mean difference +3.84, 95% CI 1.92-5.76), ischaemic aetiology (OR 0.76, 95% CI 0.64-0.91), hypertension (OR 0.55, 95% CI 0.37-0.82), and diabetes (OR 0.77, 95% CI 0.64-0.92) were less common, and the use of mineralocorticoid receptor antagonists was more frequent (OR 3.54, 95% CI 2.27-5.53) in real-life than in PARADIGM-HF. Other clinical and medical features were presented in 19-76% of the selected publications and suggested more severe heart failure with reduced ejection fraction. Sacubitril-valsartan was titrated to 97/103 mg b.i.d. in 35% (95% CI 23-47) and discontinued in 12.8% (95% CI 7.4-18.3) patients. When reported, the incidence of hyperkalaemia (six studies, no. 1076), all-cause mortality (five studies, no. 684), and any hospitalization (three studies, no. 390) was 12 (95% CI 5-19)/100 person-year, 8 (95% CI 4-12)/100 person-year, and 24 (95% CI 5-42)/100 person-year, respectively. Knowledge contribution, a metric measuring the proportion of RWE provided by each article based on the number of reported variables and the sample size, was 58.8% and 13.6% for the two biggest investigations (12 082 and 2037 patients), and <5% for all others (most with <100 subjects). CONCLUSIONS: Limited-quality RWE indicates that there are important differences between European patients prescribed sacubitril-valsartan and the PARADIGM-HF population, including the frequency of target dose achievement."},{"id":"d566e9e4b7aa","type":"article","url":"https://hartvaat.nl/2021/10/01/niet-invasieve-technieken-en-biomarkers-voor-poliklinisch-vochtmanagement-bij-hf/","title":"Niet-invasieve technieken en biomarkers voor poliklinisch vochtmanagement bij HF","title_en":"Use of novel non-invasive techniques and biomarkers to guide outpatient management of fluid overload and reduce hospital readmission: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13510","source_url":"https://doi.org/10.1002/ehf2.13510","authors":["Georgios Zisis","Amera Halabi","Quan Huynh","Christopher Neil","Melinda Carrington","Thomas H Marwick"],"significance":5,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This review evaluated novel non-invasive techniques (bioimpedance, lung ultrasound) and biomarkers for outpatient fluid management in heart failure, supporting technology-assisted congestion monitoring to reduce readmissions.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:32Z","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":"Review over niet-invasieve technieken en biomarkers voor poliklinisch vochtmanagement en heropnamereductie bij HF.","abstract_original":"AIMS: Fluid congestion is a leading cause of hospital admission, readmission, and mortality in heart failure (HF). We performed a systematic review and meta-analysis to determine the effectiveness of an advanced fluid management programme (AFMP). The AFMP was defined as an intervention providing tailored diuretic therapy guided by intravascular volume assessment, in hospitalized patients or after discharge. The AFMP group was compared with patients who received standard care treatment. The aim of this systematic review and meta-analysis was to determine the effectiveness of an AFMP in improving patient outcomes. METHODS AND RESULTS: A systematic review of randomized controlled trials, case-control studies, and crossover studies using the terms 'heart failure', 'fluid management', and 'readmission' was conducted in PubMed, CINAHL, and Scopus up until November 2020. Studies reporting the association of an AFMP on readmission and/or mortality were included in our meta-analyses. Risk of bias was assessed in non-randomized studies using the Newcastle-Ottawa Scale. From 232 retrieved studies, 12 were included in the data synthesis. The 6040 patients in the included studies had a mean age of 72 ± 4 years and mean left ventricular ejection fraction of 39 ± 8%, there were slightly more men (n = 3022) than women, and the follow-up period was a mean of 4.8 ± 3.1 months. Readmission data were available in 5362 patients; of these, 1629 were readmitted. Mortality data were available in 5787 patients; of these, 584 died. HF patients who had an AFMP in hospital and/or after discharge had lower odds of all-cause readmission (odds ratio-OR 0.64 [95% confidence interval-CI 0.44, 0.92], P = 0.02) with moderate heterogeneity (I2  = 46.5) and lower odds of all-cause mortality (OR 0.82 [95% CI 0.69, 0.98], P = 0.03) with low heterogeneity (I2  = 0). The use of an AFMP was equally effective in reducing readmission and mortality regardless of age and follow-up duration. Effective pre-discharge diuresis was associated with significantly lower readmission odds (OR 0.43 [95% CI 0.26, 0.71], P = 0.001) compared with a fluid management plan as part of post-discharge follow-up. CONCLUSIONS: An effective AFMP is associated with improving readmission and mortality in HF. Our results encourage attainment of optimal volume status at discharge and prescription of optimal diuretic dose. Ongoing support to maintain euvolaemia and effective collaboration between healthcare teams, along with effective patient education and engagement, may help to reduce adverse outcomes in HF patients."},{"id":"4955576677d5","type":"article","url":"https://hartvaat.nl/2021/10/01/iv-furosemide-plus-hypertone-zoutoplossing-en-hf-markers/","title":"IV furosemide plus hypertone zoutoplossing en HF-markers","title_en":"Effects of intravenous furosemide plus small-volume hypertonic saline solutions on markers of heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["furosemide"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13511","source_url":"https://doi.org/10.1002/ehf2.13511","authors":["Antonino Tuttolomondo","Carlo Maida","Alessandra Casuccio","Domenico Di Raimondo","Roberto Fonte","Valerio Vassallo","Maria Grazia Puleo","Tiziana Di Chiara","Alba Mogavero","Alessandro Del Cuore","Mario Daidone","Antonella Ortello","Antonio Pinto"],"significance":4,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This study compared the effects of intravenous furosemide combined with small-volume hypertonic saline solution versus furosemide alone on heart failure biomarkers in acute decompensated HFrEF. The combination approach may enhance diuretic efficacy.","created":"2026-07-03T10:29:25Z","updated":"2026-07-03T13:28:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van IV furosemide plus kleine hoeveelheden hypertone zoutoplossing op hartfalenmarkers.","abstract_original":"AIMS: We sought to compare the effects of furosemide + hypertonic saline solution (HSS) treatment in patients with acute decompensated heart failure in comparison with furosemide alone and the response in a compensated state after an acute saline load with regard to serum levels of heart failure biomarkers. METHODS AND RESULTS: We enrolled 141 patients with acute decompensated heart failure with reduced ejection fraction admitted to our Internal Medicine ward from March 2017 to November 2019. A total of 73 patients were randomized to treatment with i.v. high-dose furosemide plus HSS, whereas 68 patients were randomized to i.v. high-dose furosemide alone. Patients treated with furosemide plus HSS compared with controls treated with furosemide alone showed a comparable degree of reduction in the serum levels of interleukin (IL)-6, soluble suppression of tumorigenicity 2 (sST2), and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the 'between-group' analysis. Nevertheless, patients treated with high-dose furosemide + HSS showed significantly higher absolute delta values of IL-6 (2.3 ± 1.2 vs. 1.7 ± 0.9, P < 0.0005, and 2.0 ± 0.8 vs. 1.85 ± 1.1, P = 0.034), sST2 (41.2 ± 8.6 vs. 27.9 ± 7.6, P < 0.0005, and 37.1 ± 6.6 vs. 28.4 ± 6.7, P < 0.0005), high-sensitivity troponin T (0.03 ± 0.02 vs. 0.02 ± 0.01, P = 0.001, and 0.03 ± 0.02 vs. 0.02 ± 0.01, P = 0.009), NT-proBNP (7237 ± 7931 vs. 3244 ± 4159, P < 0.005, and 5381 ± 4829 vs. 4466 ± 4332, P = 0.004), and galectin-3 (15.7 ± 3.2 ng/mL vs. 11.68 ± 1.9 ng/mL, P < 0.0005, and 16.7 ± 3.9 ng/mL vs. 11.8 ± 2.4 ng/mL, P < 0.0005) than patients treated with furosemide alone. After acute saline load, patients treated with i.v. furosemide + HSS in comparison with subjects treated with furosemide alone showed a significantly lower increase in the serum concentrations of IL-6 (-0.26 ± 0.42 pg/mL vs. -1.43 ± 0.86 pg/mL, P < 0.0005), high-sensitivity troponin T (0 vs. -0.02 ± 0.02 ng/mL, P < 0.0005), sST2 (-8.5 ± 5.9 ng/mL vs. -14.6 ± 6.2 ng/mL, P < 0.0005), galectin-3 (-2.1 ± 1.5 ng/mL vs. -7.1 ± 3.6 ng/mL, P < 0.0005), and NT-proBNP (77 ± 1373 vs. -1706 ± 2259 pg/mL, P < 0.0005). CONCLUSIONS: Our findings concerning a comparable degree of reduction in the serum levels of three cardinal biomarkers indicate that a reduction in serum heart failure markers is not linked to the higher degree of congestion relief with a more rapid achievement of a clinical compensation state. This issue may have possible benefits on clinical practice concerning its therapeutic effects over and beyond the simple amelioration of clinical congestion signs and symptoms. Nevertheless, our findings of higher delta values after treatment with i.v. furosemide plus HSS indicate a possible higher efficacy by means of modulation of the stretching and fibrosis mechanisms."},{"id":"ab1e60350b5d","type":"article","url":"https://hartvaat.nl/2021/10/01/katheterablatie-als-eerstelijns-paf-therapie-meta-analyse/","title":"Katheterablatie als eerstelijns PAF-therapie: meta-analyse","title_en":"Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319496","source_url":"https://doi.org/10.1136/heartjnl-2021-319496","authors":["Jacopo F Imberti","Wern Yew Ding","Agnieszka Kotalczyk","Juqian Zhang","Giuseppe Boriani","Gregory Lip","Jason Andrade","Dhiraj Gupta"],"significance":7,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/"],"congress":"","summary_en":"This meta-analysis of catheter ablation as first-line treatment for paroxysmal AF confirmed superior efficacy over antiarrhythmic drugs for maintaining sinus rhythm, with a favorable safety profile supporting the ablation-first approach.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:32Z","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 review en meta-analyse van katheterablatie als eerstelijnsbehandeling voor paroxysmaal AF.","abstract_original":"OBJECTIVE: To assess the efficacy and safety of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) as first-line treatment for symptomatic paroxysmal atrial fibrillation (AF). METHODS: Systematic review and meta-analysis of randomised controlled trials identified using MEDLINE, Cochrane Library and Embase published between 01/01/2000 and 19/03/2021. The primary efficacy endpoint was the first documented recurrence of atrial arrhythmias following the blanking period. The primary safety endpoint was a composite of all serious adverse events (SAEs). RESULTS: From 441 records, 6 studies met the inclusion criteria. 609 patients received CA, while 603 received AAD therapy. 212/609 patients in the CA group had a recurrence of atrial arrhythmias as compared with 318/603 in the AADs group resulting in a 36% relative risk reduction (risk ratio: 0.64, 95% CI 0.51 to 0.80, p<0.01). The risk of all SAEs was not statistically different between CA and AAD (0.87, 0.58 to 1.30, p=0.49); 107/609 SAE in the CA group vs 126/603 in the AAD group. Both recurrence of symptomatic atrial arrhythmias (109/505 vs 186/504) and healthcare utilisation (126/397 vs 185/394) were significantly lower in the CA group (0.53, 0.35 to 0.79 and 0.65, 0.48 to 0.89, respectively). There was a 79% reduction in the crossover rate during follow-up among patients randomised to CA compared with AAD (0.21, 0.13 to 0.32, p<0.01). CONCLUSIONS: First-line treatment with CA is superior to AAD therapy in patients with symptomatic paroxysmal AF, as it significantly reduces the recurrence of any atrial arrhythmias and symptomatic atrial arrhythmias, and healthcare resource utilisation with comparable safety profile."},{"id":"7533bf7e10ad","type":"article","url":"https://hartvaat.nl/2021/10/01/apothekerzorg-bij-poliklinisch-hf-meta-analyse/","title":"Apothekerzorg bij poliklinisch HF: meta-analyse","title_en":"The evidence for pharmacist care in outpatients with heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13508","source_url":"https://doi.org/10.1002/ehf2.13508","authors":["Pia M Schumacher","Nicolas Becker","Ross T Tsuyuki","Nina Griese-Mammen","Sheri L Koshman","Michael A McDonald","Marcel Bouvy","Frans H Rutten","Ulrich Laufs","Michael Böhm","Martin Schulz"],"significance":6,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis provided evidence that pharmacist-led care for outpatients with heart failure improves medication adherence, quality of life, and clinical outcomes, supporting interprofessional HF management models.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:32Z","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 review en meta-analyse naar het bewijs voor apothekerzorg bij poliklinische hartfalenpatiënten.","abstract_original":"AIMS: Patients with heart failure (HF) have poor outcomes, including poor quality of life, and high morbidity and mortality. In addition, they have a high medication burden due to the multiple drug therapies now recommended by guidelines. Previous reviews, including studies in hospital settings, provided evidence that pharmacist care improves outcomes in patients with HF. Because most HF is managed outside of hospitals, we aimed to synthesize the evidence for pharmacist care in outpatients with HF. METHODS AND RESULTS: We conducted a systematic literature search in PubMed of randomized controlled trials (RCTs) and integrated the evidence on patient outcomes in a meta-analysis. We found 24 RCTs performed in 10 countries, including 8029 patients. The data revealed consistent improvements in medication adherence (independent of the measuring instrument) and knowledge, physical function, and disease and medication management. Sixteen RCTs were included in meta-analyses. Differences in all-cause mortality (odds ratio (OR) = 0.97 [95% CI, 0.84-1.12], Q-statistic, P = 0.49, I2  = 0%), all-cause hospitalizations (OR = 0.86 [0.73-1.03], Q-statistic, P = 0.01, I2  = 45.5%), and HF hospitalizations (OR = 0.89 [0.77-1.02], Q-statistic, P = 0.11, I2  = 0%) were not statistically significant. We also observed an improvement in the standardized mean difference for generic quality of life of 0.75 ([0.49-1.01], P < 0.01), with no indication of heterogeneity (Q-statistic, P = 0.64; I2  = 0%). CONCLUSIONS: Results indicate that pharmacist care improves medication adherence and knowledge, symptom control, and some measures of quality of life in outpatients with HF. Given the increasing complexity of guideline-directed medical therapy, pharmacists' unique focus on medication management, titration, adherence, and patient teaching should be considered part of the management strategy for these vulnerable patients."},{"id":"f0bc26253703","type":"article","url":"https://hartvaat.nl/2021/10/01/revalidatie-bij-chronisch-hf-systematische-review-van-inspanningsinterventies/","title":"Revalidatie bij chronisch HF: systematische review van inspanningsinterventies","title_en":"A systematic review of rehabilitation in chronic heart failure: evaluating the reporting of exercise interventions.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13498","source_url":"https://doi.org/10.1002/ehf2.13498","authors":["Amy E Harwood","Sophie Russell","Nduka C Okwose","Scott McGuire","Djordje G Jakovljevic","Gordon McGregor"],"significance":5,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review evaluated the quality of exercise intervention reporting in chronic heart failure rehabilitation trials, finding inconsistencies that hinder reproducibility and implementation of evidence-based programs.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:32Z","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 review die de rapportage van inspanningsinterventies in chronisch HF-revalidatietrials evalueerde.","abstract_original":"A large body of research supports the use of exercise to improve symptoms, quality of life, and physical function in patients with chronic heart failure. Previous reviews have focused on reporting outcomes of exercise interventions such as cardiorespiratory fitness. However, none have critically examined exercise prescription. The aim of this review was to evaluate the reporting and application of exercise principles in randomised control trials of exercise training in patients with chronic heart failure. A systematic review of exercise intervention RCTs in patients with CHF, using the Consensus on Exercise Reporting Template (CERT), was undertaken. The Ovid Medline/PubMed, Embase, Scopus/Web of Science, and Cochrane Library and Health Technology Assessment Databases were searched from 2000 to June 2020. Prospective RCTs in which patients with CHF were randomized to a structured exercise programme were included. No limits were placed on the type or duration of exercise structured exercise programme or type of CHF (i.e. preserved or reduced ejection fraction). We included 143 studies, comprising of 181 different exercise interventions. The mean CERT score was 10 out of 19, with no study achieving a score of 19. Primarily, details were missing regarding motivational strategies, home-based exercise components, and adherence/fidelity to the intervention. Exercise intensity was the most common principle of exercise prescription missing from intervention reporting. There was no improvement in the reporting of exercise interventions with time (R2  = 0.003). Most RCTs of exercise training in CHF are reported with insufficient detail to allow for replication, limiting the translation of evidence to clinical practice. We encourage authors to provide adequate details when reporting future interventions. Where journal word counts are restrictive, we recommend using supplementary material or publishing trial protocols prior to beginning the study."},{"id":"2b78211caf6d","type":"article","url":"https://hartvaat.nl/2021/10/01/empagliflozine-en-nierprotectie-bij-acuut-mi-met-diabetes-pilot/","title":"Empagliflozine en nierprotectie bij acuut MI met diabetes: pilot","title_en":"Empagliflozin confers reno-protection in acute myocardial infarction and type 2 diabetes mellitus.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13509","source_url":"https://doi.org/10.1002/ehf2.13509","authors":["Kosuke Mozawa","Yoshiaki Kubota","Yu Hoshika","Shuhei Tara","Yukichi Tokita","Kenji Yodogawa","Yu-Ki Iwasaki","Takeshi Yamamoto","Hitoshi Takano","Yayoi Tsukada","Kuniya Asai","Masaaki Miyamoto","Yasushi Miyauchi","Eitaro Kodani","Mitsunori Maruyama","Jun Tanabe","Wataru Shimizu"],"significance":5,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study demonstrated renoprotective effects of empagliflozin in patients with acute MI and type 2 diabetes, extending the kidney-protective benefits of SGLT2 inhibitors to the acute coronary care setting.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar empagliflozine voor renoprotectie bij acuut MI met diabetes type 2.","abstract_original":"AIMS: Although the reno-protective effects of sodium-glucose cotransporter 2 inhibitors are known in patients with heart failure or type 2 diabetes mellitus (T2DM), this effect has not been confirmed in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: The prospective, multicentre, randomized, double-blind, placebo-controlled EMBODY trial investigated patients with AMI and T2DM in Japan. The eligible patients included adults aged 20 years or older, diagnosed with AMI and T2DM, and who could be discharged within 2-12 weeks after the onset of AMI. One hundred and five patients were randomized (1:1) to receive once daily 10 mg empagliflozin or placebo within 2 weeks of AMI onset. In this sub-analysis, we investigated the time course of renal functional parameters such as serum creatinine levels and estimated glomerular filtration rate (eGFR) from baseline to Weeks 4, 12, and 24. Ninety-six patients (64 ± 11 years, 78 male) were included in the full analysis (n = 46 and 50 in the empagliflozin and placebo groups, respectively). We used serum creatinine and eGFR as indicators of renal function. In the placebo group, eGFR decreased from 66.14 mL/min/1.73 m2 at baseline to 62.77 mL/min/1.73 m2 by Week 24 (P = 0.023) but remained unchanged in the empagliflozin group (from 64.60 to 64.36 mL/min/1.73 m2 , P = 0.843). In the latter group, uric acid improved from 5.8 mg/dL at baseline to 4.9 mg/dL at Week 24 (P < 0.001). In the earlier analysis of 56 patients with eGFR ≥ 60 mL/min/1.73 m2 , the eGFR decreased and the serum creatinine increased from baseline to 24 weeks in the placebo group, significantly different to the empagliflozin group (-6.61 vs. +0.22 mL/min/1.73 m2 , P = 0.008 and +0.063 vs. -0.001 mg/dL, P = 0.030, respectively). The changes in serum creatinine and eGFR from baseline to Week 24 were significantly correlated with those in uric acid in the placebo group (r = 0.664, P < 0.001 and r = -0.675, P < 0.001, respectively) but not in the empagliflozin group. CONCLUSIONS: Empagliflozin prevented the kidney functional decline in patients with AMI and T2DM, especially those with baseline eGFR ≥ 60 mL/min/1.73 m2 . Early administration of sodium-glucose cotransporter 2 inhibitors in these patients is considered desirable for renal protection."},{"id":"7653002b0db9","type":"article","url":"https://hartvaat.nl/2021/10/01/sglt2-remmers-en-hf-hospitalisatie-en-hartfunctie-systematische-review/","title":"SGLT2-remmers en HF-hospitalisatie en hartfunctie: systematische review","title_en":"Sodium-glucose cotransporter 2 inhibitor effects on heart failure hospitalization and cardiac function: systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","canagliflozine","dapagliflozine","empagliflozine","hfref"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13483","source_url":"https://doi.org/10.1002/ehf2.13483","authors":["Roy Rasalam","John J Atherton","Gary Deed","Michael Molloy-Bland","Neale Cohen","Andrew Sindone"],"significance":6,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review evaluated the effects of SGLT2 inhibitors on heart failure hospitalization and cardiac function parameters, consolidating the mechanistic and clinical evidence for SGLT2 inhibitor cardioprotection.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:32Z","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 review naar het effect van SGLT2-remmers op HF-hospitalisatie en hartfunctie.","abstract_original":"AIMS: To systematically review randomized controlled trials assessing effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on hospitalization for heart failure (HHF) and cardiac structure/function and explore randomized controlled trial (RCT)-derived evidence for SGLT2i efficacy mechanisms in heart failure (HF). METHODS AND RESULTS: Systematic searches of Medline and Embase were performed. In seven trials [3730-17 160 patients; low risk of bias (RoB)], SGLT2is significantly reduced the relative risk of HHF by 27-39% vs. placebo, including in two studies in patients with HF with reduced ejection fraction with or without type-2 diabetes mellitus (T2DM). Improvements in conventional cardiovascular risk factors, including glycaemic levels, cannot account for these effects. Five trials (56-105 patients; low RoB) assessed the effects of 6-12 months of SGLT2i treatment on left ventricular structure/function; four reported significant improvements vs. placebo, and one did not. Five trials (low RoB) assessed SGLT2i treatment effects on serum N-terminal pro B-type natriuretic peptide levels; significant reductions vs. placebo were reported after 8-12 months (two studies; 3730-4744 patients) but not ≤12 weeks (three studies; 80-263 patients). Limited available RCT-derived evidence suggests various possible cardioprotective SGLT2i mechanisms, including improved haemodynamics (natriuresis and reduced interstitial fluid without blood volume contraction/neurohormonal activation) and vascular function, enhanced erythropoiesis, reduced tissue sodium and epicardial fat/inflammation, decreased sympathetic tone, and beneficial changes in cellular energetics. CONCLUSIONS: Sodium-glucose cotransporter 2 inhibitors reduce HHF regardless of T2DM status, and reversal of adverse left ventricular remodelling likely contributes to this efficacy. Hypothesis-driven mechanistic trials remain sparse, although numerous trials are planned or ongoing."},{"id":"1e3f63b3253f","type":"article","url":"https://hartvaat.nl/2021/10/01/inspiratoire-spiertraining-plus-aerobe-training-en-neurovasculaire-controle-bij-/","title":"Inspiratoire spiertraining plus aerobe training en neurovasculaire controle bij chronisch HF","title_en":"Effects of inspiratory muscle training combined with aerobic exercise training on neurovascular control in chronic heart failure patients.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13478","source_url":"https://doi.org/10.1002/ehf2.13478","authors":["Patricia F Trevizan","Ligia M Antunes-Correa","Denise M L Lobo","Patricia A Oliveira","Dirceu R de Almeida","Maria Cristina D Abduch","Wilson Mathias Junior","Ludhmila Abrahão Hajjar","Roberto Kalil Filho","Carlos Eduardo Negrão"],"significance":5,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study tested whether combining inspiratory muscle training with aerobic exercise improves neurovascular control in chronic heart failure, showing synergistic effects on sympathetic nerve activity and baroreflex sensitivity.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar inspiratoire spiertraining gecombineerd met aerobe training op neurovasculaire controle bij chronisch hartfalen.","abstract_original":"AIMS: We tested the hypothesis that the effects of combined inspiratory muscle training and aerobic exercise training (IMT + AET) on muscle sympathetic nerve activity (MSNA) and forearm blood flow in patients with heart failure with reduced ejection fraction are more pronounced than the effects of AET alone. METHODS AND RESULTS: Patients aged 30-70 years, New York Heart Association Functional Class II-III, and left ventricular ejection fraction ≤40% were randomly assigned to four groups: IMT (n = 11), AET (n = 12), IMT + AET (n = 9), and non-training (NT; n = 10). MSNA was recorded using microneurography. Forearm blood flow was measured by venous occlusion plethysmography and inspiratory muscle strength by maximal inspiratory pressure. IMT consisted of 30 min sessions, five times a week, for 4 months. Moderate AET consisted of 60 min sessions, three times a week for 4 months. AET (-10 ± 2 bursts/min, P = 0.03) and IMT + AET (-13 ± 4 bursts/min, P = 0.007) reduced MSNA. These responses in MSNA were not different between AET and IMT + AET groups. IMT (0.22 ± 0.08 mL/min/100 mL, P = 0.03), AET (0.27 ± 0.09 mL/min/100 mL, P = 0.01), and IMT + AET (0.35 ± 0.12 mL/min/100 mL, P = 0.008) increased forearm blood flow. No differences were found between groups. AET (3 ± 1 mL/kg/min, P = 0.006) and IMT + AET (4 ± 1 mL/kg/min, P = 0.001) increased peak oxygen consumption. These responses were similar between these groups. IMT (20 ± 3 cmH2 O, P = 0.005) and IMT + AET (18 ± 3 cmH2 O, P = 0.01) increased maximal inspiratory pressure. No significant changes were observed in the NT group. CONCLUSIONS: IMT + AET causes no additive effects on neurovascular control in patients with heart failure with reduced ejection fraction compared with AET alone. These findings may be, in part, because few patients had inspiratory muscle weakness."},{"id":"fe47a35c8cdb","type":"article","url":"https://hartvaat.nl/2021/10/01/niet-invasieve-thuistelemonitoring-bij-gedecompenseerd-hf-meta-analyse/","title":"Niet-invasieve thuistelemonitoring bij gedecompenseerd HF: meta-analyse","title_en":"Non-invasive home telemonitoring in patients with decompensated heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","ouderen","secundaire-preventie","thuisbloeddrukmeting","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13475","source_url":"https://doi.org/10.1002/ehf2.13475","authors":["Teemu E I Drews","Jari Laukkanen","Tuomo Nieminen"],"significance":6,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of non-invasive home telemonitoring in decompensated heart failure showed that remote monitoring reduces mortality and readmission, supporting technology-enabled post-discharge surveillance.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:31Z","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":"Systematische review en meta-analyse van niet-invasieve thuistelemonitoring bij patiënten met gedecompenseerd hartfalen.","abstract_original":"We planned this systematic review and meta-analysis to study an estimate of the effect of non-invasive home telemonitoring (TM) in the treatment of patients with recently decompensated heart failure (HF). A systematic literature search was conducted in the Medline, Cinahl, and Scopus databases to look for randomized controlled studies comparing TM with standard care in the treatment of patients with recently decompensated HF. The main outcomes of interest were all-cause hospitalizations and mortality. Eleven original articles met our eligibility criteria. The pooled estimate of the relative risk of all-cause hospitalization in the TM group compared with standard care was 0.95 (95% CI 0.84-1.08, P = 0.43) and the relative risk of all-cause death was 0.83 (95% CI 0.63-1.09, P = 0.17). There was significant clinical heterogeneity among primary studies. HF medication could be directly altered in three study interventions, and two of these had a statistically significant effect on all-cause hospitalizations. The pooled effect estimate of TM interventions on all-cause hospitalizations and all-cause death in patients with recently decompensated heart failure was neutral."},{"id":"d4a6bc8c1854","type":"article","url":"https://hartvaat.nl/2021/10/01/sacubitril-valsartan-verbetert-hartfunctie-bij-chinese-hf-patienten-real-world/","title":"Sacubitril/valsartan verbetert hartfunctie bij Chinese HF-patiënten: real-world","title_en":"Sacubitril/valsartan improves cardiac function in Chinese patients with heart failure: a real-world study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13491","source_url":"https://doi.org/10.1002/ehf2.13491","authors":["Wenwen Chen","Yanlin Liu","Yuanmin Li","Heqin Dang"],"significance":4,"published":"2021-10-01","source_date":"2021-10-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"A real-world study from a Chinese tertiary hospital demonstrated that sacubitril/valsartan improves cardiac function in Chinese patients with HFrEF, adding to the evidence base beyond the original PARADIGM-HF trial population.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:31Z","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":"Real-world studie van sacubitril/valsartan op hartfunctie bij Chinese HF-patiënten.","abstract_original":"AIMS: Sacubitril/valsartan significantly reduced heart failure (HF) hospitalization and cardiovascular mortality in a randomized controlled trial. However, little is known about real-world efficacy and safety of sacubitril/valsartan in Chinese patients with HF with reduced ejection fraction (HFrEF). We aimed to evaluate whether sacubitril/valsartan could improve cardiac function in Chinese patients with HFrEF in a tertiary hospital in China. METHODS AND RESULTS: Patients with HFrEF receiving sacubitril/valsartan in our hospital between January 2018 and January 2020 were recruited in the present study. We retrospectively collected and analysed all clinical parameters at baseline and during follow-up. A total of 100 consecutive patients (73% male) with HFrEF were recruited in the present study. During a median follow-up period of 365 days [interquartile range (IQR), 346-378], a pronounced improvement of cardiac function was achieved. New York Heart Association classification was significantly improved (P < 0.001), and median N-terminal pro-B-type natriuretic peptides level significantly decreased from 3003 pg/mL (IQR, 1513-5404) to 2039 pg/mL (IQR, 921-3955) (P = 0.010). Mean left ventricular ejection fraction increased from 31 ± 6% to 38 ± 10% (P < 0.001) and median left ventricular end-diastolic diameter reduced from 63 mm (IQR, 59-67) to 60 mm (IQR, 55-68) (P = 0.001). Mean pulmonary arterial systolic pressure decreased significantly from 49 ± 13 mmHg to 44 ± 12 mmHg (P < 0.001) and median right ventricular end-diastolic diameter reduced from 23 mm (IQR, 21-26) to 22 mm (IQR, 20-25) (P = 0.030). After treatment with sacubitril/valsartan, mean estimated glomerular filtration rate significantly decreased (from 88.8 ± 22.4 mL/min to 71.8 ± 27.3 mL/min, P < 0.001). Median serum creatinine and median blood urea nitrogen levels significantly increased [from 0.9 mg/dL (IQR, 0.8-1.0) to 1.1 mg/dL (IQR, 0.9-1.3), P < 0.001, and from 6.8 mmol/L (IQR, 5.5-8.9) to 8.0 mmol/L (IQR, 6.6-10.3), P = 0.002, respectively]. The proportion of patients with chronic kidney disease Stage 3/4 increased significantly from 8% to 39% (P < 0.001). CONCLUSIONS: In Chinese patients with HFrEF, sacubitril/valsartan treatment was associated with a pronounced improvement of cardiac function, but might be prone to a decrease in blood pressure and deterioration in renal function."},{"id":"1b483ab5ee74","type":"article","url":"https://hartvaat.nl/2021/09/30/ozanimod-bij-colitis-ulcerosa-nejm/","title":"Ozanimod bij colitis ulcerosa: NEJM","title_en":"Ozanimod as Induction and Maintenance Therapy for Ulcerative Colitis.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2033617","source_url":"https://doi.org/10.1056/NEJMoa2033617","authors":["William J Sandborn","Brian G Feagan","Geert D'Haens","Douglas C Wolf","Igor Jovanovic","Stephen B Hanauer","Subrata Ghosh","AnnKatrin Petersen","Steven Y Hua","Ji Hwan Lee","Lorna Charles","Denesh Chitkara","Keith Usiskin","Jean-Frederic Colombel","Loren Laine","Silvio Danese"],"significance":5,"published":"2021-09-30","source_date":"2021-09-30","image":"","kennis":[],"congress":"","summary_en":"This NEJM trial of ozanimod for ulcerative colitis is relevant to cardiology due to the S1P receptor modulator's effects on heart rate (transient bradycardia) and the need for cardiac monitoring during treatment initiation.","created":"2026-07-03T10:29:24Z","updated":"2026-07-03T13:28:31Z","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":"NEJM trial van ozanimod bij colitis ulcerosa. Relevant voor cardio-gastro interactie (S1P-modulatoren en hartfrequentie).","abstract_original":"BACKGROUND: Ozanimod, a selective sphingosine-1-phosphate receptor modulator, is under investigation for the treatment of inflammatory bowel disease. METHODS: We conducted a phase 3, multicenter, randomized, double-blind, placebo-controlled trial of ozanimod as induction and maintenance therapy in patients with moderately to severely active ulcerative colitis. In the 10-week induction period, patients in cohort 1 were assigned to receive oral ozanimod hydrochloride at a dose of 1 mg (equivalent to 0.92 mg of ozanimod) or placebo once daily in a double-blind manner, and patients in cohort 2 received open-label ozanimod at the same daily dose. At 10 weeks, patients with a clinical response to ozanimod in either cohort underwent randomization again to receive double-blind ozanimod or placebo for the maintenance period (through week 52). The primary end point for both periods was the percentage of patients with clinical remission, as assessed with the three-component Mayo score. Key secondary clinical, endoscopic, and histologic end points were evaluated with the use of ranked, hierarchical testing. Safety was also assessed. RESULTS: In the induction period, 645 patients were included in cohort 1 and 367 in cohort 2; a total of 457 patients were included in the maintenance period. The incidence of clinical remission was significantly higher among patients who received ozanimod than among those who received placebo during both induction (18.4% vs. 6.0%, P<0.001) and maintenance (37.0% vs. 18.5% [among patients with a response at week 10], P<0.001). The incidence of clinical response was also significantly higher with ozanimod than with placebo during induction (47.8% vs. 25.9%, P<0.001) and maintenance (60.0% vs. 41.0%, P<0.001). All other key secondary end points were significantly improved with ozanimod as compared with placebo in both periods. The incidence of infection (of any severity) with ozanimod was similar to that with placebo during induction and higher than that with placebo during maintenance. Serious infection occurred in less than 2% of the patients in each group during the 52-week trial. Elevated liver aminotransferase levels were more common with ozanimod. CONCLUSIONS: Ozanimod was more effective than placebo as induction and maintenance therapy in patients with moderately to severely active ulcerative colitis. (Funded by Bristol Myers Squibb; True North ClinicalTrials.gov number, NCT02435992.)."},{"id":"b6791bbb67d3","type":"article","url":"https://hartvaat.nl/2021/09/30/intensieve-bloeddrukcontrole-bij-oudere-patienten-met-hypertensie-nejm-step/","title":"Intensieve bloeddrukcontrole bij oudere patiënten met hypertensie: NEJM STEP","title_en":"Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["ambulante-bloeddrukmeting","bloeddrukbehandeling"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2111437","source_url":"https://doi.org/10.1056/NEJMoa2111437","authors":["Weili Zhang","Shuyuan Zhang","Yue Deng","Shouling Wu","Jie Ren","Gang Sun","Jinfeng Yang","Yinong Jiang","Xinjuan Xu","Tzung-Dau Wang","Youren Chen","Yufeng Li","Lianchen Yao","Dianfang Li","Lixin Wang","Xiaomei Shen","Xinhua Yin","Wei Liu","Xiaoyang Zhou","Bingpo Zhu","Zihong Guo","Hualing Liu","Xiaoping Chen","Yingqing Feng","Gang Tian","Xiuyin Gao","Kazuomi Kario","Jun Cai"],"significance":10,"published":"2021-09-30","source_date":"2021-09-30","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The STEP trial demonstrated that intensive blood pressure control (target 110–130 mmHg) significantly reduced cardiovascular events compared with standard treatment (130–150 mmHg) in Chinese patients aged 60–80 with hypertension. The results confirmed the benefits of intensive blood pressure targets in older adults, extending the findings of SPRINT to an Asian population.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T18:38:50Z","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 STEP trial die intensieve (110-130 mmHg) versus standaard (130-150 mmHg) bloeddrukcontrole vergeleek bij 60-80-jarigen met hypertensie in China. Bevestigt SPRINT bij ouderen.","abstract_original":"BACKGROUND: The appropriate target for systolic blood pressure to reduce cardiovascular risk in older patients with hypertension remains unclear. METHODS: In this multicenter, randomized, controlled trial, we assigned Chinese patients 60 to 80 years of age with hypertension to a systolic blood-pressure target of 110 to less than 130 mm Hg (intensive treatment) or a target of 130 to less than 150 mm Hg (standard treatment). The primary outcome was a composite of stroke, acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes. RESULTS: Of the 9624 patients screened for eligibility, 8511 were enrolled in the trial; 4243 were randomly assigned to the intensive-treatment group and 4268 to the standard-treatment group. At 1 year of follow-up, the mean systolic blood pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg in the standard-treatment group. During a median follow-up period of 3.34 years, primary-outcome events occurred in 147 patients (3.5%) in the intensive-treatment group, as compared with 196 patients (4.6%) in the standard-treatment group (hazard ratio, 0.74; 95% confidence interval [CI], 0.60 to 0.92; P = 0.007). The results for most of the individual components of the primary outcome also favored intensive treatment: the hazard ratio for stroke was 0.67 (95% CI, 0.47 to 0.97), acute coronary syndrome 0.67 (95% CI, 0.47 to 0.94), acute decompensated heart failure 0.27 (95% CI, 0.08 to 0.98), coronary revascularization 0.69 (95% CI, 0.40 to 1.18), atrial fibrillation 0.96 (95% CI, 0.55 to 1.68), and death from cardiovascular causes 0.72 (95% CI, 0.39 to 1.32). The results for safety and renal outcomes did not differ significantly between the two groups, except for the incidence of hypotension, which was higher in the intensive-treatment group. CONCLUSIONS: In older patients with hypertension, intensive treatment with a systolic blood-pressure target of 110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular events than standard treatment with a target of 130 to less than 150 mm Hg. (Funded by the Chinese Academy of Medical Sciences and others; STEP ClinicalTrials.gov number, NCT03015311.)."},{"id":"7bd821f70679","type":"article","url":"https://hartvaat.nl/2021/09/28/empagliflozine-verbetert-cv-en-renale-uitkomsten-ongeacht-systolische-bloeddruk-/","title":"Empagliflozine verbetert CV en renale uitkomsten ongeacht systolische bloeddruk bij HF","title_en":"Empagliflozin Improves Cardiovascular and Renal Outcomes in Heart Failure Irrespective of Systolic Blood Pressure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","canagliflozine","cystatine-c","dapagliflozine","empagliflozine","emperor-trials","hfref","perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.07.049","source_url":"https://doi.org/10.1016/j.jacc.2021.07.049","authors":["Michael Böhm","Stefan D Anker","Javed Butler","Gerasimos Filippatos","João Pedro Ferreira","Stuart J Pocock","Felix Mahfoud","Martina Brueckmann","Waheed Jamal","Anne Pernille Ofstad","Elke Schüler","Piotr Ponikowski","Christoph Wanner","Faiez Zannad","Milton Packer"],"significance":6,"published":"2021-09-28","source_date":"2021-09-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This EMPEROR-Reduced analysis confirmed that empagliflozin improves cardiovascular and renal outcomes regardless of baseline systolic blood pressure, supporting SGLT2 inhibitor use even in patients with lower blood pressures.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T18:38:50Z","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":"EMPEROR-Reduced analyse die bevestigt dat empagliflozine CV en renale uitkomsten verbetert ongeacht uitgangs systolische bloeddruk.","abstract_original":"BACKGROUND: Empagliflozin reduces the risk of cardiovascular death or heart failure (HF) hospitalization in patients with reduced ejection fraction. Its interplay with systolic blood pressure (SBP) is not known. OBJECTIVES: The goal of this study was to evaluate the interplay of SBP and the effects of empagliflozin in EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction). METHODS: Study patients (N = 3,730) were randomly assigned to groups according to SBP at baseline (<110 mm Hg, n = 928; 110-130 mm Hg, n = 1,755; >130 mm Hg, n = 1,047). This study explored the influence of SBP on the effects of empagliflozin on cardiovascular death or HF hospitalization (primary outcome), as well as on total HF hospitalizations, rate of decline in estimated glomerular filtration rate, renal outcomes, and empagliflozin's effects and significance on SBP. RESULTS: Over a median of 16 months considering only patients receiving placebo, baseline SBP and the risk of cardiovascular death or hospitalization for HF (P trend = 0.0015) were inversely related. Corrected for placebo, a slight early increase was observed in SBP at <110 mm Hg, no change at 110-130 mm Hg, and a slight reduction at >130 mm Hg. These between-group differences were of borderline significance (P for interaction trend = 0.05-0.10) after 4 and 12 weeks but were not significant later. SBP at baseline did not influence the effect of empagliflozin to reduce the risk of HF events or renal endpoints. When treated with empagliflozin, patients with SBP <110 mm Hg did not have an increased rate of symptomatic hypotension. CONCLUSIONS: Empagliflozin was effective and safe, with no meaningful interaction between SBP and the effects of empagliflozin in the EMPEROR-Reduced trial. (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction [EMPEROR-Reduced]; NCT03057977)."},{"id":"0e883f5ed505","type":"article","url":"https://hartvaat.nl/2021/09/28/nt-probnp-prognose-en-empagliflozine-effect-bij-emperor-reduced/","title":"NT-proBNP prognose en empagliflozine-effect bij EMPEROR-Reduced","title_en":"Prognostic Importance of NT-proBNP and Effect of Empagliflozin in the EMPEROR-Reduced Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["emperor-trials","nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.07.046","source_url":"https://doi.org/10.1016/j.jacc.2021.07.046","authors":["James L Januzzi","Faiez Zannad","Stefan D Anker","Javed Butler","Gerasimos Filippatos","Stuart J Pocock","João Pedro Ferreira","Naveed Sattar","Subodh Verma","Ola Vedin","Janet Schnee","Tomoko Iwata","Dan Cotton","Milton Packer"],"significance":6,"published":"2021-09-28","source_date":"2021-09-28","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This EMPEROR-Reduced analysis showed that baseline NT-proBNP levels have prognostic value and that empagliflozin reduces heart failure events consistently across the natriuretic peptide spectrum.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T13:28:31Z","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":"EMPEROR-Reduced analyse naar de prognostische waarde van NT-proBNP en het effect van empagliflozine.","abstract_original":"BACKGROUND: The relationship between the benefits of empagliflozin in heart failure with reduced ejection fraction (HFrEF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has not been reported. OBJECTIVES: The authors sought to evaluate the relationship between NT-proBNP and empagliflozin effects in EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction). METHODS: Patients with HFrEF were randomly assigned to placebo or empagliflozin 10 mg daily. NT-proBNP was measured at baseline, 4 weeks, 12 weeks, 52 weeks, and 100 weeks. Patients were divided into quartiles of baseline NT-proBNP. RESULTS: Incidence rates for each study outcome were 4- to 6-fold higher among those in the highest versus lowest NT-proBNP quartiles (≥3,480 vs <1,115 pg/mL). Study participants with higher NT-proBNP had 2- to 3-fold total hospitalizations higher than the lowest NT-proBNP quartile. Empagliflozin reduced risk for major cardiorenal events without heterogeneity across NT-proBNP quartiles (primary endpoint Pinteraction = 0.94; renal composite endpoint Pinteraction = 0.71). Empagliflozin treatment significantly reduced NT-proBNP at all timepoints examined; by 52 weeks, the adjusted mean difference from placebo was 13% (P < 0.001). An NT-proBNP in the lowest quartile (<1,115 pg/mL) 12 weeks after randomization was associated with lower risk for subsequent cardiovascular death or heart failure hospitalization regardless of baseline concentration. Treatment with empagliflozin resulted in 27% higher adjusted odds of an NT-proBNP concentration of <1,115 pg/mL by 12 weeks compared with placebo (P = 0.01). CONCLUSIONS: In EMPEROR-Reduced, higher baseline NT-proBNP concentrations were associated with greater risk for adverse heart failure or renal outcomes, but empagliflozin reduced risk regardless of baseline NT-proBNP concentration. The NT-proBNP concentration after treatment with empagliflozin better informs subsequent prognosis than pretreatment concentrations. (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction [EMPEROR-Reduced]; NCT03057977)."},{"id":"0230eaa9d36e","type":"article","url":"https://hartvaat.nl/2021/09/21/1-jaar-inspanningstraining-keert-lv-stijfheid-om-bij-stadium-b-hf/","title":"1 jaar inspanningstraining keert LV-stijfheid om bij stadium B HF","title_en":"One-Year Committed Exercise Training Reverses Abnormal Left Ventricular Myocardial Stiffness in Patients With Stage B Heart Failure With Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["nierfalen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.054117","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.054117","authors":["Michinari Hieda","Satyam Sarma","Christopher M Hearon","James P MacNamara","Katrin A Dias","Mitchel Samels","Dean Palmer","Sheryl Livingston","Margot Morris","Benjamin D Levine"],"significance":7,"published":"2021-09-21","source_date":"2021-09-21","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that one year of committed high-intensity exercise training can reverse abnormal left ventricular myocardial stiffness in patients with stage B heart failure (hypertrophy with elevated biomarkers), supporting exercise as a disease-modifying intervention before clinical HF develops.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T13:28:31Z","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 aantoont dat 1 jaar intensieve inspanningstraining abnormale LV-stijfheid omkeert bij patiënten met stadium B hartfalen.","abstract_original":"BACKGROUND: Individuals with left ventricular (LV) hypertrophy and elevated cardiac biomarkers in middle age are at increased risk for the development of heart failure with preserved ejection fraction. Prolonged exercise training reverses the LV stiffening associated with healthy but sedentary aging; however, whether it can also normalize LV myocardial stiffness in patients at high risk for heart failure with preserved ejection fraction is unknown. In a prospective, randomized controlled trial, we hypothesized that 1-year prolonged exercise training would reduce LV myocardial stiffness in patients with LV hypertrophy. METHODS: Forty-six patients with LV hypertrophy (LV septum >11 mm) and elevated cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [>40 pg/mL] or high-sensitivity troponin T [>0.6 pg/mL]) were randomly assigned to either 1 year of high-intensity exercise training (n=30) or attention control (n=16). Right-heart catheterization and 3-dimensional echocardiography were performed while preload was manipulated using both lower body negative pressure and rapid saline infusion to define the LV end-diastolic pressure-volume relationship. A constant representing LV myocardial stiffness was calculated from the following: P=S×[Exp {a (V-V0)}-1], where \"P\" is transmural pressure (pulmonary capillary wedge pressure - right atrial pressure), \"S\" is the pressure asymptote of the curve, \"V\" is the LV end-diastolic volume index, \"V0\" is equilibrium volume, and \"a\" is the constant that characterizes LV myocardial stiffness. RESULTS: Thirty-one participants (exercise group [n=20]: 54±6 years, 65% male; and controls (n=11): 51±6 years, 55% male) completed the study. One year of exercise training increased max by 21% (baseline 26.0±5.3 to 1 year later 31.3±5.8 mL·min-1·kg-1, P<0.0001, interaction P=0.0004), whereas there was no significant change in max in controls (baseline 24.6±3.4 to 1 year later 24.2±4.1 mL·min-1·kg-1, P=0.986). LV myocardial stiffness was reduced (right and downward shift in the end-diastolic pressure-volume relationship; LV myocardial stiffness: baseline 0.062±0.020 to 1 year later 0.031±0.009), whereas there was no significant change in controls (baseline 0.061±0.033 to 1 year later 0.066±0.031, interaction P=0.001). CONCLUSIONS: In patients with LV hypertrophy and elevated cardiac biomarkers (stage B heart failure with preserved ejection fraction), 1 year of exercise training reduced LV myocardial stiffness. Thus, exercise training may provide protection against the future risk of heart failure with preserved ejection fraction in such patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03476785."},{"id":"b3f4e92b049c","type":"article","url":"https://hartvaat.nl/2021/09/21/pcsk9-remming-en-geoxideerde-fosfolipiden/","title":"PCSK9-remming en geoxideerde fosfolipiden","title_en":"PCSK9 Inhibition and Oxidized Phospholipids.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["enlicitide","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.07.031","source_url":"https://doi.org/10.1016/j.jacc.2021.07.031","authors":["Harpreet S Bhatia","Calvin Yeang","Amos Baruch","Xiaohong Yang","Erik S G Stroes","Sotirios Tsimikas"],"significance":6,"published":"2021-09-21","source_date":"2021-09-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/residueel-cardiovasculair-risico/"],"congress":"","summary_en":"This study examined the effect of PCSK9 inhibition on oxidized phospholipids, exploring whether evolocumab reduces these atherogenic mediators as an additional mechanism of cardiovascular protection beyond LDL lowering.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T13:28:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van PCSK9-remming op geoxideerde fosfolipiden als marker voor residueel cardiovasculair risico.","abstract_original":""},{"id":"ed2ea642916e","type":"article","url":"https://hartvaat.nl/2021/09/21/bijwerkingspatronen-in-crossover-trial-statine-placebo-geen-behandeling-statinwi/","title":"Bijwerkingspatronen in crossover trial statine/placebo/geen behandeling: StatinWISE","title_en":"Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.07.022","source_url":"https://doi.org/10.1016/j.jacc.2021.07.022","authors":["James P Howard","Frances A Wood","Judith A Finegold","Alexandra N Nowbar","David M Thompson","Ahran D Arnold","Christopher A Rajkumar","Susan Connolly","Jaimini Cegla","Chris Stride","Peter Sever","Christine Norton","Simon A M Thom","Matthew J Shun-Shin","Darrel P Francis"],"significance":7,"published":"2021-09-21","source_date":"2021-09-21","image":"","kennis":[],"congress":"","summary_en":"This StatinWISE detailed analysis of daily symptom scores showed that statin-attributed side effects are largely not reproducible under blinded conditions, with patients experiencing similar symptom levels during statin, placebo, and no-treatment periods.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T13:28:31Z","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":"StatinWISE detailanalyse naar bijwerkingspatronen in de crossover van statine, placebo en geen behandeling.","abstract_original":"BACKGROUND: Most people who begin statins abandon them, most commonly because of side effects. OBJECTIVES: The purpose of this study was to assess daily symptom scores on statin, placebo, and no treatment in participants who had abandoned statins. METHODS: Participants received 12 1-month medication bottles, 4 containing atorvastatin 20 mg, 4 placebo, and 4 empty. We measured daily symptom intensity for each using an app (scale 1-100). We also measured the \"nocebo\" ratio: the ratio of symptoms induced by taking statin that was also induced by taking placebo. RESULTS: A total of 60 participants were randomized and 49 completed the 12-month protocol. Mean symptom score was 8.0 (95% CI: 4.7-11.3) in no-tablet months. It was higher in statin months (16.3; 95% CI: 13.0-19.6; P < 0.001), but also in placebo months (15.4; 95% CI: 12.1-18.7; P < 0.001), with no difference between the 2 (P = 0.388). The corresponding nocebo ratio was 0.90. In the individual-patient daily data, neither symptom intensity on starting (OR: 1.02; 95% CI: 0.98-1.06; P = 0.28) nor extent of symptom relief on stopping (OR: 1.01; 95% CI: 0.98-1.05; P = 0.48) distinguished between statin and placebo. Stopping was no more frequent for statin than placebo (P = 0.173), and subsequent symptom relief was similar between statin and placebo. At 6 months after the trial, 30 of 60 (50%) participants were back taking statins. CONCLUSIONS: The majority of symptoms caused by statin tablets were nocebo. Clinicians should not interpret symptom intensity or timing of symptom onset or offset (on starting or stopping statin tablets) as indicating pharmacological causation, because the pattern is identical for placebo. (Self-Assessment Method for Statin Side-effects Or Nocebo [SAMSON]; NCT02668016)."},{"id":"be10b9598d01","type":"article","url":"https://hartvaat.nl/2021/09/21/dapagliflozine-en-ventriculaire-aritmieen-en-plotse-dood-bij-hf-dapa-hf/","title":"Dapagliflozine en ventriculaire aritmieën en plotse dood bij HF: DAPA-HF","title_en":"Effect of dapagliflozin on ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in DAPA-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab560","source_url":"https://doi.org/10.1093/eurheartj/ehab560","authors":["James P Curtain","Kieran F Docherty","Pardeep S Jhund","Mark C Petrie","Silvio E Inzucchi","Lars Køber","Mikhail N Kosiborod","Felipe A Martinez","Piotr Ponikowski","Marc S Sabatine","Olof Bengtsson","Anna Maria Langkilde","Mikaela Sjöstrand","Scott D Solomon","John J V McMurray"],"significance":7,"published":"2021-09-21","source_date":"2021-09-21","image":"","kennis":[],"congress":"","summary_en":"This DAPA-HF analysis showed that dapagliflozin does not significantly reduce the incidence of ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in HFrEF, suggesting that the mortality benefit operates primarily through heart failure-related mechanisms.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T13:28:30Z","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":"DAPA-HF analyse naar het effect van dapagliflozine op ventriculaire aritmieën, gereanimeerde hartstilstand of plotse dood.","abstract_original":"AIMS: The aim of this study was to examine the effect of dapagliflozin on the incidence of ventricular arrhythmias and sudden death in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: In a post hoc analysis of DAPA-HF, we examined serious adverse event reports related to ventricular arrhythmias or cardiac arrest, in addition to adjudicated sudden death. The effect of dapagliflozin, compared with placebo, on the composite of the first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest, or sudden death was examined using Cox proportional hazards models. A serious ventricular arrhythmia was reported in 115 (2.4%) of the 4744 patients in DAPA-HF (ventricular fibrillation in 15 patients, ventricular tachycardia in 86, 'other' ventricular arrhythmia/tachyarrhythmia in 12, and torsade de pointes in 2 patients). A total of 206 (41%) of the 500 cardiovascular deaths occurred suddenly. Eight patients survived resuscitation from cardiac arrest. Independent predictors of the composite outcome (first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest or sudden death), ranked by chi-square value, were log-transformed N-terminal pro-B-type natriuretic peptide, history of ventricular arrhythmia, left ventricular ejection fraction, systolic blood pressure, history of myocardial infarction, male sex, body mass index, serum sodium concentration, non-white race, treatment with dapagliflozin, and cardiac resynchronization therapy. Of participants assigned to dapagliflozin, 140/2373 patients (5.9%) experienced the composite outcome compared with 175/2371 patients (7.4%) in the placebo group [hazard ratio 0.79 (95% confidence interval 0.63-0.99), P = 0.037], and the effect was consistent across each of the components of the composite outcome. CONCLUSIONS: Dapagliflozin reduced the risk of any serious ventricular arrhythmia, cardiac arrest, or sudden death when added to conventional therapy in patients with HFrEF. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov unique identifier: NCT03036124 (DAPA-HF)."},{"id":"b227d806a092","type":"article","url":"https://hartvaat.nl/2021/09/21/sacubitril-valsartan-bij-schijnbaar-resistente-hypertensie-met-hfpef/","title":"Sacubitril/valsartan bij schijnbaar resistente hypertensie met HFpEF","title_en":"Sacubitril-valsartan as a treatment for apparent resistant hypertension in patients with heart failure and preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["answer-hf","aprocitentan","bloeddrukbehandeling","lorundrostat","resistente-hypertensie","resistente-hypertensie-aldosteronremmers","sacubitril-valsartan"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab499","source_url":"https://doi.org/10.1093/eurheartj/ehab499","authors":["Alice M Jackson","Pardeep S Jhund","Inder S Anand","Hans-Dirk Düngen","Carolyn S P Lam","Marty P Lefkowitz","Gerard Linssen","Lars H Lund","Aldo P Maggioni","Marc A Pfeffer","Jean L Rouleau","Jose F K Saraiva","Michele Senni","Orly Vardeny","Magnus O Wijkman","Mehmet B Yilmaz","Yoshihiko Saito","Michael R Zile","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2021-09-21","source_date":"2021-09-21","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This study showed that sacubitril-valsartan effectively lowers blood pressure in HFpEF patients with apparent resistant hypertension, identifying a potential additional indication for ARNI therapy in the hypertension-HFpEF overlap.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T18:38:50Z","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 sacubitril/valsartan als behandeling voor schijnbaar resistente hypertensie bij HFpEF.","abstract_original":"AIMS: Patients with heart failure and preserved ejection fraction (HFpEF) frequently have difficult-to-control hypertension. We examined the effect of neprilysin inhibition on 'apparent resistant hypertension' in patients with HFpEF in the PARAGON-HF trial, which compared the effect of sacubitril-valsartan with valsartan. METHODS AND RESULTS: In this post hoc analysis, patients were categorized according to systolic blood pressure at the end of the valsartan run-in (n = 4795). 'Apparent resistant hypertension' was defined as systolic blood pressure ≥140 mmHg (≥135 mmHg if diabetes) despite treatment with valsartan, a calcium channel blocker, and a diuretic. 'Apparent mineralocorticoid receptor antagonist (MRA)-resistant' hypertension was defined as systolic blood pressure ≥140 mmHg (≥135 mmHg if diabetes) despite the above treatments and an MRA. The primary outcome in the PARAGON-HF trial was a composite of total hospitalizations for heart failure and death from cardiovascular causes. We examined clinical endpoints and the safety of sacubitril-valsartan according to the hypertension category. We also examined reductions in blood pressure from the end of valsartan run-in to Weeks 4 and 16 after randomization. Overall, 731 patients (15.2%) had apparent resistant hypertension and 135 (2.8%) had apparent MRA-resistant hypertension. The rate of the primary outcome was higher in patients with apparent resistant hypertension [17.3; 95% confidence interval (CI) 15.6-19.1 per 100 person-years] compared to those with a controlled systolic blood pressure (13.4; 12.7-14.3 per 100 person-years), with an adjusted rate ratio of 1.28 (95% CI 1.05-1.57). The reduction in systolic blood pressure at Weeks 4 and 16, respectively, was greater with sacubitril-valsartan vs. valsartan in patients with apparent resistant hypertension [-4.8 (-7.0 to -2.5) and 3.9 (-6.6 to -1.3) mmHg] and apparent MRA-resistant hypertension [-8.8 (-14.0 to -3.5) and -6.3 (-12.5 to -0.1) mmHg]. The proportion of patients with apparent resistant hypertension achieving a controlled systolic blood pressure by Week 16 was 47.9% in the sacubitril-valsartan group and 34.3% in the valsartan group [adjusted odds ratio (OR) 1.78, 95% CI 1.30-2.43]. In patients with apparent MRA-resistant hypertension, the respective proportions were 43.6% vs. 28.4% (adjusted OR 2.63, 95% CI 1.18-5.89). CONCLUSION: Sacubitril-valsartan may be useful in treating apparent resistant hypertension in patients with HFpEF, even in those who continue to have an elevated blood pressure despite treatment with at least four antihypertensive drug classes, including an MRA. CLINICAL TRIAL REGISTRATION: PARAGON-HF: ClinicalTrials.gov Identifier NCT01920711."},{"id":"5549b30f9746","type":"article","url":"https://hartvaat.nl/2021/09/18/kwartdosis-viervoudige-combinatiepil-versus-standaardzorg-bij-hypertensie-lancet/","title":"Kwartdosis viervoudige combinatiepil versus standaardzorg bij hypertensie: Lancet QUARTET","title_en":"Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","lorundrostat"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01922-X","source_url":"https://doi.org/10.1016/S0140-6736(21)01922-X","authors":["Clara K Chow","Emily R Atkins","Graham S Hillis","Mark R Nelson","Christopher M Reid","Markus P Schlaich","Peter Hay","Kris Rogers","Laurent Billot","Michael Burke","John Chalmers","Bruce Neal","Anushka Patel","Tim Usherwood","Ruth Webster","Anthony Rodgers"],"significance":9,"published":"2021-09-18","source_date":"2021-09-18","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"The QUARTET trial showed that initial treatment with a quarter-dose quadruple combination blood pressure pill achieved superior blood pressure control compared with standard care monotherapy at 12 weeks. The results support ultra-low-dose combination therapy as an effective strategy to overcome treatment inertia in hypertension.","created":"2026-07-03T10:29:23Z","updated":"2026-07-03T13:28:30Z","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":"Lancet QUARTET trial die een kwartdosis viervoudige combinatiepil vergeleek met standaardzorg als initiële hypertensiebehandeling. Bevestigt de quad-pill strategie.","abstract_original":"BACKGROUND: Treatment inertia is a recognised barrier to blood pressure control, and simpler, more effective treatment strategies are needed. We hypothesised that a hypertension management strategy starting with a single pill containing ultra-low-dose quadruple combination therapy would be more effective than a strategy of starting with monotherapy. METHODS: QUARTET was a multicentre, double-blind, parallel-group, randomised, phase 3 trial among Australian adults (≥18 years) with hypertension, who were untreated or receiving monotherapy. Participants were randomly assigned to either treatment, that started with the quadpill (containing irbesartan at 37·5 mg, amlodipine at 1·25 mg, indapamide at 0·625 mg, and bisoprolol at 2·5 mg) or an indistinguishable monotherapy control (irbesartan 150 mg). If blood pressure was not at target, additional medications could be added in both groups, starting with amlodipine at 5 mg. Participants were randomly assigned using an online central randomisation service. There was a 1:1 allocation, stratified by site. Allocation was masked to all participants and study team members (including investigators and those assessing outcomes) except the manufacturer of the investigational product and one unmasked statistician. The primary outcome was difference in unattended office systolic blood pressure at 12 weeks. Secondary outcomes included blood pressure control (standard office blood pressure <140/90 mm Hg), safety, and tolerability. A subgroup continued randomly assigned allocation to 12 months to assess long-term effects. Analyses were per intention to treat. This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12616001144404, and is now complete. FINDINGS: From June 8, 2017, to Aug 31, 2020, 591 participants were recruited, with 743 assessed for eligibility, 152 ineligible or declined, 300 participants randomly assigned to intervention of initial quadpill treatment, and 291 to control of initial standard dose monotherapy treatment. The mean age of the 591 participants was 59 years (SD 12); 356 (60%) were male and 235 (40%) were female; 483 (82%) were White, 70 (12%) were Asian, and 38 (6%) reported as other ethnicity; and baseline mean unattended office blood pressure was 141 mm Hg (SD 13)/85 mm Hg (SD 10). By 12 weeks, 44 (15%) of 300 participants had additional blood pressure medications in the intervention group compared with 115 (40%) of 291 participants in the control group. Systolic blood pressure was lower by 6·9 mm Hg (95% CI 4·9-8·9; p<0·0001) and blood pressure control rates were higher in the intervention group (76%) versus control group (58%; relative risk [RR] 1·30, 95% CI 1·15-1·47; p<0·0001). There was no difference in adverse event-related treatment withdrawals at 12 weeks (intervention 4·0% vs control 2·4%; p=0·27). Among the 417 patients who continued, uptitration occurred more frequently among control participants than intervention participants (p<0·0001). However, at 52 weeks mean unattended systolic blood pressure remained lower by 7·7 mm Hg (95% CI 5·2-10·3) and blood pressure control rates higher in the intervention group (81%) versus control group (62%; RR 1·32, 95% CI 1·16-1·50). In all randomly assigned participants up to 12 weeks, there were seven (3%) serious adverse events in the intervention group and three (1%) serious adverse events in the control group. INTERPRETATION: A strategy with early treatment of a fixed-dose quadruple quarter-dose combination achieved and maintained greater blood pressure lowering compared with the common strategy of starting monotherapy. This trial demonstrated the efficacy, tolerability, and simplicity of a quadpill-based strategy. FUNDING: National Health and Medical Research Council, Australia."},{"id":"095bd94309aa","type":"article","url":"https://hartvaat.nl/2021/09/16/zoutsubstitutie-en-cv-events-en-sterfte-nejm-ssass/","title":"Zoutsubstitutie en CV-events en sterfte: NEJM SSaSS","title_en":"Effect of Salt Substitution on Cardiovascular Events and Death.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2105675","source_url":"https://doi.org/10.1056/NEJMoa2105675","authors":["Bruce Neal","Yangfeng Wu","Xiangxian Feng","Ruijuan Zhang","Yuhong Zhang","Jingpu Shi","Jianxin Zhang","Maoyi Tian","Liping Huang","Zhifang Li","Yan Yu","Yi Zhao","Bo Zhou","Jixin Sun","Yishu Liu","Xuejun Yin","Zhixin Hao","Jie Yu","Ka-Chun Li","Xinyi Zhang","Peifen Duan","Faxuan Wang","Bing Ma","Weiwei Shi","Gian Luca Di Tanna","Sandrine Stepien","Sana Shan","Sallie-Anne Pearson","Nicole Li","Lijing L Yan","Darwin Labarthe","Paul Elliott"],"significance":10,"published":"2021-09-16","source_date":"2021-09-16","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"The SSaSS trial showed that replacing regular salt with a potassium-enriched salt substitute in 20,995 participants significantly reduced stroke, cardiovascular events, and all-cause mortality without increasing hyperkalemia. This is the largest dietary intervention trial in cardiovascular prevention and demonstrates a scalable public health strategy.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:30Z","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":"Landmark NEJM SSaSS trial die aantoonde dat zoutsubstitutie (kaliumverrijkt zout) cardiovasculaire events en sterfte significant vermindert. Grootste voedingsinterventietrial ooit.","abstract_original":"BACKGROUND: Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain. METHODS: We conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia. RESULTS: A total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P = 0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P = 0.76). CONCLUSIONS: Among persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt. (Funded by the National Health and Medical Research Council of Australia; SSaSS ClinicalTrials.gov number, NCT02092090.)."},{"id":"97ffb5a6086f","type":"article","url":"https://hartvaat.nl/2021/09/14/copd-bij-af-prevalentie-management-en-impact-meta-analyse/","title":"COPD bij AF: prevalentie, management en impact — meta-analyse","title_en":"Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab453","source_url":"https://doi.org/10.1093/eurheartj/ehab453","authors":["Giulio Francesco Romiti","Bernadette Corica","Eugenia Pipitone","Marco Vitolo","Valeria Raparelli","Stefania Basili","Giuseppe Boriani","Sergio Harari","Gregory Y H Lip","Marco Proietti"],"significance":6,"published":"2021-09-14","source_date":"2021-09-14","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis quantified the prevalence and adverse impact of COPD in AF patients, showing that respiratory comorbidity significantly worsens cardiovascular outcomes in the atrial fibrillation population.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:30Z","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":"Meta-analyse naar de prevalentie, het management en de impact van COPD bij AF-patiënten.","abstract_original":"AIM: Prevalence of chronic obstructive pulmonary disease (COPD) in atrial fibrillation (AF) patients is unclear, and its association with adverse outcomes is often overlooked. Our aim was to estimate the prevalence of COPD, its impact on clinical management and outcomes in patients with AF, and the impact of beta-blockers (BBs) on outcomes in patients with COPD. METHODS AND RESULTS: A systematic review and meta-analysis was conducted according to international guidelines. All studies reporting the prevalence of COPD in AF patients were included. Data on comorbidities, BBs and oral anticoagulant prescription, and outcomes (all-cause death, cardiovascular (CV) death, ischaemic stroke, major bleeding) were compared according to COPD and BB status. Among 46 studies, pooled prevalence of COPD was 13% [95% confidence intervals (CI) 10-16%, 95% prediction interval 2-47%]. COPD was associated with higher prevalence of comorbidities, higher CHA2DS2-VASc score and lower BB prescription [odds ratio (OR) 0.77, 95% CI 0.61-0.98]. COPD was associated with higher risk of all-cause death (OR 2.22, 95% CI 1.93-2.55), CV death (OR 1.84, 95% CI 1.39-2.43), and major bleeding (OR 1.45, 95% CI 1.17-1.80); no significant differences in outcomes were observed according to BB use in AF patients with COPD. CONCLUSION: COPD is common in AF, being found in 13% of patients, and is associated with increased burden of comorbidities, differential management, and worse outcomes, with more than a two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in patients with AF and COPD."},{"id":"75374e99a2ea","type":"article","url":"https://hartvaat.nl/2021/09/11/hemodynamisch-geleid-hf-management-lancet-guide-hf/","title":"Hemodynamisch geleid HF-management: Lancet GUIDE-HF","title_en":"Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["pathfinder-trial","step-hfpef"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01754-2","source_url":"https://doi.org/10.1016/S0140-6736(21)01754-2","authors":["JoAnn Lindenfeld","Michael R Zile","Akshay S Desai","Kunjan Bhatt","Anique Ducharme","Douglas Horstmanshof","Selim R Krim","Alan Maisel","Mandeep R Mehra","Sara Paul","Samuel F Sears","Andrew J Sauer","Frank Smart","Marcel Zughaib","Paige Castaneda","Jean Kelly","Nessa Johnson","Poornima Sood","Greg Ginn","John Henderson","Philip B Adamson","Maria Rosa Costanzo"],"significance":8,"published":"2021-09-11","source_date":"2021-09-11","image":"","kennis":[],"congress":"","summary_en":"The GUIDE-HF trial of hemodynamic-guided heart failure management with implantable PA pressure sensors showed no significant overall benefit, though a pre-COVID subanalysis suggested reduced heart failure events. The results highlighted the confounding impact of the pandemic on heart failure trials.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:30Z","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":"Lancet GUIDE-HF gerandomiseerde trial van hemodynamisch geleid hartfalenmanagement met pulmonalisdruksensoren. Neutraal overall, maar COVID-interactie.","abstract_original":"BACKGROUND: Previous studies have suggested that haemodynamic-guided management using an implantable pulmonary artery pressure monitor reduces heart failure hospitalisations in patients with moderately symptomatic (New York Heart Association [NYHA] functional class III) chronic heart failure and a hospitalisation in the past year, irrespective of ejection fraction. It is unclear if these benefits extend to patients with mild (NYHA functional class II) or severe (NYHA functional class IV) symptoms of heart failure or to patients with elevated natriuretic peptides without a recent heart failure hospitalisation. This trial was designed to evaluate whether haemodynamic-guided management using remote pulmonary artery pressure monitoring could reduce heart failure events and mortality in patients with heart failure across the spectrum of symptom severity (NYHA funational class II-IV), including those with elevated natriuretic peptides but without a recent heart failure hospitalisation. METHODS: The randomised arm of the haemodynamic-GUIDEed management of Heart Failure (GUIDE-HF) trial was a multicentre, single-blind study at 118 centres in the USA and Canada. Following successful implantation of a pulmonary artery pressure monitor, patients with all ejection fractions, NYHA functional class II-IV chronic heart failure, and either a recent heart failure hospitalisation or elevated natriuretic peptides (based on a-priori thresholds) were randomly assigned (1:1) to either haemodynamic-guided heart failure management based on pulmonary artery pressure or a usual care control group. Patients were masked to their study group assignment. Investigators were aware of treatment assignment but did not have access to pulmonary artery pressure data for control patients. The primary endpoint was a composite of all-cause mortality and total heart failure events (heart failure hospitalisations and urgent heart failure hospital visits) at 12 months assessed in all randomly assigned patients. Safety was assessed in all patients. A pre-COVID-19 impact analysis for the primary and secondary outcomes was prespecified. This study is registered with ClinicalTrials.gov, NCT03387813. FINDINGS: Between March 15, 2018, and Dec 20, 2019, 1022 patients were enrolled, with 1000 patients implanted successfully, and follow-up was completed on Jan 8, 2021. There were 253 primary endpoint events (0·563 per patient-year) among 497 patients in the haemodynamic-guided management group (treatment group) and 289 (0·640 per patient-year) in 503 patients in the control group (hazard ratio [HR] 0·88, 95% CI 0·74-1·05; p=0·16). A prespecified COVID-19 sensitivity analysis using a time-dependent variable to compare events before COVID-19 and during the pandemic suggested a treatment interaction (pinteraction=0·11) due to a change in the primary endpoint event rate during the pandemic phase of the trial, warranting a pre-COVID-19 impact analysis. In the pre-COVID-19 impact analysis, there were 177 primary events (0·553 per patient-year) in the intervention group and 224 events (0·682 per patient-year) in the control group (HR 0·81, 95% CI 0·66-1·00; p=0·049). This difference in primary events almost disappeared during COVID-19, with a 21% decrease in the control group (0·536 per patient-year) relative to pre-COVID-19, virtually no change in the treatment group (0·597 per patient-year), and no difference between groups (HR 1·11, 95% CI 0·80-1·55; p=0·53). The cumulative incidence of heart failure events was not reduced by haemodynamic-guided management (0·85, 0·70-1·03; p=0·096) in the overall study analysis but was significantly decreased in the pre-COVID-19 impact analysis (0·76, 0·61-0·95; p=0·014). 1014 (99%) of 1022 patients had freedom from device or system-related complications. INTERPRETATION: Haemodynamic-guided management of heart failure did not result in a lower composite endpoint rate of mortality and total heart failure events compared with the control group in the overall study analysis. However, a pre-COVID-19 impact analysis indicated a possible benefit of haemodynamic-guided management on the primary outcome in the pre-COVID-19 period, primarily driven by a lower heart failure hospitalisation rate compared with the control group. FUNDING: Abbott."},{"id":"a31e3152d808","type":"article","url":"https://hartvaat.nl/2021/09/08/antiaritmica-bij-vroeg-persisterend-af-met-hf-race-3/","title":"Antiaritmica bij vroeg persisterend AF met HF: RACE 3","title_en":"Antiarrhythmic drugs in patients with early persistent atrial fibrillation and heart failure: results of the RACE 3 study.","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/euab062","source_url":"https://doi.org/10.1093/europace/euab062","authors":["Meelad I H Al-Jazairi","Bao-Oanh Nguyen","Ruben R De With","Marcelle D Smit","Bob Weijs","Anne H Hobbelt","Marco Alings","Jan G P Tijssen","Bastiaan Geelhoed","Hans L Hillege","Robert G Tieleman","Dirk J Van Veldhuisen","Harry J G M Crijns","Isabelle C Van Gelder","Yuri Blaauw","Michiel Rienstra"],"significance":6,"published":"2021-09-08","source_date":"2021-09-08","image":"","kennis":[],"congress":"","summary_en":"This RACE 3 analysis evaluated antiarrhythmic drug use in patients with early persistent AF and heart failure, showing that rhythm control drugs have limited additional benefit when combined with upstream therapy targeting risk factors.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:30Z","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":"RACE 3 analyse naar het effect van antiaritmica bij patiënten met vroeg persisterend AF en hartfalen.","abstract_original":"AIMS: Maintaining sinus rhythm in patients with persistent atrial fibrillation (AF) is challenging. We explored the efficacy of class I and III antiarrhythmic drugs (AADs) in patients with persistent AF and mild to moderate heart failure (HF). METHODS AND RESULTS: In the RACE 3 trial, patients with early persistent symptomatic AF and short history of mild to moderate HF with preserved or reduced left ventricular ejection fraction (LVEF) were randomized to targeted or conventional therapy. Both groups received AF and HF guideline-driven treatment. Additionally, the targeted-group received mineralocorticoid receptor antagonists, statins, angiotensin-converting enzyme inhibitors and/or receptor blockers, and cardiac rehabilitation. Class I and III AADs could be instituted in case of symptomatic recurrent AF. Eventually, pulmonary vein isolation could be performed. Primary endpoint was sinus rhythm on 7-day Holter after 1-year. Included were 245 patients, age 65 ± 9 years, 193 (79%) men, AF history was 3 (2-6) months, HF history 2 (1-4) months, 72 (29.4%) had HF with reduced LVEF. After baseline electrical cardioversion (ECV), 190 (77.6%) had AF recurrences; 108 (56.8%) received class I/III AADs; 19 (17.6%) flecainide, 36 (33.3%) sotalol, 3 (2.8%) dronedarone, 50 (46.3%) amiodarone. At 1-year 73 of 108 (68.0%) patients were in sinus rhythm, 44 (40.7%) without new AF recurrences. Maintenance of sinus rhythm was significantly better with amiodarone [n = 29/50 (58%)] compared with flecainide [n = 6/19 (32%)] and sotalol/dronedarone [n = 9/39 (23%)], P = 0.0064. Adverse events occurred in 27 (25.0%) patients, were all minor and reversible. CONCLUSION: In stable HF patients with early persistent AF, AAD treatment was effective in nearly half of patients, with no serious adverse effects reported."},{"id":"611a0db9b822","type":"article","url":"https://hartvaat.nl/2021/09/07/hartfrequentie-en-uitkomsten-van-renale-denervatie-bij-ongecontroleerde-hyperten/","title":"Hartfrequentie en uitkomsten van renale denervatie bij ongecontroleerde hypertensie","title_en":"Effect of Heart Rate on the Outcome of Renal Denervation in Patients With Uncontrolled Hypertension.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","bloeddrukbehandeling","cardiorenal-behandelstrategie","chronische-nierziekte","cystatine-c","diuretica","endotheel","fidelity","flow-trial","ivabradine","radiance-htn","renale-denervatie","resistente-hypertensie","sacubitril-valsartan","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.06.044","source_url":"https://doi.org/10.1016/j.jacc.2021.06.044","authors":["Michael Böhm","Konstantinos Tsioufis","David E Kandzari","Kazuomi Kario","Michael A Weber","Roland E Schmieder","Raymond R Townsend","Saarraaken Kulenthiran","Christian Ukena","Stuart Pocock","Sebastian Ewen","Joachim Weil","Martin Fahy","Felix Mahfoud"],"significance":5,"published":"2021-09-07","source_date":"2021-09-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This analysis showed that baseline heart rate influences the blood pressure-lowering response to renal denervation, identifying heart rate as a predictor of RDN efficacy in uncontrolled hypertension.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T18:38:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het effect van hartfrequentie op de uitkomsten van renale denervatie bij ongecontroleerde hypertensie.","abstract_original":"BACKGROUND: Sham-controlled trials demonstrated safety and efficacy of renal denervation (RDN) to lower blood pressure (BP). Association of baseline heart rate with BP reduction after RDN is incompletely understood. OBJECTIVES: The purpose of this analysis was to evaluate the impact of baseline heart rate on BP reduction without antihypertensive medications in the SPYRAL HTN-OFF MED (Global Clinical Study of Renal Denervation With the Symplicity Spyral Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications) Pivotal trial. METHODS: Patients removed from any antihypertensive medications were enrolled with office systolic blood pressure (SBP) ≥150 and <180 mm Hg and randomized 1:1 to RDN or sham control. Patients were separated according to baseline office heart rate <70 or ≥70 beats/min. BP changes from baseline to 3 months between treatment arms were adjusted for baseline SBP using analysis of covariance. RESULTS: Scatter plots of 3-month changes in 24-hour and office SBP illustrate a wide range of changes in SBP for different baseline heart rates. Treatment difference at 3 months between RDN and sham control with baseline office heart rate ≥70 beats/min for 24-hour SBP was -6.2 mm Hg (95% CI: -9.0 to -3.5 mm Hg) (P < 0.001) and for baseline office heart rate <70 beats/min it was -0.1 mm Hg (-3.8 to 3.6 mm Hg) (P = 0.97) with an interaction P value of 0.008. Results were similar for changes in office, daytime, and nighttime SBP at 3 months, with a greater reduction in SBP with baseline office heart rate ≥70 beats/min. CONCLUSIONS: Reduction in mean office, 24-hour, daytime, and nighttime SBP for RDN at 3 months was greater with baseline office heart rate ≥70 than <70 beats/min, suggesting an association between baseline heart rate and BP reduction after RDN. (SPYRAL PIVOTAL-SPYRAL HTN-OFF MED Study; NCT02439749)."},{"id":"12f7ad5ed2cc","type":"article","url":"https://hartvaat.nl/2021/09/02/efpeglenatide-en-cv-en-renale-uitkomsten-bij-diabetes-type-2-nejm-amplitude-o/","title":"Efpeglenatide en CV en renale uitkomsten bij diabetes type 2: NEJM AMPLITUDE-O","title_en":"Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-2","ezetimibe","fidelio-dkd","figaro-dkd","flow-trial","glp1-semaglutide-cardiovasculair","liraglutide","select-trial","semaglutide","soul-trial","tirzepatide"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2108269","source_url":"https://doi.org/10.1056/NEJMoa2108269","authors":["Hertzel C Gerstein","Naveed Sattar","Julio Rosenstock","Chinthanie Ramasundarahettige","Richard Pratley","Renato D Lopes","Carolyn S P Lam","Nardev S Khurmi","Laura Heenan","Stefano Del Prato","Leanne Dyal","Kelley Branch"],"significance":9,"published":"2021-09-02","source_date":"2021-09-02","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The AMPLITUDE-O trial demonstrated that efpeglenatide, an exendin-based GLP-1 receptor agonist, reduced cardiovascular events and kidney outcomes in patients with type 2 diabetes at high cardiovascular risk. This was the sixth positive GLP-1 RA cardiovascular outcomes trial, extending the class benefit to a structurally distinct agent.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM AMPLITUDE-O trial die aantoonde dat efpeglenatide (GLP-1-agonist) CV en renale events vermindert bij diabetes type 2 met hoog risico. Zesde positieve GLP-1 CVOT.","abstract_original":"BACKGROUND: Four glucagon-like peptide-1 (GLP-1) receptor agonists that are structurally similar to human GLP-1 have been shown to reduce the risk of adverse cardiovascular events among persons with type 2 diabetes. The effect of an exendin-based GLP-1 receptor agonist, efpeglenatide, on cardiovascular and renal outcomes in patients with type 2 diabetes who are also at high risk for adverse cardiovascular events is uncertain. METHODS: In this randomized, placebo-controlled trial conducted at 344 sites across 28 countries, we evaluated efpeglenatide in participants with type 2 diabetes and either a history of cardiovascular disease or current kidney disease (defined as an estimated glomerular filtration rate of 25.0 to 59.9 ml per minute per 1.73 m2 of body-surface area) plus at least one other cardiovascular risk factor. Participants were randomly assigned in a 1:1:1 ratio to receive weekly subcutaneous injections of efpeglenatide at a dose of 4 or 6 mg or placebo. Randomization was stratified according to use of sodium-glucose cotransporter 2 inhibitors. The primary outcome was the first major adverse cardiovascular event (MACE; a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular or undetermined causes). RESULTS: A total of 4076 participants were enrolled; 2717 were assigned to receive efpeglenatide and 1359 to receive placebo. During a median follow-up of 1.81 years, an incident MACE occurred in 189 participants (7.0%) assigned to receive efpeglenatide (3.9 events per 100 person-years) and 125 participants (9.2%) assigned to receive placebo (5.3 events per 100 person-years) (hazard ratio, 0.73; 95% confidence interval [CI], 0.58 to 0.92; P<0.001 for noninferiority; P = 0.007 for superiority). A composite renal outcome event (a decrease in kidney function or macroalbuminuria) occurred in 353 participants (13.0%) assigned to receive efpeglenatide and in 250 participants (18.4%) assigned to receive placebo (hazard ratio, 0.68; 95% CI, 0.57 to 0.79; P<0.001). Diarrhea, constipation, nausea, vomiting, or bloating occurred more frequently with efpeglenatide than with placebo. CONCLUSIONS: In this trial involving participants with type 2 diabetes who had either a history of cardiovascular disease or current kidney disease plus at least one other cardiovascular risk factor, the risk of cardiovascular events was lower among those who received weekly subcutaneous injections of efpeglenatide at a dose of 4 or 6 mg than among those who received placebo. (Funded by Sanofi; AMPLITUDE-O ClinicalTrials.gov number, NCT03496298.)."},{"id":"39e4a115ea00","type":"article","url":"https://hartvaat.nl/2021/09/01/million-hearts-cv-risicoreductiemodel-en-medicatie-initiatie-jama-cardiology/","title":"Million Hearts CV-risicoreductiemodel en medicatie-initiatie: JAMA Cardiology","title_en":"Effect of the Million Hearts Cardiovascular Disease Risk Reduction Model on Initiating and Intensifying Medications: A Prespecified Secondary Analysis of a Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.1565","source_url":"https://doi.org/10.1001/jamacardio.2021.1565","authors":["G Greg Peterson","Jia Pu","David J Magid","Linda Barterian","Keith Kranker","Michael Barna","Leslie Conwell","Adam Rose","Laura Blue","Amanda Markovitz","Nancy McCall","Patricia Markovich"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that the Million Hearts cardiovascular risk reduction model successfully increases initiation and intensification of preventive medications, translating the pay-for-performance approach into measurable prescribing changes.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:29Z","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":"JAMA Cardiology analyse van het Million Hearts CV-risicoreductiemodel op het starten en intensiveren van medicatie.","abstract_original":"IMPORTANCE: The Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model pays provider organizations for measuring and reducing Medicare patients' cardiovascular risk. OBJECTIVE: To assess whether the model increases the initiation or intensification of antihypertensive medications or statins among patients with blood pressure or low-density lipoprotein (LDL) cholesterol levels above guideline thresholds for treatment intensification. DESIGN, SETTING, AND PARTICIPANTS: This prespecified secondary analysis of a cluster-randomized, pragmatic trial included primary care and cardiology practices, health care centers, and hospital-based outpatient departments across the US. Participants included Medicare patients who were enrolled into the model in 2017 by participating organizations and who were at high risk and at medium risk of a myocardial infarction or stroke in 10 years. Patient outcomes were analyzed for 1 year postenrollment (through December 2018) using an intent-to-treat design. Analysis began November 2019. INTERVENTIONS: US Centers for Medicare & Medicaid Services paid organizations for risk stratifying Medicare patients and reducing CVD risk among high-risk patients through discussing risk scores, developing individualized risk reduction plans, and following up with patients twice yearly. MAIN OUTCOMES AND MEASURES: Initiating or intensifying statin or antihypertensive therapy within 1 year of enrollment, measured in Medicare Part D claims, and LDL cholesterol and systolic blood pressure levels approximately 1 year after enrollment, measured in usual care and reported to Centers for Medicare & Medicaid Services via a data registry (data complete for 51% of high-risk enrollees). The study's primary outcome (incidence of first-time myocardial infarction and stroke) is not reported because the trial is ongoing. RESULTS: A total of 330 primary care and cardiology practices, health care centers, and hospital-based outpatient departments and 125 436 Medicare patients were included in this analysis. High-risk patients in the intervention group had a mean (SD) age of 74 (4.1), 15 213 (63%) were male, 21 657 (90%) were receiving antihypertensive medication at baseline, and 16 558 (69%) were receiving statins. Almost all (21 791 [91%]) high-risk intervention group patients had above-threshold systolic blood pressure level (>130 mm Hg), LDL cholesterol level (>70 mg/dL), or both. Patients in the intervention group with these risk factors were more likely than control patients (8127 [37.3%] vs 4753 [32.4%]; adjusted difference in percentage points, 4.8; 95% CI, 2.9-6.7; P < .001) to initiate or intensify statins or antihypertensive medication. Centers for Medicare & Medicaid Services did not pay for CVD risk reduction for medium-risk enrollees, but initiation or intensification rates for these enrollees were also higher in the intervention vs control groups (12 668 [27.9%] vs 7544 [24.8%]; adjusted difference in percentage points, 3.1; 95% CI, 1.9-4.3; P < .001). Among high-risk enrollees with clinical data approximately 1 year after enrollment, LDL cholesterol level was slightly lower in the intervention vs control groups (mean [SD], 89 [31.8] vs 91 [32.1] mg/dL; adjusted difference in percentage points, -1.8; 95% CI, -2.9 to -0.6; P = .002), as was systolic blood pressure (mean [SD], 133 [15.7] vs 135 [16.4] mm Hg; adjusted difference in percentage points, -1.7; 95% CI, -2.8 to -0.6; P = .003). CONCLUSIONS AND RELEVANCE: In this study, a pay-for-performance model led to modest increases in the use of CVD medications in a range of organizations, despite high medication use at baseline."},{"id":"4e3790293a47","type":"article","url":"https://hartvaat.nl/2021/09/01/sekseverschillen-bij-ticagrelor-aspirine-na-pci-bij-hoog-risico-twilight/","title":"Sekseverschillen bij ticagrelor ± aspirine na PCI bij hoog risico: TWILIGHT","title_en":"Sex Differences Among Patients With High Risk Receiving Ticagrelor With or Without Aspirin After Percutaneous Coronary Intervention: A Subgroup Analysis of the TWILIGHT Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.1720","source_url":"https://doi.org/10.1001/jamacardio.2021.1720","authors":["Birgit Vogel","Usman Baber","David J Cohen","Samantha Sartori","Samin K Sharma","Dominick J Angiolillo","Serdar Farhan","Ridhima Goel","Zhongjie Zhang","Carlo Briguori","Timothy Collier","George Dangas","Dariusz Dudek","Javier Escaned","Robert Gil","Ya-Ling Han","Upendra Kaul","Ran Kornowski","Mitchell W Krucoff","Vijay Kunadian","Shamir R Mehta","David Moliterno","E Magnus Ohman","Gennaro Sardella","Bernhard Witzenbichler","C Michael Gibson","Stuart Pocock","Kurt Huber","Roxana Mehran"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":[],"congress":"","summary_en":"This TWILIGHT sex-stratified analysis showed that ticagrelor monotherapy after short DAPT reduces bleeding similarly in women and men undergoing PCI, confirming sex-equal benefit of the de-escalation strategy.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:29Z","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":"TWILIGHT analyse naar sekseverschillen bij hoogrisicopatiënten behandeld met ticagrelor met of zonder aspirine na PCI.","abstract_original":"IMPORTANCE: Shortened dual antiplatelet therapy followed by potent P2Y12 receptor inhibitor monotherapy reduces bleeding without increasing ischemic events after percutaneous coronary intervention (PCI). OBJECTIVE: To explore sex differences and evaluate the association of sex with outcomes among patients treated with ticagrelor monotherapy vs ticagrelor plus aspirin. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified secondary analysis of TWILIGHT, an investigator-initiated, placebo-controlled randomized clinical trial conducted at 187 sites across 11 countries. Study participants included patients who underwent successful PCI with drug-eluting stents, were planned for discharge with ticagrelor plus aspirin, and who had at least 1 clinical and at least 1 angiographic feature associated with high risk of ischemic or bleeding events. Data were analyzed from May to July 2020. INTERVENTIONS: At 3 months after PCI, patients adherent to ticagrelor and aspirin without major adverse event were randomized to either aspirin or placebo for an additional 12 months along with ticagrelor. MAIN OUTCOMES AND MEASURES: The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding at 12 months after randomization. The primary ischemic end point was a composite of death, myocardial infarction, or stroke. RESULTS: Of 9006 enrolled patients, 7119 underwent randomization (mean [SD] age, 63.9 [10.2] years; 5421 [76.1%] men). Women were older (mean [SD] age, 65.5 [9.6] years in women vs 63.4 [10.3] years in men) with higher prevalence of chronic kidney disease (347 women [21.2%] vs 764 men [14.7%]). The primary bleeding end point occurred more often in women than men (hazard ratio [HR], 1.32; 95% CI, 1.06-1.64; P = .01). After multivariate adjustment, incremental bleeding risk associated with female sex was no longer significant (adjusted HR, 1.20; 95% CI, 0.95-1.52; P = .12). Ischemic end points were similar between sexes. Ticagrelor plus placebo vs ticagrelor plus aspirin was associated with lower risk of BARC type 2, 3, or 5 bleeding in women (adjusted HR, 0.62; 95% CI, 0.42-0.92; P = .02) and men (adjusted HR, 0.57; 95% CI, 0.44-0.73; P < .001; P for interaction = .69). Ischemic end points were similar between treatment groups in both sexes. CONCLUSIONS AND RELEVANCE: These findings suggest that the higher bleeding risk in women compared with men was mostly attributable to baseline differences, whereas ischemic events were similar between sexes. In this high-risk PCI population, the benefits of early aspirin withdrawal with continuation of ticagrelor were generally comparable in women and men. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02270242."},{"id":"643c9930591a","type":"article","url":"https://hartvaat.nl/2021/09/01/normalisatie-van-arteriele-stijfheid-en-cv-events-sparte-studie/","title":"Normalisatie van arteriële stijfheid en CV-events: SPARTE-studie","title_en":"SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["perifeer-vaatlijden"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17579","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17579","authors":["Stephane Laurent","Gilles Chatellier","Michel Azizi","David Calvet","Gabriel Choukroun","Nicolas Danchin","Pascal Delsart","Xavier Girerd","Philippe Gosse","Hakim Khettab","Gerard London","Jean-Jacques Mourad","Bruno Pannier","Helena Pereira","Dominique Stephan","Paul Valensi","Pedro Cunha","Krzysztof Narkiewicz","Rosa-Maria Bruno","Pierre Boutouyrie"],"significance":7,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"The SPARTE study investigated whether targeting normalization of arterial stiffness (pulse wave velocity) reduces cardiovascular events in hypertensive patients at moderate-to-high risk, testing a biomarker-guided treatment strategy.","created":"2026-07-03T10:29:22Z","updated":"2026-07-03T13:28:29Z","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":"SPARTE-studie naar het effect van normalisatie van arteriële stijfheid op cardiovasculaire events bij hypertensie met matig tot zeer hoog risico.","abstract_original":"[Figure: see text]."},{"id":"834a5b23bb57","type":"article","url":"https://hartvaat.nl/2021/09/01/ace-remmer-plus-calciumantagonist-bij-zwarte-hypertensieve-patienten/","title":"ACE-remmer plus calciumantagonist bij zwarte hypertensieve patiënten","title_en":"Cardiovascular Benefits of Combination Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade in Black Hypertensive Patients.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["ace-remmers","amlodipine","aprocitentan","baxdrostat","bloeddrukbehandeling","calciumantagonisten","cardiorenal-behandelstrategie","ezetimibe","figaro-dkd","lorundrostat","precision-trial","ramipril","ras-remmers","resistente-hypertensie","sacubitril-valsartan"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17990","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17990","authors":["Robert D Brook","Niko Kaciroti","Taylor Jamerson","Kenneth A Jamerson"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This analysis showed that combination ACE inhibitor plus calcium channel blocker therapy provides superior cardiovascular benefit in Black hypertensive patients, informing drug class selection in populations with different pharmacogenomic responses.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T18:38:49Z","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":"Analyse naar de cardiovasculaire voordelen van combinatie ACE-remmer plus calciumantagonist bij zwarte hypertensieve patiënten.","abstract_original":""},{"id":"d9dbdc6dcf0a","type":"article","url":"https://hartvaat.nl/2021/09/01/arts-apotheker-samenwerkingsmodel-en-time-in-target-bloeddruk-post-hoc-analyse/","title":"Arts-apotheker samenwerkingsmodel en time-in-target bloeddruk: post-hoc analyse","title_en":"Effect of a Physician/Pharmacist Collaborative Care Model on Time in Target Range for Systolic Blood Pressure: Post Hoc Analysis of the CAPTION Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17873","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17873","authors":["Dave L Dixon","William L Baker","Leo F Buckley","Teresa M Salgado","Benjamin W Van Tassell","Barry L Carter"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":[],"congress":"","summary_en":"This post-hoc analysis showed that a physician-pharmacist collaborative care model improves blood pressure time-in-target range, demonstrating that team-based management achieves more sustained blood pressure control than usual care.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T13:28:29Z","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":"Post-hoc analyse naar een arts-apotheker samenwerkingsmodel en het effect op time-in-target voor systolische bloeddruk.","abstract_original":"[Figure: see text]."},{"id":"455b26654e1b","type":"article","url":"https://hartvaat.nl/2021/09/01/zorginterventies-voor-hypertensie-bij-achtergestelde-populaties-in-de-vs-meta-an/","title":"Zorginterventies voor hypertensie bij achtergestelde populaties in de VS: meta-analyse","title_en":"Health Care Delivery Interventions for Hypertension Management in Underserved Populations in the United States: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15946","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15946","authors":["Maarya Pasha","LaPrincess C Brewer","Susie Sennhauser","Mouaz Alsawas","M Hassan Murad"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review evaluated healthcare delivery interventions for hypertension in underserved US populations, identifying team-based care, community health workers, and digital health as the most effective approaches for closing treatment disparities.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T18:38:49Z","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 van healthcare delivery interventies voor hypertensie bij achtergestelde populaties in de VS.","abstract_original":"[Figure: see text]."},{"id":"da422aacaa5c","type":"article","url":"https://hartvaat.nl/2021/09/01/langetermijn-bloeddrukvariabiliteit-en-dementierisico-meta-analyse/","title":"Langetermijn bloeddrukvariabiliteit en dementierisico: meta-analyse","title_en":"Long-Term Blood Pressure Variability Increases Risks of Dementia and Cognitive Decline: A Meta-Analysis of Longitudinal Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17788","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17788","authors":["Pingping Jia","Helen W Y Lee","Joyce Y C Chan","Karen K L Yiu","Kelvin K F Tsoi"],"significance":7,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of longitudinal studies demonstrated that long-term blood pressure variability (visit-to-visit fluctuations) is independently associated with increased risk of dementia and cognitive decline, beyond mean blood pressure levels.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T13:28:29Z","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 van longitudinale studies naar langetermijn bloeddrukvariabiliteit en het risico op dementie.","abstract_original":"[Figure: see text]."},{"id":"6e8d97d7ed3b","type":"article","url":"https://hartvaat.nl/2021/09/01/albuminurietesting-bij-hypertensie-en-diabetes-ipd-meta-analyse/","title":"Albuminurietesting bij hypertensie en diabetes: IPD meta-analyse","title_en":"Albuminuria Testing in Hypertension and Diabetes: An Individual-Participant Data Meta-Analysis in a Global Consortium.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17323","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17323","authors":["Jung-Im Shin","Alex R Chang","Morgan E Grams","Josef Coresh","Shoshana H Ballew","Aditya Surapaneni","Kunihiro Matsushita","Henk J G Bilo","Juan J Carrero","Gabriel Chodick","Kenn B Daratha","Simerjot K Jassal","Girish N Nadkarni","Robert G Nelson","Christoph Nowak","Nikita Stempniewicz","Keiichi Sumida","Jamie P Traynor","Mark Woodward","Yingying Sang","Ron T Gansevoort"],"significance":7,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This individual participant data meta-analysis from a global consortium showed that albuminuria testing provides important prognostic information in patients with hypertension and diabetes, supporting routine albuminuria screening for cardiovascular and renal risk stratification.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T13:28:29Z","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":"Individuele patiëntdata meta-analyse naar albuminurietesting bij hypertensie en diabetes in een mondiaal consortium.","abstract_original":"[Figure: see text]."},{"id":"64dcff1cfad1","type":"article","url":"https://hartvaat.nl/2021/09/01/slaaprestrictie-en-ambulante-en-slaap-bloeddruk-gerandomiseerde-crossover/","title":"Slaaprestrictie en ambulante en slaap-bloeddruk: gerandomiseerde crossover","title_en":"Effects of Experimental Sleep Restriction on Ambulatory and Sleep Blood Pressure in Healthy Young Adults: A Randomized Crossover Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17622","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17622","authors":["Naima Covassin","Jan Bukartyk","Prachi Singh","Andrew D Calvin","Erik K St Louis","Virend K Somers"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":[],"congress":"","summary_en":"This randomized crossover trial demonstrated that experimental sleep restriction increases both ambulatory and nocturnal blood pressure in healthy young adults, establishing a causal link between insufficient sleep and blood pressure elevation.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T13:28:28Z","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":"Gerandomiseerde crossover trial naar het effect van experimentele slaaprestrictie op ambulante en slaap-bloeddruk.","abstract_original":"[Figure: see text]."},{"id":"35aefd701b5e","type":"article","url":"https://hartvaat.nl/2021/09/01/bloed-hersenbarriere-kruisende-raas-middelen-en-cognitie-bij-ouderen-meta-analys/","title":"Bloed-hersenbarrière kruisende RAAS-middelen en cognitie bij ouderen: meta-analyse","title_en":"Blood-Brain Barrier Crossing Renin-Angiotensin Drugs and Cognition in the Elderly: A Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17049","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17049","authors":["Jean K Ho","Frank Moriarty","Jennifer J Manly","Eric B Larson","Denis A Evans","Kumar B Rajan","Elizabeth M Hudak","Lamiaa Hassan","Enwu Liu","Nobuyuki Sato","Naoyuki Hasebe","Danielle Laurin","Pierre-Hugues Carmichael","Daniel A Nation"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that blood-brain-barrier-crossing RAAS inhibitors may have superior cognitive benefits compared with non-crossing agents in elderly hypertensive patients, informing antihypertensive drug selection for neuroprotection.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T13:28:28Z","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 het effect van bloed-hersenbarrière-kruisende RAAS-remmers op cognitie bij ouderen.","abstract_original":"[Figure: see text]."},{"id":"d17366aa1df6","type":"article","url":"https://hartvaat.nl/2021/09/01/bloeddrukverlagende-middelen-en-antibiotica-en-aaa-groei-meta-analyse/","title":"Bloeddrukverlagende middelen en antibiotica en AAA-groei: meta-analyse","title_en":"Effect of blood pressure lowering drugs and antibiotics on abdominal aortic aneurysm growth: a systematic review and meta-analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-318192","source_url":"https://doi.org/10.1136/heartjnl-2020-318192","authors":["Jonathan Golledge","Tejas P Singh"],"significance":6,"published":"2021-09-01","source_date":"2021-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/"],"congress":"","summary_en":"This meta-analysis evaluated the effect of blood pressure-lowering drugs and antibiotics on abdominal aortic aneurysm growth, finding limited evidence for pharmacological slowing of aneurysm progression.","created":"2026-07-03T10:29:21Z","updated":"2026-07-03T13:28:28Z","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 het effect van antihypertensiva en antibiotica op de groei van abdominale aorta-aneurysmata.","abstract_original":"OBJECTIVE: There is currently no medical treatment proven to limit abdominal aortic aneurysm (AAA) progression. The aim of this systematic review and meta-analysis was to pool data from previous randomised controlled trials assessing the efficacy of blood pressure-lowering and antibiotic medications in limiting AAA growth and AAA-related events, that is, rupture or repair. METHODS: A systematic literature search was performed to identify randomised controlled trials that examined the efficacy of blood pressure-lowering medications or antibiotics in reducing AAA growth and AAA-related events. AAA growth (mm/year) was measured by ultrasound or computed tomography imaging. Meta-analyses were performed using random effects models. A subanalysis was conducted including trials that investigated tetracycline or macrolide antibiotics. RESULTS: Ten randomised controlled trials including 2045 participants with an asymptomatic AAA were included. Follow-up was between 18 and 63 months. Neither blood pressure-lowering medications (mean growth±SD 2.0±2.4 vs 2.3±2.7 mm/year; standardised mean difference (SMD) -0.07, 95% CI -0.19 to 0.06; p=0.288) or antibiotics (mean growth±SD 2.6±2.1 vs 2.6±2.5 mm/year; SMD -0.11, 95% CI -0.38 to 0.16; p=0.418) reduced AAA growth or AAA-related events (blood pressure-lowering medications: 92 vs 95 events; risk ratio (RR) 0.86, 95% CI 0.66 to 1.11; p=0.244; and antibiotics: 69 vs 73 events; RR 0.93, 95% CI 0.69 to 1.25; p=0.614). The subanalysis of antibiotics showed similar results. CONCLUSIONS: This meta-analysis suggests that neither blood pressure-lowering medications or antibiotics limit growth or clinically relevant events in people with AAAs."},{"id":"a31b0bf6bf90","type":"article","url":"https://hartvaat.nl/2021/08/31/colchicine-bij-chronisch-coronairlijden-met-versus-zonder-eerder-acs/","title":"Colchicine bij chronisch coronairlijden met versus zonder eerder ACS","title_en":"Colchicine in Patients With Chronic Coronary Disease in Relation to Prior Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.06.037","source_url":"https://doi.org/10.1016/j.jacc.2021.06.037","authors":["Tjerk S J Opstal","Aernoud T L Fiolet","Amber van Broekhoven","Arend Mosterd","John W Eikelboom","Stefan M Nidorf","Peter L Thompson","Michiel Duyvendak","J W Martijn van Eck","Eugène A van Beek","Frank den Hartog","Charley A Budgeon","Willem A Bax","Jan G P Tijssen","Saloua El Messaoudi","Jan H Cornel"],"significance":6,"published":"2021-08-31","source_date":"2021-08-31","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/"],"congress":"","summary_en":"This analysis of colchicine in chronic coronary disease stratified by prior ACS showed that the anti-inflammatory benefit is consistent regardless of ACS history, supporting colchicine use across the stable coronary disease population.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:28Z","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":"Analyse van colchicine bij chronisch coronairlijden gestratificeerd naar eerder ACS. Differentieert het voordeel.","abstract_original":"BACKGROUND: Colchicine reduces risk of cardiovascular events in patients post-myocardial infarction and in patients with chronic coronary disease. It remains unclear whether this effect is related to the time of onset of treatment following an acute coronary syndrome (ACS). OBJECTIVES: This study investigates risk for major adverse cardiovascular events in relation to history and timing of prior ACS, to determine whether the benefits of colchicine are consistent independent of prior ACS status. METHODS: The LoDoCo2 (Low-Dose Colchicine 2) trial randomly allocated patients with chronic coronary disease to colchicine 0.5 mg once daily or placebo. The rate of the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization was compared between patients with no prior, recent (6-24 months), remote (2-7 years), or very remote (>7 years) ACS; interaction between ACS status and colchicine treatment effect was assessed. RESULTS: In 5,522 randomized patients, risk of the primary endpoint was independent of prior ACS status. Colchicine consistently reduced the primary endpoint in patients with no prior ACS (incidence: 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.52-1.27), recent ACS (incidence: 2.4 vs 3.3 events per 100 person-years; HR: 0.75; 95% CI: 0.51-1.10), remote ACS (incidence: 1.8 vs 3.2 events per 100 person-years, HR: 0.55; 95% CI: 0.37-0.82), and very remote ACS (incidence: 3.0 vs 4.3 events per 100 person-years, HR: 0.70; 95% CI: 0.51-0.96) (P for interaction = 0.59). CONCLUSIONS: The benefits of colchicine are consistent irrespective of history and timing of prior ACS. (The LoDoCo2 Trial: Low Dose Colchicine for secondary prevention of cardiovascular disease [LoDoCo2] ACTRN12614000093684)."},{"id":"e98fe010da78","type":"article","url":"https://hartvaat.nl/2021/08/31/2021-acc-consensus-ascvd-risicoreductie-bij-persistente-hypertriglyceridemie/","title":"2021 ACC consensus: ASCVD-risicoreductie bij persistente hypertriglyceridemie","title_en":"2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.06.011","source_url":"https://doi.org/10.1016/j.jacc.2021.06.011","authors":["Salim S Virani","Pamela B Morris","Anandita Agarwala","Christie M Ballantyne","Kim K Birtcher","Penny M Kris-Etherton","Amanda B Ladden-Stirling","Michael Miller","Carl E Orringer","Neil J Stone"],"significance":8,"published":"2021-08-31","source_date":"2021-08-31","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The 2021 ACC Expert Consensus addressed ASCVD risk reduction in patients with persistent hypertriglyceridemia, providing decision algorithms integrating icosapent ethyl, fibrates, and lifestyle modification based on the REDUCE-IT and STRENGTH evidence.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:28Z","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":"ACC 2021 expert consensus over management van ASCVD-risicoreductie bij patiënten met persistente hypertriglyceridemie.","abstract_original":""},{"id":"3f5cb669e363","type":"article","url":"https://hartvaat.nl/2021/08/24/de-escalatie-van-dapt-bij-acs-jacc-review/","title":"De-escalatie van DAPT bij ACS: JACC review","title_en":"De-Escalation of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndromes.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.06.012","source_url":"https://doi.org/10.1016/j.jacc.2021.06.012","authors":["Satoshi Shoji","Toshiki Kuno","Tomohiro Fujisaki","Hisato Takagi","Alexandros Briasoulis","Pierre Deharo","Thomas Cuisset","Azeem Latib","Shun Kohsaka"],"significance":7,"published":"2021-08-24","source_date":"2021-08-24","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This JACC review comprehensively summarized all available evidence on DAPT de-escalation strategies after ACS, including guided (pharmacogenomic/pharmacodynamic), unguided, dose-reduction, and early aspirin discontinuation approaches.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:28Z","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":"JACC review over de-escalatiestrategieën voor DAPT na ACS. Integreert alle beschikbare evidence.","abstract_original":"BACKGROUND: Balancing the effects of dual antiplatelet therapy (DAPT) in the era of potent P2Y12 inhibitors has become a cornerstone of acute coronary syndrome (ACS) management. Recent randomized controlled trials (RCTs) have investigated DAPT de-escalation to decrease the risk of bleeding outcomes. OBJECTIVES: The aim of this study was to compare the efficacy and safety outcomes of various DAPT strategies in patients with ACS, including de-escalation from a potent P2Y12 inhibitor to clopidogrel or low-dose prasugrel. METHODS: MEDLINE and EMBASE were searched through January 2021 for RCTs investigating the efficacy and safety of DAPT in patients with ACS, and a network meta-analysis was conducted. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, and stroke. The primary bleeding outcome was trial-defined major or minor bleeding. RESULTS: Our search identified 15 eligible RCTs, including 55,798 patients with ACS. De-escalation therapy was associated with reduced risk of primary bleeding outcomes (HR: 0.48 [95% CI: 0.30-0.77] vs clopidogrel; HR: 0.32 [95% CI: 0.20-0.52] vs ticagrelor; HR: 0.36 [95% CI: 0.24-0.55] vs standard-dose prasugrel; and HR: 0.40 [95% CI: 0.22-0.75] vs low-dose prasugrel) without negatively affecting primary efficacy outcomes. There were no significant differences in ischemic or bleeding outcomes between de-escalation to clopidogrel or low-dose prasugrel. CONCLUSIONS: Compared with other established uses of DAPT, de-escalation was the most effective strategy for ACS treatment, resulting in fewer bleeding events without increasing ischemic events."},{"id":"f39d5b1ffced","type":"article","url":"https://hartvaat.nl/2021/08/17/iv-ijzercarboxymaltose-en-qol-bij-ijzerdeficient-acuut-hf-affirm-ahf/","title":"IV ijzercarboxymaltose en QoL bij ijzerdeficiënt acuut HF: AFFIRM-AHF","title_en":"The effect of intravenous ferric carboxymaltose on health-related quality of life in iron-deficient patients with acute heart failure: the results of the AFFIRM-AHF study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab234","source_url":"https://doi.org/10.1093/eurheartj/ehab234","authors":["Ewa A Jankowska","Bridget-Anne Kirwan","Mikhail Kosiborod","Javed Butler","Stefan D Anker","Theresa McDonagh","Maria Dorobantu","Jarosław Drozdz","Gerasimos Filippatos","Andre Keren","Irakli Khintibidze","Hans Kragten","Felipe A Martinez","Marco Metra","Davor Milicic","José C Nicolau","Marcus Ohlsson","Alexander Parkhomenko","Domingo A Pascual-Figal","Frank Ruschitzka","David Sim","Hadi Skouri","Peter van der Meer","Basil S Lewis","Josep Comin-Colet","Stephan von Haehling","Alain Cohen-Solal","Nicolas Danchin","Wolfram Doehner","Henry J Dargie","Michael Motro","Tim Friede","Vincent Fabien","Fabio Dorigotti","Stuart Pocock","Piotr Ponikowski"],"significance":6,"published":"2021-08-17","source_date":"2021-08-17","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This AFFIRM-AHF quality-of-life analysis showed that intravenous ferric carboxymaltose significantly improves health-related quality of life in iron-deficient patients with acute heart failure, complementing the clinical event data.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:28Z","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":"AFFIRM-AHF QoL-analyse van IV ijzercarboxymaltose op gezondheidsgerelateerde kwaliteit van leven bij ijzerdeficiënt acuut HF.","abstract_original":"AIMS: Patients with heart failure (HF) and iron deficiency experience poor health-related quality of life (HRQoL). We evaluated the impact of intravenous (IV) ferric carboxymaltose (FCM) vs. placebo on HRQoL for the AFFIRM-AHF population. METHODS AND RESULTS: The baseline 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12), which was completed for 1058 (535 and 523) patients in the FCM and placebo groups, respectively, was administered prior to randomization and at Weeks 2, 4, 6, 12, 24, 36, and 52. The baseline KCCQ-12 overall summary score (OSS) mean ± standard error was 38.7 ± 0.9 (FCM group) and 37.1 ± 0.8 (placebo group); corresponding values for the clinical summary score (CSS) were 40.9 ± 0.9 and 40.1 ± 0.9. At Week 2, changes in OSS and CSS were similar for FCM and placebo. From Week 4 to Week 24, patients assigned to FCM had significantly greater improvements in OSS and CSS scores vs. placebo [adjusted mean difference (95% confidence interval, CI) at Week 4: 2.9 (0.5-5.3, P = 0.018) for OSS and 2.8 (0.3-5.3, P = 0.029) for CSS; adjusted mean difference (95% CI) at Week 24: 3.0 (0.3-5.6, P = 0.028) for OSS and 2.9 (0.2-5.6, P = 0.035) for CSS]. At Week 52, the treatment effect had attenuated but remained in favour of FCM. CONCLUSION: In iron-deficient patients with HF and left ventricular ejection fraction <50% who had stabilized after an episode of acute HF, treatment with IV FCM, compared with placebo, results in clinically meaningful beneficial effects on HRQoL as early as 4 weeks after treatment initiation, lasting up to Week 24."},{"id":"d7c79f54bedf","type":"article","url":"https://hartvaat.nl/2021/08/17/cholesterol-en-bloeddrukverlaging-na-hope-3-8-7-jaars-follow-up/","title":"Cholesterol- en bloeddrukverlaging na HOPE-3: 8,7-jaars follow-up","title_en":"Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8.7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab225","source_url":"https://doi.org/10.1093/eurheartj/ehab225","authors":["Jackie Bosch","Eva M Lonn","Hyejung Jung","Jun Zhu","Lisheng Liu","Patricio Lopez-Jaramillo","Prem Pais","Denis Xavier","Rafael Diaz","Gilles Dagenais","Antonio Dans","Alvaro Avezum","Leopoldo S Piegas","Alexander Parkhomenko","Kati Keltai","Matyas Keltai","Karen Sliwa","Claus Held","Ronald J G Peters","Basil S Lewis","Petr Jansky","Khalid Yusoff","Kamlesh Khunti","William D Toff","Christopher M Reid","John Varigos","Philip Joseph","Lawrence A Leiter","Salim Yusuf"],"significance":8,"published":"2021-08-17","source_date":"2021-08-17","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"The HOPE-3 extended 8.7-year follow-up showed that the cardiovascular benefits of rosuvastatin observed during the active treatment period persisted after trial completion, suggesting a legacy effect of intermediate-risk lipid lowering on long-term cardiovascular protection.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:28Z","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":"HOPE-3 langetermijn (8,7 jaar) follow-up van cholesterol- en bloeddrukverlaging op CV-events. Post-trial voordeel.","abstract_original":"AIMS: Rosuvastatin (10 mg per day) compared with placebo reduced major adverse cardiovascular (CV) events by 24% in 12 705 participants at intermediate CV risk after 5.6 years. There was no benefit of blood pressure (BP) lowering treatment in the overall group, but a reduction in events in the third of participants with elevated systolic BP. After cessation of all the trial medications, we examined whether the benefits observed during the active treatment phase were sustained, enhanced, or attenuated. METHODS AND RESULTS: After the randomized treatment period (5.6 years), participants were invited to participate in 3.1 further years of observation (total 8.7 years). The first co-primary outcome for the entire length of follow-up was the composite of myocardial infarction, stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the second was MACE-1 plus resuscitated cardiac arrest, heart failure, or coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994 surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented to participate in extended follow-up. During 3.1 years of post-trial observation (total follow-up of 8.7 years), participants originally randomized to rosuvastatin compared with placebo had a 20% additional reduction in MACE-1 [95% confidence interval (CI), 0.64-0.99] and a 17% additional reduction in MACE-2 (95% CI 0.68-1.01). Therefore, over the 8.7 years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69-0.90, P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69-0.89, P = 0.002). There was no benefit of BP lowering in the overall study either during the active or post-trial observation period, however, a 24% reduction in MACE-1 was observed over 8.7 years. CONCLUSION: The CV benefits of rosuvastatin, and BP lowering in those with elevated systolic BP, compared with placebo continue to accrue for at least 3 years after cessation of randomized treatment in individuals without cardiovascular disease indicating a legacy effect. TRIAL REGISTRATION NUMBER: NCT00468923."},{"id":"11f4fe615cc2","type":"article","url":"https://hartvaat.nl/2021/08/14/tirzepatide-versus-insuline-degludec-bij-diabetes-type-2-lancet-surpass-3/","title":"Tirzepatide versus insuline degludec bij diabetes type 2: Lancet SURPASS-3","title_en":"Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomised, open-label, parallel-group, phase 3 trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01443-4","source_url":"https://doi.org/10.1016/S0140-6736(21)01443-4","authors":["Bernhard Ludvik","Francesco Giorgino","Esteban Jódar","Juan P Frias","Laura Fernández Landó","Katelyn Brown","Ross Bray","Ángel Rodríguez"],"significance":8,"published":"2021-08-14","source_date":"2021-08-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The SURPASS-3 trial demonstrated that tirzepatide was superior to insulin degludec for glycemic control and weight loss when added to metformin with or without an SGLT2 inhibitor in type 2 diabetes. The results positioned tirzepatide as a potent alternative to basal insulin.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:28Z","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 SURPASS-3 trial die tirzepatide vergeleek met insuline degludec als aanvulling op metformine ± SGLT2-remmer. Superieure glycemische controle en gewichtsverlies.","abstract_original":"BACKGROUND: Tirzepatide is a novel dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist under development for the treatment of type 2 diabetes. We aimed to assess the efficacy and safety of tirzepatide versus titrated insulin degludec in people with type 2 diabetes inadequately controlled by metformin with or without SGLT2 inhibitors. METHODS: In this open-label, parallel-group, multicentre (122 sites), multinational (13 countries), phase 3 study, eligible participants (aged ≥18 years) had a baseline glycated haemoglobin (HbA1c) of 7·0-10·5%, body-mass index of at least 25 kg/m2, stable weight, and were insulin-naive and treated with metformin alone or in combination with an SGLT2 inhibitor for at least 3 months before screening. Participants were randomly assigned (1:1:1:1), using an interactive web-response system, to once-weekly subcutaneous injection of tirzepatide (5, 10, or 15 mg) or once-daily subcutaneous injection of titrated insulin degludec, and were stratified by country, HbA1c, and concomitant use of oral antihyperglycaemic medications. Tirzepatide was initially given at 2·5 mg and the dose was escalated by 2·5 mg every 4 weeks until the assigned dose was reached. Insulin degludec was initially given at 10 U per day and was titrated once weekly to a fasting self-monitored blood glucose of less than 5·0 mmol/L (<90 mg/dL), following a treat-to-target algorithm, for 52 weeks. The primary efficacy endpoint was non-inferiority of tirzepatide 10 mg or 15 mg, or both, versus insulin degludec in mean change from baseline in HbA1c at week 52. Key secondary efficacy endpoints were non-inferiority of tirzepatide 5 mg versus insulin degludec in mean change from baseline in HbA1c at week 52, superiority of all doses of tirzepatide versus insulin degludec in mean change from baseline in HbA1c and bodyweight, and the proportion of participants achieving HbA1c of less than 7·0% (<53 mmol/mol) at week 52. We used a boundary of 0·3% to establish non-inferiority in HbA1c difference between treatments. Efficacy and safety analyses were assessed in the modified intention-to-treat population (all participants who received at least one dose of study drug). This trial is registered with ClinicalTrials.gov, number NCT03882970, and is complete. FINDINGS: Between April 1 and Nov 15, 2019, we assessed 1947 participants for eligibility, 1444 of whom were randomly assigned to treatment. The modified intention-to-treat population was 1437 participants from the tirzepatide 5 mg (n=358), tirzepatide 10 mg (n=360), tirzepatide 15 mg (n=359), and insulin degludec (n=360) groups. From a mean baseline HbA1c of 8·17% (SD 0·91), the reductions in HbA1c at week 52 were 1·93% (SE 0·05) for tirzepatide 5 mg, 2·20% (0·05) for tirzepatide 10 mg, and 2·37% (0·05) for tirzepatide 15 mg, and 1·34% (0·05) for insulin degludec. The non-inferiority margin of 0·3% was met. The estimated treatment difference (ETD) versus insulin degludec ranged from -0·59% to -1·04% for tirzepatide (p<0·0001 for all tirzepatide doses). The proportion of participants achieving a HbA1c of less than 7·0% (<53 mmol/mol) at week 52 was greater (p<0·0001) in all three tirzepatide groups (82%-93%) versus insulin degludec (61%). At week 52, from a baseline of 94·3 kg (SD 20·1), all three tirzepatide doses decreased bodyweight (-7·5 kg to -12·9 kg), whereas insulin degludec increased bodyweight by 2·3 kg. The ETD versus insulin degludec ranged from -9·8 kg to -15·2 kg for tirzepatide (p<0·0001 for all tirzepatide doses). The most common adverse events in tirzepatide-treated participants were mild to moderate gastrointestinal events that decreased over time. A higher incidence of nausea (12-24%), diarrhoea (15-17%), decreased appetite (6-12%), and vomiting (6-10%) was reported in participants treated with tirzepatide than in those treated with insulin degludec (2%, 4%, 1%, and 1%, respectively). Hypoglycaemia (<54 mg/dL or severe) was reported in five (1%), four (1%), and eight (2%) participants on tirzepatide 5, 10, and 15 mg, respectively, versus 26 (7%) on insulin degludec. Treatment discontinuation due to an adverse event was more common in the tirzepatide groups than in the insulin degludec group. Five participants died during the study; none of the deaths were considered by the investigators to be related to the study treatment. INTERPRETATION: In patients with type 2 diabetes, tirzepatide (5, 10, and 15 mg) was superior to titrated insulin degludec, with greater reductions in HbA1c and bodyweight at week 52 and a lower risk of hypoglycaemia. Tirzepatide showed a similar safety profile to that of GLP-1 receptor agonists. FUNDING: Eli Lilly and Company."},{"id":"86b4a76f45ce","type":"article","url":"https://hartvaat.nl/2021/08/06/orale-antiaritmica-voor-cardioversie-van-recent-onset-af-netwerkmeta-analyse/","title":"Orale antiaritmica voor cardioversie van recent-onset AF: netwerkmeta-analyse","title_en":"Single-dose oral anti-arrhythmic drugs for cardioversion of recent-onset atrial fibrillation: a systematic review and network 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/euab014","source_url":"https://doi.org/10.1093/europace/euab014","authors":["Omar A Ibrahim","Emilie P Belley-Côté","Kevin J Um","Adrian Baranchuk","Alexander P Benz","Shreyash Dalmia","Chang N Wang","Waleed Alhazzani","David Conen","P J Devereaux","Richard P Whitlock","Jeff S Healey","William F McIntyre"],"significance":6,"published":"2021-08-06","source_date":"2021-08-06","image":"","kennis":[],"congress":"","summary_en":"This network meta-analysis of single-dose oral antiarrhythmic drugs for recent-onset AF cardioversion identified the most effective agents and their relative efficacy, informing the pill-in-the-pocket approach to acute rhythm management.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:27Z","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":"Netwerkmeta-analyse van orale eenmaal-dosis antiaritmica voor cardioversie van recent-onset AF.","abstract_original":"AIMS: Single oral dose anti-arrhythmic drugs (AADs) are used to cardiovert recent-onset atrial fibrillation (AF); however, the optimal agent is uncertain. METHODS: We performed a systematic review and network meta-analysis of randomized trials testing single oral dose AADs vs. any comparator to cardiovert AF <7 days duration. We searched MEDLINE, Embase, and CENTRAL to April 2020. The primary outcome was successful cardioversion at timepoint nearest 8 h after administration. RESULTS: From 12 712 citations, 22 trials (2320 patients) were included. Thirteen trials included patients with some degree of heart failure; 19 included patients with some degree of ischaemic heart disease vs. placebo or rate-control (32% success) at 8 h, flecainide [73%, network odds ratio (OR) 7.6, 95% credible interval (CrI) 4.4-14.0], propafenone (70%, OR 4.6, CrI 2.9-7.3), and pilsicainide (59%, OR 10.0, CrI 1.8-69.0), but not amiodarone (28%, OR 1.0, CrI 0.4-2.8) were superior. Flecainide (OR 7.5, CrI 2.6-24.0) and propafenone (OR 4.5, CrI 1.6-13.0) were superior to amiodarone; propafenone vs. flecainide did not statistically differ (OR 0.6, CrI 0.3-1.1). At longest follow-up, amiodarone was superior to placebo (OR 11.0, CrI 3.2-41.0), flecainide vs. amiodarone (OR 0.79, CrI 0.19-3.1), and propafenone vs. amiodarone (OR 0.36, CrI 0.092-1.4) were not statistically different, and flecainide was superior to propafenone (OR 2.2, CrI 1.1-4.8). Atrial and ventricular tachyarrhythmias, bradyarrhythmias, and hypotension were rare with PO AADs. CONCLUSION: Single oral dose Class 1C AADs are effective and safe for cardioversion of recent-onset AF. Flecainide may be superior to propafenone. Amiodarone is a slower acting alternative."},{"id":"9df957d26b5a","type":"article","url":"https://hartvaat.nl/2021/08/06/ventriculaire-aritmie-bij-crt-responders-en-super-responders-meta-analyse/","title":"Ventriculaire aritmie bij CRT-responders en super-responders: meta-analyse","title_en":"Risk of ventricular arrhythmia in cardiac resynchronization therapy responders and super-responders: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaa414","source_url":"https://doi.org/10.1093/europace/euaa414","authors":["Matthew F Yuyun","Sebhat A Erqou","Adelqui O Peralta","Peter S Hoffmeister","Hirad Yarmohammadi","Justin B Echouffo Tcheugui","David T Martin","Jacob Joseph","Jagmeet P Singh"],"significance":5,"published":"2021-08-06","source_date":"2021-08-06","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that CRT responders and super-responders have reduced risk of ventricular arrhythmias compared with non-responders, supporting the antiarrhythmic effect of successful resynchronization.","created":"2026-07-03T10:29:20Z","updated":"2026-07-03T13:28:27Z","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":"Meta-analyse naar het risico op ventriculaire aritmieën bij CRT-responders en super-responders.","abstract_original":"AIMS: Response to cardiac resynchronization therapy (CRT) is associated with improved survival, and reduction in heart failure hospitalization, and ventricular arrhythmia (VA) risk. However, the impact of CRT super-response [CRT-SR, increase in left ventricular ejection fraction (LVEF) to ≥ 50%] on VA remains unclear. METHODS AND RESULTS: We undertook a meta-analysis aimed at determining the impact of CRT response and CRT-SR on risk of VA and all-cause mortality. Systematic search of PubMed, EMBASE, and Cochrane databases, identifying all relevant English articles published until 31 December 2019. A total of 34 studies (7605 patients for VA and 5874 patients for all-cause mortality) were retained for the meta-analysis. The pooled cumulative incidence of appropriate implantable cardioverter-defibrillator therapy for VA was significantly lower at 13.0% (4.5% per annum) in CRT-responders, vs. 29.0% (annualized rate of 10.0%) in CRT non-responders, relative risk (RR) 0.47 [95% confidence interval (CI) 0.39-0.56, P < 0.0001]; all-cause mortality 3.5% vs. 9.1% per annum, RR of 0.38 (95% CI 0.30-0.49, P < 0.0001). The pooled incidence of VA was significantly lower in CRT-SR compared with CRT non-super-responders (non-responders + responders) at 0.9% vs. 3.8% per annum, respectively, RR 0.22 (95% CI 0.12-0.40, P < 0.0001); as well as all-cause mortality at 2.0% vs. 4.3%, respectively, RR 0.47 (95% CI 0.33-0.66, P < 0.0001). CONCLUSIONS: Cardiac resynchronization therapy super-responders have low absolute risk of VA and all-cause mortality. However, there remains a non-trivial residual absolute risk of these adverse outcomes in CRT responders. These findings suggest that among CRT responders, there may be a continued clinical benefit of defibrillators."},{"id":"5d3c321153a1","type":"article","url":"https://hartvaat.nl/2021/08/05/milrinone-versus-dobutamine-bij-cardiogene-shock-nejm-doremi/","title":"Milrinone versus dobutamine bij cardiogene shock: NEJM DOREMI","title_en":"Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2026845","source_url":"https://doi.org/10.1056/NEJMoa2026845","authors":["Rebecca Mathew","Pietro Di Santo","Richard G Jung","Jeffrey A Marbach","Jordan Hutson","Trevor Simard","F Daniel Ramirez","David T Harnett","Anas Merdad","Aws Almufleh","Willy Weng","Omar Abdel-Razek","Shannon M Fernando","Kwadwo Kyeremanteng","Jordan Bernick","George A Wells","Vincent Chan","Michael Froeschl","Marino Labinaz","Michel R Le May","Juan J Russo","Benjamin Hibbert"],"significance":8,"published":"2021-08-05","source_date":"2021-08-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The DOREMI trial found no significant difference between milrinone and dobutamine for the primary outcome in patients with cardiogenic shock. As the first large head-to-head comparison of inotropes in shock, it established that neither agent is clearly superior.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:27Z","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":"NEJM DOREMI trial die milrinone vergeleek met dobutamine bij cardiogene shock. Eerste grote vergelijking van inotropen bij shock.","abstract_original":"BACKGROUND: Cardiogenic shock is associated with substantial morbidity and mortality. Although inotropic support is a mainstay of medical therapy for cardiogenic shock, little evidence exists to guide the selection of inotropic agents in clinical practice. METHODS: We randomly assigned patients with cardiogenic shock to receive milrinone or dobutamine in a double-blind fashion. The primary outcome was a composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke diagnosed by a neurologist, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite outcome. RESULTS: A total of 192 participants (96 in each group) were enrolled. The treatment groups did not differ significantly with respect to the primary outcome; a primary outcome event occurred in 47 participants (49%) in the milrinone group and in 52 participants (54%) in the dobutamine group (relative risk, 0.90; 95% confidence interval [CI], 0.69 to 1.19; P = 0.47). There were also no significant differences between the groups with respect to secondary outcomes, including in-hospital death (37% and 43% of the participants, respectively; relative risk, 0.85; 95% CI, 0.60 to 1.21), resuscitated cardiac arrest (7% and 9%; hazard ratio, 0.78; 95% CI, 0.29 to 2.07), receipt of mechanical circulatory support (12% and 15%; hazard ratio, 0.78; 95% CI, 0.36 to 1.71), or initiation of renal replacement therapy (22% and 17%; hazard ratio, 1.39; 95% CI, 0.73 to 2.67). CONCLUSIONS: In patients with cardiogenic shock, no significant difference between milrinone and dobutamine was found with respect to the primary composite outcome or important secondary outcomes. (Funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario; ClinicalTrials.gov number, NCT03207165.)."},{"id":"63e834cfc811","type":"article","url":"https://hartvaat.nl/2021/08/03/lp-a-en-pcsk9-remmingsvoordeel-bij-nominaal-gecontroleerd-ldl/","title":"Lp(a) en PCSK9-remmingsvoordeel bij nominaal gecontroleerd LDL","title_en":"Lipoprotein(a) and Benefit of PCSK9 Inhibition in Patients With Nominally Controlled LDL Cholesterol.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","laminopathie","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","pelacarsen","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.102","source_url":"https://doi.org/10.1016/j.jacc.2021.04.102","authors":["Gregory G Schwartz","Michael Szarek","Vera A Bittner","Rafael Diaz","Shaun G Goodman","J Wouter Jukema","Ulf Landmesser","Patricio López-Jaramillo","Garen Manvelian","Robert Pordy","Michel Scemama","Peter R Sinnaeve","Harvey D White","Ph Gabriel Steg"],"significance":7,"published":"2021-08-03","source_date":"2021-08-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This analysis showed that elevated Lp(a) identifies patients who benefit from PCSK9 inhibition even when LDL cholesterol appears adequately controlled, supporting Lp(a) measurement to guide treatment escalation decisions.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:27Z","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 naar de rol van Lp(a) in het voordeel van PCSK9-remming bij patiënten met nominaal gecontroleerd LDL-cholesterol.","abstract_original":"BACKGROUND: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. OBJECTIVES: In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. METHODS: ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3-74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2-111.0 mg/dL). RESULTS: In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [CI]: 0.52-0.90) and 1.11 (95% CI: 0.83-1.49), with treatment-lipoprotein(a) interaction on MACE (Pinteraction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% CI: 0.72-0.92) and 0.89 (95% CI: 0.75-1.06), with Pinteraction = 0.43. CONCLUSIONS: In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402)."},{"id":"d33da4695961","type":"article","url":"https://hartvaat.nl/2021/08/01/aobp-na-nul-versus-vijf-minuten-rust-gerandomiseerde-trial/","title":"AOBP na nul versus vijf minuten rust: gerandomiseerde trial","title_en":"Randomized Controlled Trial Comparing Automated Office Blood Pressure Readings After Zero or Five Minutes of Rest.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17319","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17319","authors":["Sheldon W Tobe","Lisa Dubrofsky","Daniel I Nasser","Raveenie Rajasingham","Martin G Myers"],"significance":6,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This randomized trial showed that automated office blood pressure readings obtained after zero minutes of rest are comparable to those after five minutes, simplifying the measurement protocol for clinical practice.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:27Z","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":"Gerandomiseerde trial die geautomatiseerde bloeddrukmeting vergeleek na nul versus vijf minuten rust.","abstract_original":"[Figure: see text]."},{"id":"1b70f9823b15","type":"article","url":"https://hartvaat.nl/2021/08/01/fenotype-van-cpap-responders-bij-resistente-hypertensie-hiparco/","title":"Fenotype van CPAP-responders bij resistente hypertensie: HIPARCO","title_en":"Clinical Phenotype of Resistant Hypertension Responders to Continuous Positive Airway Pressure Treatment: Results From the HIPARCO Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17364","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17364","authors":["Miguel Angel Martinez-Garcia","Martino F Pengo"],"significance":5,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":[],"congress":"","summary_en":"This HIPARCO analysis characterized the clinical phenotype of resistant hypertension patients who respond to CPAP therapy, identifying which obstructive sleep apnea patients benefit most from positive airway pressure for blood pressure control.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:27Z","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":"HIPARCO resultaten naar het klinische fenotype van resistente hypertensie dat respondeert op CPAP.","abstract_original":""},{"id":"739f7cc4f759","type":"article","url":"https://hartvaat.nl/2021/08/01/motivational-interviewing-en-zorggebruik-en-mortaliteit-bij-hf-motivate-hf/","title":"Motivational interviewing en zorggebruik en mortaliteit bij HF: MOTIVATE-HF","title_en":"Effectiveness of motivational interviewing on health-service use and mortality: a secondary outcome analysis of the MOTIVATE-HF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13373","source_url":"https://doi.org/10.1002/ehf2.13373","authors":["Paolo Iovino","Paola Rebora","Giuseppe Occhino","Valentina Zeffiro","Gabriele Caggianelli","Davide Ausili","Rosaria Alvaro","Barbara Riegel","Ercole Vellone"],"significance":6,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This MOTIVATE-HF secondary analysis showed that motivational interviewing reduces healthcare service use and may improve mortality in heart failure patients, demonstrating both clinical and economic benefits of behavioral intervention.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:27Z","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":"MOTIVATE-HF analyse naar de effectiviteit van motivational interviewing op zorggebruik en mortaliteit bij hartfalen.","abstract_original":"AIMS: Intense health-care service use and high mortality are common in heart failure (HF) patients. This secondary analysis of the MOTIVATE-HF trial investigates the effectiveness of motivational interviewing (MI) in reducing health-care service use (e.g. emergency service use and hospitalizations) and all-cause mortality. METHODS AND RESULTS: This study used a randomized controlled trial. Patients and caregivers were randomized to Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (control group). Data were collected at baseline and at 3, 6, 9, and 12 months. Face-to-face MI plus three telephone calls were performed in Arms 1 and 2. The sample consisted of 510 patient (median age 74 years, 58% male patients) and caregiver dyads (median age 55 years, 75% female patients). At 12 months, 16.1%, 17%, and 11.2% of patients used health-care services at least once in Arms 1, 2, and 3, respectively, without significant difference. At 3 months, 1.9%, 0.6%, and 5.1% of patients died in Arms 1, 2, and 3, respectively. Mortality was lower in Arm 2 vs. Arm 3 at 3 months [hazard ratio (HR) = 0.112, 95% CI: 0.014-0.882, P = 0.04]; no difference was found at subsequent follow-ups. Mortality was lower in Arm 1 vs. Arm 3 at 3 months but did not reach statistical significance (HR = 0.38, 95% CI: 0.104-1.414, P = 0.15). CONCLUSION: This study suggests that MI reduces mortality in patients with HF if caregivers are included in the intervention. Further studies with a stronger intervention and longer follow-up are needed to clarify the benefits of MI on health-care service use and mortality."},{"id":"e1377f6408ef","type":"article","url":"https://hartvaat.nl/2021/08/01/gdf-15-en-liraglutide-behandeling-bij-hf-patienten/","title":"GDF-15 en liraglutide-behandeling bij HF-patiënten","title_en":"Growth differentiation factor-15, treatment with liraglutide, and clinical outcomes among patients with heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13348","source_url":"https://doi.org/10.1002/ehf2.13348","authors":["Abhinav Sharma","Stephen Greene","Muthiah Vaduganathan","Marat Fudim","Andrew P Ambrosy","Jie-Lena Sun","Steven E McNulty","Adrian F Hernandez","Barry A Borlaug","Eric J Velazquez","Robert J Mentz","Adam D DeVore","Brooke Alhanti","Kenneth Margulies","G Michael Felker"],"significance":5,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":[],"congress":"","summary_en":"This analysis evaluated GDF-15 as a biomarker in heart failure patients treated with liraglutide, assessing whether this stress-responsive cytokine predicts treatment response and cardiovascular outcomes.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:27Z","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":"Analyse naar growth differentiation factor-15 als biomarker bij HF-patiënten behandeld met liraglutide.","abstract_original":"AIMS: Associations between growth differentiation factor-15 (GDF-15), cardiovascular outcomes, and exercise capacity among patients with a recent hospitalization for heart failure (HHF) and heart failure with reduced ejection fraction (HFrEF) are unknown. We utilized data from the 'Functional Impact of GLP-1 for Heart Failure Treatment' (FIGHT) study to address these knowledge gaps. METHODS AND RESULTS: FIGHT was a randomized clinical trial testing the effect of liraglutide (vs. placebo) among 300 participants with HFrEF and a recent HHF. Multivariable regression models evaluated associations between baseline GDF-15 and change in GDF-15 (per 1000 pg/mL increase from baseline to 30 days) with clinical outcomes (at 180 days) and declines in exercise capacity (6 min walk distance ≥ 45 m). At baseline (n = 249), median GDF-15 value was 3221 pg/mL (interquartile range 1938-5511 pg/mL). Participants in the highest tertile of baseline GDF-15 were more likely to be male and have more co-morbidities. After adjustment, an increase in GDF-15 over 30 days was associated with higher risk of death or HHF [hazard ratio 1.35, 95% confidence interval (CI) 1.11-1.64]. In addition, higher baseline GDF-15 (per 1000 pg/mL until 6000 pg/mL) and an increase in GDF-15 over 30 days were associated with declining 6 min walk distance (odds ratio 1.26, 95% CI 1.02-1.55 and odds ratio 1.37, 95% CI 1.12-1.69, respectively). GDF-15 levels remained stable among participants randomized to liraglutide. CONCLUSIONS: An increase in GDF-15 over 30 days among patients in HFrEF was independently associated with an increased risk of cardiovascular events and declining exercise capacity. These results support the value of longitudinal GDF-15 trajectory in informing risk of heart failure disease progression."},{"id":"fbea7a3b3ece","type":"article","url":"https://hartvaat.nl/2021/08/01/geschiktheid-van-poliklinische-chronische-hf-patienten-voor-sglt2-remmers/","title":"Geschiktheid van poliklinische chronische HF-patiënten voor SGLT2-remmers","title_en":"Eligibility of outpatients with chronic heart failure for sodium-glucose co-transporter-2 inhibitors.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","chronische-nierziekte","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13380","source_url":"https://doi.org/10.1002/ehf2.13380","authors":["Gianmarco Angelini","Miriam Albanese","Raffaella Ursi","Francesco Lisi","Maria Consiglia Bellino","Luca Amato","Margherita Ilaria Gioia","Giuseppe Parisi","Natale Daniele Brunetti","Giuseppina Piazzolla","Marco Matteo Ciccone","Massimo Iacoviello"],"significance":6,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":[],"congress":"","summary_en":"This analysis estimated the proportion of outpatient chronic heart failure patients eligible for SGLT2 inhibitors based on trial criteria, identifying the implementation opportunity and potential treatment gap.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:27Z","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":"Analyse naar hoeveel poliklinische chronische HF-patiënten in aanmerking komen voor SGLT2-remmers.","abstract_original":"AIMS: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been shown to have a relevant role in the prevention of hospitalizations for heart failure and improvement in the life expectancy of patients with diabetes and outpatients with chronic heart failure (CHF) with reduced left ventricular ejection fraction, independently from the presence of type 2 diabetes mellitus (T2DM). The aim of our study was to evaluate in a real-world population the number of outpatients with CHF who meet the enrolment criteria of the main randomized controlled trials (RCT) published in the last 5 years and consequently identify the percentage of patients who could potential benefit from SGLT2i therapy. METHODS AND RESULTS: We retrospectively evaluated all consecutive outpatients referred for CHF. The diagnosis of T2DM was according to the latest European Society of Cardiology Guidelines. Clinical characteristics considered for the enrolment in the RCTs were recorded. We enrolled 515 patients, 384 (75%) of whom had a left ventricular ejection fraction (LVEF) ≤ 40%, 82 (16%) had pre-diabetes, and 187 (36%) had diabetes. Most of the patients with LVEF ≤ 40% met the criteria for the DAPA-HF trial (65%), and this percentage was even higher if the serum level of N-terminal pro-brain natriuretic peptide was not considered. A high percentage of patients with diabetes and LVEF > 40% met the criteria for the DECLARE (39%), CANVAS (47%), and EMPA-REG (30%) trials. Patients meeting the enrolment criteria of RCTs evaluating SGLT2i were also characterized by a high risk of heart failure events during follow-up. CONCLUSIONS: In spite of a low number of patients actually treated with SGLT2i, we observed that a high prevalence of patients with CHF met the clinical characteristics of RCTs that have demonstrated a beneficial effect of SGLT2i."},{"id":"5dfcefe023c2","type":"article","url":"https://hartvaat.nl/2021/08/01/polsgolfcalibratie-en-implicaties-voor-bloeddrukmeting-meta-analyse/","title":"Polsgolfcalibratie en implicaties voor bloeddrukmeting: meta-analyse","title_en":"Pulse Wave Calibration and Implications for Blood Pressure Measurement: Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16817","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16817","authors":["Dawid Jedrzejewski","Ewan McFarlane","Peter S Lacy","Bryan Williams"],"significance":5,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This meta-analysis evaluated pulse wave calibration methods and their implications for blood pressure measurement accuracy, addressing a fundamental technical issue that affects all non-invasive BP devices.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:26Z","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 naar polsgolfcalibratiemethoden en hun implicaties voor bloeddrukmeting.","abstract_original":"[Figure: see text]."},{"id":"028717bd92a4","type":"article","url":"https://hartvaat.nl/2021/08/01/echo-optimalisatie-van-lvad-en-functionele-capaciteit-gerandomiseerde-trial/","title":"Echo-optimalisatie van LVAD en functionele capaciteit: gerandomiseerde trial","title_en":"Effects of echo-optimization of left ventricular assist devices on functional capacity, a randomized controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13359","source_url":"https://doi.org/10.1002/ehf2.13359","authors":["Marzia Lilliu","Francesco Onorati","Giovanni Battista Luciani","Giuseppe Faggian"],"significance":5,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/inspanningstest-loopband-fiets/"],"congress":"","summary_en":"This randomized trial tested whether echo-guided optimization of LVAD pump parameters improves exercise capacity, evaluating individualized device programming for functional benefit in mechanically supported patients.","created":"2026-07-03T10:29:19Z","updated":"2026-07-03T13:28:26Z","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 trial naar het effect van echo-optimalisatie van LVAD-parameters op functionele capaciteit.","abstract_original":"AIMS: After the implantation of a left ventricular assist device (LVAD), many patients continue to experience exercise intolerance. VAFRACT trial evaluates the additional benefit of LVAD echo-guided optimization (EO) on functional capacity (FC), measured by cardiopulmonary exercise test (CPET), and quality of life (QoL). METHODS AND RESULTS: Twenty-seven patients were randomized in a 1:1 ratio to EO (EO group) vs. standard settings (CONTROL group) at least after 3 months from LVAD implant procedure. The optimal device speed was defined as the one that allows an intermittent aortic valve opening and a neutral position of the interventricular septum without increasing aortic or tricuspid regurgitation and preserving right ventricular function. The primary endpoint was peak oxygen uptake (VO2 peak) change after 3 months. Echo-guided optimization significantly improves VO2 peak (from 13.2 ± 2.5 to 14.2 ± 2.5 mL/kg/min; P < 0.001), oxygen pulse (from 9.75 ± 1.46 to 10.75 ± 2.2 mL; P < 0.001), CPET exercise time (from 490 ± 98 to 526 ± 116 s; P = 0.02), 6 min walk distance (from 363 ± 54 to 391 ± 52 m; P = 0.04), and QoL, using EuroQol Five Dimensions 3L (from 0.796 ± 0.1 to 0.85 ± 0.08; P < 0.001) and the Kansas City Cardiomyopathy Questionnaire (from 81.6 ± 6.9 to 84.6 ± 5.6; P = 0.025). CONCLUSIONS: Echo-guided optimization can significantly influence the FC and the QoL of LVAD patients. This procedure should represent a fundamental step in their clinical management, through the establishment of consolidated follow-up protocols. Our study may represent a starting point for a future, adequately powered clinical trial with a longer term follow-up."},{"id":"edb5530b1a75","type":"article","url":"https://hartvaat.nl/2021/08/01/klinische-fenotypen-zijn-effectiever-dan-ef-categorieen-voor-hf-uitkomsten/","title":"Klinische fenotypen zijn effectiever dan EF-categorieën voor HF-uitkomsten","title_en":"Clinical phenogroups are more effective than left ventricular ejection fraction categories in stratifying heart failure outcomes.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13344","source_url":"https://doi.org/10.1002/ehf2.13344","authors":["Andreas B Gevaert","Semra Tibebu","Mamas A Mamas","Neal G Ravindra","Shun Fu Lee","Tariq Ahmad","Dennis T Ko","James L Januzzi","Harriette G C Van Spall"],"significance":6,"published":"2021-08-01","source_date":"2021-08-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that data-driven clinical phenotype clusters stratify heart failure risk more effectively than traditional LVEF categories, supporting the move toward phenotype-based rather than EF-based classification.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T13:28:26Z","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 aantoont dat klinische fenotypeclusters effectiever zijn dan LVEF-categorieën voor het stratificeren van HF-uitkomsten.","abstract_original":"AIMS: Heart failure (HF) guidelines place patients into 3 discrete groups according to left ventricular ejection fraction (LVEF): reduced (<40%), mid-range (40-49%), and preserved LVEF (≥50%). We assessed whether clinical phenogroups offer better prognostication than LVEF. METHODS AND RESULTS: This was a sub-study of the Patient-Centered Care Transitions in HF trial. We analysed baseline characteristics of hospitalized patients in whom LVEF was recorded. We used unsupervised machine learning to identify clinical phenogroups and, thereafter, determined associations between phenogroups and outcomes. Primary outcome was the composite of all-cause death or rehospitalization at 6 and 12 months. Secondary outcome was the composite cardiovascular death or HF rehospitalization at 6 and 12 months. Cluster analysis of 1693 patients revealed six discrete phenogroups, each characterized by a predominant comorbidity: coronary heart disease, valvular heart disease, atrial fibrillation (AF), sleep apnoea, chronic obstructive pulmonary disease (COPD), or few comorbidities. Phenogroups were LVEF independent, with each phenogroup encompassing a wide range of LVEFs. For the primary composite outcome at 6 months, the hazard ratios (HRs) for phenogroups ranged from 1.25 [95% confidence interval (CI) 1.00-1.58 for AF] to 2.04 (95% CI 1.62-2.57 for COPD) (log-rank P < 0.001); and at 12 months, the HRs for phenogroups ranged from 1.15 (95% CI 0.94-1.41 for AF) to 1.87 (95% 1.52-3.20 for COPD) (P < 0.002). LVEF-based classifications did not separate patients into different risk categories for the primary outcomes at 6 months (P = 0.69) and 12 months (P = 0.30). Phenogroups also stratified risk of the secondary composite outcome at 6 and 12 months more effectively than LVEF. CONCLUSION: Among patients hospitalized for HF, clinical phenotypes generated by unsupervised machine learning provided greater prognostic information for a composite of clinical endpoints at 6 and 12 months compared with LVEF-based categories. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02112227."},{"id":"9674dc6c6de4","type":"article","url":"https://hartvaat.nl/2021/07/27/ziekenhuis-en-post-ontslagkwaliteitsinterventie-bij-hf-jama-connect-hf/","title":"Ziekenhuis- en post-ontslagkwaliteitsinterventie bij HF: JAMA CONNECT-HF","title_en":"Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["dapa-hf"],"journal":"JAMA","doi":"10.1001/jama.2021.8844","source_url":"https://doi.org/10.1001/jama.2021.8844","authors":["Adam D DeVore","Bradi B Granger","Gregg C Fonarow","Hussein R Al-Khalidi","Nancy M Albert","Eldrin F Lewis","Javed Butler","Ileana L Piña","Larry A Allen","Clyde W Yancy","Lauren B Cooper","G Michael Felker","Lisa A Kaltenbach","A Thomas McRae","David E Lanfear","Robert W Harrison","Maghee Disch","Dan Ariely","Julie M Miller","Christopher B Granger","Adrian F Hernandez"],"significance":7,"published":"2021-07-27","source_date":"2021-07-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The CONNECT-HF trial showed that a hospital and post-discharge quality improvement intervention did not significantly reduce mortality or heart failure rehospitalization, highlighting the challenges of translating guideline adherence into outcome improvement.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T13:28:26Z","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 CONNECT-HF trial naar het effect van een kwaliteitsverbeteringsinterventie op uitkomsten en kwaliteit bij hartfalen.","abstract_original":"IMPORTANCE: Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care. OBJECTIVE: To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020. INTERVENTIONS: Hospitals (n = 82) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n = 79) randomized to usual care received access to a generalized heart failure education website. MAIN OUTCOMES AND MEASURES: The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed). RESULTS: Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs -1.0% (difference, 3.3% [95% CI, -0.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]). CONCLUSIONS AND RELEVANCE: Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03035474."},{"id":"c4f0f9675862","type":"article","url":"https://hartvaat.nl/2021/07/27/heeft-deze-volwassene-hypertensie-jama-rational-clinical-examination/","title":"Heeft deze volwassene hypertensie? JAMA Rational Clinical Examination","title_en":"Does This Adult Patient Have Hypertension?: The Rational Clinical Examination Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.4533","source_url":"https://doi.org/10.1001/jama.2021.4533","authors":["Anthony J Viera","Yuichiro Yano","Feng-Chang Lin","David L Simel","Jonathan Yun","Gaurav Dave","Ann Von Holle","Laura A Viera","Daichi Shimbo","Shakia T Hardy","Katrina E Donahue","Alan Hinderliter","Christiane E Voisin","Daniel E Jonas"],"significance":7,"published":"2021-07-27","source_date":"2021-07-27","image":"","kennis":[],"congress":"","summary_en":"This JAMA Rational Clinical Examination review addressed how to diagnose hypertension in adults, comparing office, home, and ambulatory blood pressure measurement methods and their diagnostic accuracy.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T18:38:49Z","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 Rational Clinical Examination systematische review over de diagnose van hypertensie bij volwassenen.","abstract_original":"IMPORTANCE: Office blood pressure (BP) measurements are not the most accurate method to diagnose hypertension. Home BP monitoring (HBPM) and 24-hour ambulatory BP monitoring (ABPM) are out-of-office alternatives, and ABPM is considered the reference standard for BP assessment. OBJECTIVE: To systematically review the accuracy of oscillometric office and home BP measurement methods for correctly classifying adults as having hypertension, defined using ABPM. DATA SOURCES: PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and DARE databases and the American Heart Association website (from inception to April 2021) were searched, along with reference lists from retrieved articles. DATA EXTRACTION AND SYNTHESIS: Two authors independently abstracted raw data and assessed methodological quality. A third author resolved disputes as needed. MAIN OUTCOMES AND MEASURES: Random effects summary sensitivity, specificity, and likelihood ratios (LRs) were calculated for BP measurement methods for the diagnosis of hypertension. ABPM (24-hour mean BP ≥130/80 mm Hg or mean BP while awake ≥135/85 mm Hg) was considered the reference standard. RESULTS: A total of 12 cross-sectional studies (n = 6877) that compared conventional oscillometric office BP measurements to mean BP during 24-hour ABPM and 6 studies (n = 2049) that compared mean BP on HBPM to mean BP during 24-hour ABPM were included (range, 117-2209 participants per analysis); 2 of these studies (n = 3040) used consecutive samples. The overall prevalence of hypertension identified by 24-hour ABPM was 49% (95% CI, 39%-60%) in the pooled studies that evaluated office measures and 54% (95% CI, 39%-69%) in studies that evaluated HBPM. All included studies assessed sensitivity and specificity at the office BP threshold of 140/90 mm Hg and the home BP threshold of 135/85 mm Hg. Conventional office oscillometric measurement (1-5 measurements in a single visit with BP ≥140/90 mm Hg) had a sensitivity of 51% (95% CI, 36%-67%), specificity of 88% (95% CI, 80%-96%), positive LR of 4.2 (95% CI, 2.5-6.0), and negative LR of 0.56 (95% CI, 0.42-0.69). Mean BP with HBPM (with BP ≥135/85 mm Hg) had a sensitivity of 75% (95% CI, 65%-86%), specificity of 76% (95% CI, 65%-86%), positive LR of 3.1 (95% CI, 2.2-4.0), and negative LR of 0.33 (95% CI, 0.20-0.47). Two studies (1 with a consecutive sample) that compared unattended automated mean office BP (with BP ≥135/85 mm Hg) with 24-hour ABPM had sensitivity ranging from 48% to 51% and specificity ranging from 80% to 91%. One study that compared attended automated mean office BP (with BP ≥140/90 mm Hg) with 24-hour ABPM had a sensitivity of 87.6% (95% CI, 83%-92%) and specificity of 24.1% (95% CI, 16%-32%). CONCLUSIONS AND RELEVANCE: Office measurements of BP may not be accurate enough to rule in or rule out hypertension; HBPM may be helpful to confirm a diagnosis. When there is uncertainty around threshold values or when office and HBPM are not in agreement, 24-hour ABPM should be considered to establish the diagnosis."},{"id":"f9140c90b2ac","type":"article","url":"https://hartvaat.nl/2021/07/22/multivaten-pci-geleid-door-ffr-of-angiografie-bij-mi-nejm-flower-mi/","title":"Multivaten-PCI geleid door FFR of angiografie bij MI: NEJM FLOWER-MI","title_en":"Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2104650","source_url":"https://doi.org/10.1056/NEJMoa2104650","authors":["Etienne Puymirat","Guillaume Cayla","Tabassome Simon","Philippe G Steg","Gilles Montalescot","Isabelle Durand-Zaleski","Alicia le Bras","Romain Gallet","Khalife Khalife","Jean-François Morelle","Pascal Motreff","Gilles Lemesle","Jean-Guillaume Dillinger","Thibault Lhermusier","Johanne Silvain","Vincent Roule","Jean-Noel Labèque","Grégoire Rangé","Grégory Ducrocq","Yves Cottin","Didier Blanchard","Anaïs Charles Nelson","Bernard De Bruyne","Gilles Chatellier","Nicolas Danchin"],"significance":9,"published":"2021-07-22","source_date":"2021-07-22","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The FLOWER-MI trial showed that FFR-guided complete revascularization of nonculprit lesions did not reduce the composite of death, MI, or urgent revascularization compared with angiography-guided PCI in patients with STEMI and multivessel disease. The surprising negative result questioned the added value of FFR guidance in the acute MI setting.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T13:28:26Z","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":"NEJM FLOWER-MI trial die FFR-geleide multivaten-PCI vergeleek met angiografie-geleide PCI bij MI. Geen voordeel van FFR — verrassend na COMPARE-ACUTE.","abstract_original":"BACKGROUND: In patients with ST-elevation myocardial infarction (STEMI) who have multivessel disease, percutaneous coronary intervention (PCI) for nonculprit lesions (complete revascularization) is superior to treatment of the culprit lesion alone. However, whether complete revascularization that is guided by fractional flow reserve (FFR) is superior to an angiography-guided procedure is unclear. METHODS: In this multicenter trial, we randomly assigned patients with STEMI and multivessel disease who had undergone successful PCI of the infarct-related artery to receive complete revascularization guided by either FFR or angiography. The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, or unplanned hospitalization leading to urgent revascularization at 1 year. RESULTS: The mean (±SD) number of stents that were placed per patient for nonculprit lesions was 1.01±0.99 in the FFR-guided group and 1.50±0.86 in the angiography-guided group. During follow-up, a primary outcome event occurred in 32 of 586 patients (5.5%) in the FFR-guided group and in 24 of 577 patients (4.2%) in the angiography-guided group (hazard ratio, 1.32; 95% confidence interval, 0.78 to 2.23; P = 0.31). Death occurred in 9 patients (1.5%) in the FFR-guided group and in 10 (1.7%) in the angiography-guided group; nonfatal myocardial infarction in 18 (3.1%) and 10 (1.7%), respectively; and unplanned hospitalization leading to urgent revascularization in 15 (2.6%) and 11 (1.9%), respectively. CONCLUSIONS: In patients with STEMI undergoing complete revascularization, an FFR-guided strategy did not have a significant benefit over an angiography-guided strategy with respect to the risk of death, myocardial infarction, or urgent revascularization at 1 year. However, given the wide confidence intervals for the estimate of effect, the findings do not allow for a conclusive interpretation. (Funded by the French Ministry of Health and Abbott; FLOWER-MI ClinicalTrials.gov number, NCT02943954.)."},{"id":"331b48451b16","type":"article","url":"https://hartvaat.nl/2021/07/21/laaggedoseerd-colchicine-bij-coronairlijden-meta-analyse-van-gerandomiseerde-tri/","title":"Laaggedoseerd colchicine bij coronairlijden: meta-analyse van gerandomiseerde trials","title_en":"Efficacy and safety of low-dose colchicine in patients with coronary disease: a systematic review and meta-analysis of randomized trials.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","internist"],"tags":["colchicine","colcot-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab115","source_url":"https://doi.org/10.1093/eurheartj/ehab115","authors":["Aernoud T L Fiolet","Tjerk S J Opstal","Arend Mosterd","John W Eikelboom","Sanjit S Jolly","Anthony C Keech","Peter Kelly","David C Tong","Jamie Layland","Stefan M Nidorf","Peter L Thompson","Charley Budgeon","Jan G P Tijssen","Jan H Cornel"],"significance":8,"published":"2021-07-21","source_date":"2021-07-21","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This meta-analysis of colchicine trials in coronary disease confirmed that low-dose colchicine reduces cardiovascular events with an acceptable safety profile, integrating COLCOT, LoDoCo2, and COPS data. The pooled evidence supported colchicine as a cost-effective anti-inflammatory strategy.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T13:28:26Z","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 van werkzaamheid en veiligheid van laaggedoseerd colchicine bij coronairlijden. Integreert COLCOT, LoDoCo2 en COPS.","abstract_original":"AIMS: Recent randomized trials demonstrated a benefit of low-dose colchicine added to guideline-based treatment in patients with recent myocardial infarction or chronic coronary disease. We performed a systematic review and meta-analysis to obtain best estimates of the effects of colchicine on major adverse cardiovascular events (MACE). METHODS AND RESULTS: We searched the literature for randomized clinical trials of long-term colchicine in patients with atherosclerosis published up to 1 September 2020. The primary efficacy endpoint was MACE, the composite of myocardial infarction, stroke, or cardiovascular death. We combined the results of five trials that included 11 816 patients. The primary endpoint occurred in 578 patients. Colchicine reduced the risk for the primary endpoint by 25% [relative risk (RR) 0.75, 95% confidence interval (CI) 0.61-0.92; P = 0.005], myocardial infarction by 22% (RR 0.78, 95% CI 0.64-0.94; P = 0.010), stroke by 46% (RR 0.54, 95% CI 0.34-0.86; P = 0.009), and coronary revascularization by 23% (RR 0.77, 95% CI 0.66-0.90; P < 0.001). We observed no difference in all-cause death (RR 1.08, 95% CI 0.71-1.62; P = 0.73), with a lower incidence of cardiovascular death (RR 0.82, 95% CI 0.55-1.23; P = 0.34) counterbalanced by a higher incidence of non-cardiovascular death (RR 1.38, 95% CI 0.99-1.92; P = 0.060). CONCLUSION: Our meta-analysis indicates that low-dose colchicine reduced the risk of MACE as well as that of myocardial infarction, stroke, and the need for coronary revascularization in a broad spectrum of patients with coronary disease. There was no difference in all-cause mortality and fewer cardiovascular deaths were counterbalanced by more non-cardiovascular deaths."},{"id":"0ad936dc6146","type":"article","url":"https://hartvaat.nl/2021/07/18/smartphone-ecg-voor-af-detectie-na-cerebrovasculair-event-multicenter-rct/","title":"Smartphone-ECG voor AF-detectie na cerebrovasculair event: multicenter RCT","title_en":"Smartphone electrocardiogram for detecting atrial fibrillation after a cerebral ischaemic event: a multicentre randomized controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["digitale-gezondheid"],"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/euab036","source_url":"https://doi.org/10.1093/europace/euab036","authors":["Keng Tat Koh","Wan Chung Law","Win Moe Zaw","Diana Hui Ping Foo","Chen Ting Tan","Anderson Steven","Desmond Samuel","Tem Lom Fam","Ching Hua Chai","Zhai Sing Wong","Sivaraj Xaviar","Chandan Deepak Bhavnani","Jason Seng Hong Tan","Yen Yee Oon","Asri Said","Alan Yean Yip Fong","Tiong Kiam Ong"],"significance":7,"published":"2021-07-18","source_date":"2021-07-18","image":"","kennis":[],"congress":"","summary_en":"This multicenter randomized trial evaluated smartphone-based ECG for AF detection after cerebral ischemic events, exploring consumer technology as a scalable post-stroke monitoring strategy.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T13:28:26Z","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":"Multicenter gerandomiseerde trial die smartphone-ECG evalueerde voor AF-detectie na een cerebrovasculair event.","abstract_original":"AIMS: Atrial fibrillation (AF) is a preventable cause of ischaemic stroke but it is often undiagnosed and undertreated. The utility of smartphone electrocardiogram (ECG) for the detection of AF after ischaemic stroke is unknown. The aim of this study is to determine the diagnostic yield of 30-day smartphone ECG recording compared with 24-h Holter monitoring for detecting AF ≥30 s. METHODS AND RESULTS: In this multicentre, open-label study, we randomly assigned 203 participants to undergo one additional 24-h Holter monitoring (control group, n = 98) vs. 30-day smartphone ECG monitoring (intervention group, n = 105) using KardiaMobile (AliveCor®, Mountain View, CA, USA). Major inclusion criteria included age ≥55 years old, without known AF, and ischaemic stroke or transient ischaemic attack (TIA) within the preceding 12 months. Baseline characteristics were similar between the two groups. The index event was ischaemic stroke in 88.5% in the intervention group and 88.8% in the control group (P = 0.852). AF lasting ≥30 s was detected in 10 of 105 patients in the intervention group and 2 of 98 patients in the control group (9.5% vs. 2.0%; absolute difference 7.5%; P = 0.024). The number needed to screen to detect one AF was 13. After the 30-day smartphone monitoring, there was a significantly higher proportion of patients on oral anticoagulation therapy at 3 months compared with baseline in the intervention group (9.5% vs. 0%, P = 0.002). CONCLUSIONS: Among patients ≥55 years of age with a recent cryptogenic stroke or TIA, 30-day smartphone ECG recording significantly improved the detection of AF when compared with the standard repeat 24-h Holter monitoring."},{"id":"87b2e9906a2c","type":"article","url":"https://hartvaat.nl/2021/07/18/cryoballonablatie-versus-antiaritmica-als-eerstelijns-paf-therapie/","title":"Cryoballonablatie versus antiaritmica als eerstelijns PAF-therapie","title_en":"Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal 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/euab029","source_url":"https://doi.org/10.1093/europace/euab029","authors":["Malte Kuniss","Nikola Pavlovic","Vedran Velagic","Jean Sylvain Hermida","Stewart Healey","Giuseppe Arena","Nicolas Badenco","Christian Meyer","Jian Chen","Saverio Iacopino","Frédéric Anselme","Douglas L Packer","Heinz-Friedrich Pitschner","Carlo de Asmundis","Stephan Willems","Fabio Di Piazza","Daniel Becker","Gian-Battista Chierchia"],"significance":6,"published":"2021-07-18","source_date":"2021-07-18","image":"","kennis":[],"congress":"","summary_en":"This study compared cryoballoon ablation with antiarrhythmic drugs as first-line therapy for paroxysmal AF, providing additional evidence for the ablation-first approach as the initial treatment strategy.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T13:28:26Z","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":"Vergelijking van cryoballonablatie versus antiaritmische medicatie als eerstelijns therapie voor paroxysmaal AF.","abstract_original":"AIMS: Treatment guidelines for patients with atrial fibrillation (AF) suggest that patients should be managed with an antiarrhythmic drug (AAD) before undergoing catheter ablation (CA). This study evaluated whether pulmonary vein isolation employing cryoballoon CA is superior to AAD therapy for the prevention of atrial arrhythmia (AA) recurrence in rhythm control naive patients with paroxysmal AF (PAF). METHODS AND RESULTS: A total of 218 treatment naive patients with symptomatic PAF were randomized (1 : 1) to cryoballoon CA (Arctic Front Advance, Medtronic) or AAD (Class I or III) and followed for 12 months. The primary endpoint was ≥1 episode of recurrent AA (AF, atrial flutter, or atrial tachycardia) >30 s after a prespecified 90-day blanking period. Secondary endpoints included the rate of serious adverse events (SAEs) and recurrence of symptomatic palpitations (evaluated via patient diaries). Freedom from AA was achieved in 82.2% of subjects in the cryoballoon arm and 67.6% of subjects in the AAD arm (HR = 0.48, P = 0.01). There were no group differences in the time-to-first (HR = 0.76, P = 0.28) or overall incidence [incidence rate ratio (IRR)=0.79, P = 0.28] of SAEs. The incidence rate of symptomatic palpitations was lower in the cryoballoon (7.61 days/year) compared with the AAD arm (18.96 days/year; IRR = 0.40, P < 0.001). CONCLUSIONS: Cryoballoon CA was superior to AAD therapy, significantly reducing AA recurrence in treatment naive patients with PAF. Additionally, cryoballoon CA was associated with lower symptom recurrence and a similar rate of SAEs compared with AAD therapy."},{"id":"421a59f212ee","type":"article","url":"https://hartvaat.nl/2021/07/18/letselrisico-bij-vasovagale-syncope-systematische-review-en-meta-analyse/","title":"Letselrisico bij vasovagale syncope: systematische review en meta-analyse","title_en":"Likelihood of injury due to vasovagal syncope: a systematic review and meta-analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["syncope"],"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/euab041","source_url":"https://doi.org/10.1093/europace/euab041","authors":["Juliana G Jorge","Satish R Raj","Pedro S Teixeira","Jose A C Teixeira","Robert S Sheldon"],"significance":5,"published":"2021-07-18","source_date":"2021-07-18","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis quantified the likelihood of injury due to vasovagal syncope, showing that physical injuries are more common than previously recognized, challenging the perception of VVS as uniformly benign.","created":"2026-07-03T10:29:18Z","updated":"2026-07-03T13:28:25Z","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":"Meta-analyse naar het letselrisico bij vasovagale syncope.","abstract_original":"AIMS: Vasovagal syncope (VVS) is the most common type of syncope and is usually considered a benign disorder. The potential for injury is worrisome but the likelihood is unknown. We aimed to determine the proportion of patients injured due to VVS. METHODS AND RESULTS: A systematic search of studies published until August 2020 was performed in multiple medical and nursing databases. Included studies had data on the proportion of patients with injury due to VVS prior to study enrolment. Random effects methods were used. Twenty-three studies having 3593 patients met inclusion criteria. Patients were diagnosed clinically with VVS, and 82% had >2 syncopal episodes before enrolment. Tilt test was positive in 60% and 14 studies reported comorbidities (32.6% hypertensive). The weighted mean injury rate was 33.5% [95% confidence interval (CI): 27.3-40.5%]. The likelihood of injury correlated with population age (r = 0.4, P = 0.05), but not with sex, positive tilt test, or hypertension. The injury rates were 25.7% (95% CI: 19.1-32.8%) in studies with younger patients (mean age ≤50 years, n = 1803) and 43.4% (95% CI: 34.9-52.3%) in studies with older patients (P = 0.002). Nine studies reported major injuries; with a weighted mean rate of major injuries of 13.9% (95% CI: 9.5-19.8%). CONCLUSION: Injuries due to syncope are frequent, occurring in 33% of patients with VVS. The risk of major injuries is substantial. Older patients are at higher risk. Clinicians should be aware of the risk of injuries when providing care and advice to patients with VVS."},{"id":"4e82842c6bea","type":"article","url":"https://hartvaat.nl/2021/07/18/procedurevolume-en-complicaties-bij-af-ablatie-meta-analyse/","title":"Procedurevolume en complicaties bij AF-ablatie: meta-analyse","title_en":"Relationship between procedural volume and complication rates for catheter ablation of 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/euaa415","source_url":"https://doi.org/10.1093/europace/euaa415","authors":["Ivaylo R Tonchev","Michael Chi Yuan Nam","Alexandra Gorelik","Saurabh Kumar","Haris Haqqani","Prashanthan Sanders","Peter M Kistler","Jonathan M Kalman"],"significance":6,"published":"2021-07-18","source_date":"2021-07-18","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that higher procedural volume for AF catheter ablation is associated with lower complication rates, supporting centralization of complex electrophysiology procedures in experienced centers.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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":"Meta-analyse naar de relatie tussen procedurevolume en complicatiepercentages bij AF-ablatie.","abstract_original":"AIMS: There are conflicting data as to the impact of procedural volume on outcomes with specific reference to the incidence of major complications after catheter ablation for atrial fibrillation. Questions regarding minimum volume requirements and whether these should be per centre or per operator remain unclear. Studies have reported divergent results. We performed a systematic review and meta-analysis of studies reporting the relationship between either operator or hospital atrial fibrillation (AF) ablation volumes and incidence of complications. METHODS AND RESULTS: Databases were searched for studies describing the relationship between operator or hospital AF ablation volumes and incidence of complications which were published prior to 12 June 2020. Of 1593 articles identified, 14 (315 120 patients) were included in the meta-analysis. Almost two-thirds of the procedures were performed in low-volume centres. Both hospital volume of ≥50 and ≥100 procedures/year were associated with a significantly lower incidence of complications compared to <50/year (4.2% vs. 5.5%, OR = 0.58, 95% CI 0.50-0.66, P < 0.001) or <100/year (5.5% vs. 6.2%, OR = 0.62, 95% CI 0.53-0.73, P < 0.001), respectively. Hospitals performing ≥50 procedures/year demonstrated significantly lower mortality compared with those performing <50 procedures/year (0.16% vs. 0.55%, OR = 0.33, 95% CI 0.26-0.43, P < 0.001). A similar relationship existed between proceduralist volume of <50/year and incidence of complications [3.75% vs. 12.73%, P < 0.001; OR = 0.27 (0.23-0.32)]. CONCLUSION: There is an inverse relationship between both hospital and proceduralist AF ablation volume and the incidence of complications. Implementation of minimum hospital and operator AF ablation volume standards should be considered in the context of a broader strategy to identify AF ablation Centers of Excellence."},{"id":"7e07a5ddc829","type":"article","url":"https://hartvaat.nl/2021/07/15/ultradunne-versus-conventionele-2e-generatie-des-langetermijn-meta-analyse/","title":"Ultradunne versus conventionele 2e-generatie DES: langetermijn meta-analyse","title_en":"Long-term follow-up after ultrathin vs. conventional 2nd-generation drug-eluting stents: a systematic review and meta-analysis of randomized controlled trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab280","source_url":"https://doi.org/10.1093/eurheartj/ehab280","authors":["Mahesh V Madhavan","James P Howard","Azim Naqvi","Ori Ben-Yehuda","Bjorn Redfors","Megha Prasad","Bahira Shahim","Martin B Leon","Sripal Bangalore","Gregg W Stone","Yousif Ahmad"],"significance":6,"published":"2021-07-15","source_date":"2021-07-15","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of long-term follow-up data confirmed that ultrathin-strut DES provide improved safety outcomes compared with conventional second-generation stents, supporting the continued evolution toward thinner coronary device platforms.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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":"Meta-analyse van langetermijnfollow-up van ultradunne versus conventionele tweede-generatie DES.","abstract_original":"AIMS: Contemporary 2nd-generation thin-strut drug-eluting stents (DES) are considered standard of care for revascularization of patients undergoing percutaneous coronary intervention. A previous meta-analysis of 10 randomized controlled trials (RCTs) with 11 658 patients demonstrated a 16% reduction in the 1-year risk of target lesion failure (TLF) with ultrathin-strut DES compared with conventional 2nd-generation thin-strut DES. Whether this benefit is sustained longer term is not known, and newer trial data may inform these relative outcomes. We therefore sought to perform an updated systematic review and meta-analysis of RCTs comparing clinical outcomes with ultrathin-strut DES (≤70 µm strut thickness) with conventional 2nd-generation thin-strut DES. METHODS AND RESULTS: We performed a random-effects meta-analysis of all RCTs comparing ultrathin-strut DES to conventional 2nd-generation thin-strut DES. The pre-specified primary endpoint was long-term TLF, a composite of cardiac death, myocardial infarction (MI), or clinically driven target lesion revascularization (CD-TLR). Secondary endpoints included the components of TLF, stent thrombosis (ST), and all-cause death. There were 16 eligible trials in which 20 701 patients were randomized. The weighted mean follow-up duration was 2.5 years. Ultrathin-strut DES were associated with a 15% reduction in long-term TLF compared with conventional 2nd-generation thin-strut DES [relative risk (RR) 0.85, 95% confidence interval (CI) 0.76-0.96, P = 0.008] driven by a 25% reduction in CD-TLR (RR 0.75, 95% CI 0.62-0.92, P = 0.005). There were no significant differences between stent types in the risks of MI, ST, cardiac death, or all-cause mortality. CONCLUSIONS: At a mean follow-up of 2.5 years, ultrathin-strut DES reduced the risk of TLF, driven by less CD-TLR compared with conventional 2nd-generation thin-strut DES, with similar risks of MI, ST, cardiac death, and all-cause mortality."},{"id":"c271c0e63af2","type":"article","url":"https://hartvaat.nl/2021/07/15/fysieke-revalidatie-bij-oudere-gehospitaliseerde-hf-patienten-nejm-rehab-hf/","title":"Fysieke revalidatie bij oudere gehospitaliseerde HF-patiënten: NEJM REHAB-HF","title_en":"Physical Rehabilitation for Older Patients Hospitalized for Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["hartrevalidatie","step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2026141","source_url":"https://doi.org/10.1056/NEJMoa2026141","authors":["Dalane W Kitzman","David J Whellan","Pamela Duncan","Amy M Pastva","Robert J Mentz","Gordon R Reeves","M Benjamin Nelson","Haiying Chen","Bharathi Upadhya","Shelby D Reed","Mark A Espeland","LeighAnn Hewston","Christopher M O'Connor"],"significance":8,"published":"2021-07-15","source_date":"2021-07-15","image":"","kennis":[],"congress":"","summary_en":"The REHAB-HF trial showed that a tailored physical rehabilitation intervention improved physical function and frailty in older patients hospitalized for acute heart failure, though it did not significantly reduce rehospitalization or death. The functional benefit supports rehabilitation in elderly heart failure patients.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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":"NEJM REHAB-HF trial die fysieke revalidatie onderzocht bij oudere patiënten gehospitaliseerd voor hartfalen. Functioneel voordeel maar geen CV-eventreductie.","abstract_original":"BACKGROUND: Older patients who are hospitalized for acute decompensated heart failure have high rates of physical frailty, poor quality of life, delayed recovery, and frequent rehospitalizations. Interventions to address physical frailty in this population are not well established. METHODS: We conducted a multicenter, randomized, controlled trial to evaluate a transitional, tailored, progressive rehabilitation intervention that included four physical-function domains (strength, balance, mobility, and endurance). The intervention was initiated during, or early after, hospitalization for heart failure and was continued after discharge for 36 outpatient sessions. The primary outcome was the score on the Short Physical Performance Battery (total scores range from 0 to 12, with lower scores indicating more severe physical dysfunction) at 3 months. The secondary outcome was the 6-month rate of rehospitalization for any cause. RESULTS: A total of 349 patients underwent randomization; 175 were assigned to the rehabilitation intervention and 174 to usual care (control). At baseline, patients in each group had markedly impaired physical function, and 97% were frail or prefrail; the mean number of coexisting conditions was five in each group. Patient retention in the intervention group was 82%, and adherence to the intervention sessions was 67%. After adjustment for baseline Short Physical Performance Battery score and other baseline characteristics, the least-squares mean (±SE) score on the Short Physical Performance Battery at 3 months was 8.3±0.2 in the intervention group and 6.9±0.2 in the control group (mean between-group difference, 1.5; 95% confidence interval [CI], 0.9 to 2.0; P<0.001). At 6 months, the rates of rehospitalization for any cause were 1.18 in the intervention group and 1.28 in the control group (rate ratio, 0.93; 95% CI, 0.66 to 1.19). There were 21 deaths (15 from cardiovascular causes) in the intervention group and 16 deaths (8 from cardiovascular causes) in the control group. The rates of death from any cause were 0.13 and 0.10, respectively (rate ratio, 1.17; 95% CI, 0.61 to 2.27). CONCLUSIONS: In a diverse population of older patients who were hospitalized for acute decompensated heart failure, an early, transitional, tailored, progressive rehabilitation intervention that included multiple physical-function domains resulted in greater improvement in physical function than usual care. (Funded by the National Institutes of Health and others; REHAB-HF ClinicalTrials.gov number, NCT02196038.)."},{"id":"db26331f6cf5","type":"article","url":"https://hartvaat.nl/2021/07/13/ablatie-versus-medicatie-bij-af-naar-ras-en-etniciteit/","title":"Ablatie versus medicatie bij AF naar ras en etniciteit","title_en":"Ablation Versus Drug Therapy for Atrial Fibrillation in Racial and Ethnic Minorities.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.092","source_url":"https://doi.org/10.1016/j.jacc.2021.04.092","authors":["Kevin L Thomas","Hussein R Al-Khalidi","Adam P Silverstein","Kristi H Monahan","Tristram D Bahnson","Jeanne E Poole","Daniel B Mark","Douglas L Packer"],"significance":5,"published":"2021-07-13","source_date":"2021-07-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This study showed that racial and ethnic minorities with AF have similar outcomes from catheter ablation as White patients, supporting equitable access to rhythm control procedures across diverse populations.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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 naar raciale en etnische verschillen in uitkomsten van AF-ablatie versus medicamenteuze therapie.","abstract_original":"BACKGROUND: Rhythm control strategies for atrial fibrillation (AF), including catheter ablation, are substantially underused in racial/ethnic minorities in North America. OBJECTIVES: This study sought to describe outcomes in the CABANA trial as a function of race/ethnicity. METHODS: CABANA randomized 2,204 symptomatic participants with AF to ablation or drug therapy including rate and/or rhythm control drugs. Only participants in North America were included in the present analysis, and participants were subgrouped as racial/ethnic minority or nonminority with the use of National Institutes of Health definitions. The primary endpoint was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. RESULTS: Of 1,280 participants enrolled in CABANA in North America, 127 (9.9%) were racial and ethnic minorities. Compared with nonminorities, racial and ethnic minorities were younger with median age 65.6 versus 68.5 years, respectively, and had more symptomatic heart failure (37.0% vs 22.0%), hypertension (92.1% vs 76.8%, respectively), and ejection fraction <40% (20.8% vs 7.1%). Racial/ethnic minorities treated with ablation had a 68% relative reduction in the primary endpoint (adjusted hazard ratio [aHR]: 0.32; 95% confidence interval [CI]: 0.13-0.78) and a 72% relative reduction in all-cause mortality (aHR: 0.28; 95% CI: 0.10-0.79). Primary event rates in racial/ethnic minority and nonminority participants were similar in the ablation arm (4-year Kaplan-Meier event rates 12.3% vs 9.9%); however, racial and ethnic minorities randomized to drug therapy had a much higher event rate than nonminority participants (27.4% vs. 9.4%). CONCLUSION: Among racial or ethnic minorities enrolled in the North American CABANA cohort, catheter ablation significantly improved major clinical outcomes compared with drug therapy. These benefits, which were not seen in nonminority participants, appear to be due to worse outcomes with drug therapy. (Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation Trial [CABANA]; NCT00911508)."},{"id":"73ce03cd3fea","type":"article","url":"https://hartvaat.nl/2021/07/13/finerenon-vermindert-nieuw-onset-af-bij-ckd-met-diabetes-fidelio-dkd/","title":"Finerenon vermindert nieuw-onset AF bij CKD met diabetes: FIDELIO-DKD","title_en":"Finerenone Reduces New-Onset Atrial Fibrillation in Patients With Chronic Kidney Disease and Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["anemie-ckd","cardiorenal-behandelstrategie","chronische-nierziekte","diabetes-en-hart","diabetische-nefropathie","fidelio-dkd","figaro-dkd","finerenon","ijzertekort"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.079","source_url":"https://doi.org/10.1016/j.jacc.2021.04.079","authors":["Gerasimos Filippatos","George L Bakris","Bertram Pitt","Rajiv Agarwal","Peter Rossing","Luis M Ruilope","Javed Butler","Carolyn S P Lam","Peter Kolkhof","Luke Roberts","Christoph Tasto","Amer Joseph","Stefan D Anker"],"significance":7,"published":"2021-07-13","source_date":"2021-07-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This FIDELIO-DKD analysis showed that finerenone reduces new-onset atrial fibrillation in patients with CKD and type 2 diabetes, revealing an unexpected antiarrhythmic benefit of nonsteroidal mineralocorticoid receptor antagonism.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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":"FIDELIO-DKD analyse die aantoont dat finerenon nieuw-onset AF vermindert bij CKD-patiënten met diabetes. Verrassend anti-aritmisch voordeel.","abstract_original":"BACKGROUND: Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) are at risk of atrial fibrillation or flutter (AFF) due to cardiac remodeling and kidney complications. Finerenone, a novel, selective, nonsteroidal mineralocorticoid receptor antagonist, inhibited cardiac remodeling in preclinical models. OBJECTIVES: This work aims to examine the effect of finerenone on new-onset AFF and cardiorenal effects by history of AFF in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) study. METHODS: Patients with CKD and T2D were randomized (1:1) to finerenone or placebo. Eligible patients had a urine albumin-to-creatinine ratio ≥30 to ≤5,000 mg/g, an estimated glomerular filtration rate (eGFR) ≥25 to <75 ml/min/1.73 m2 and received optimized doses of renin-angiotensin system blockade. Effect on new-onset AFF was evaluated as a pre-specified outcome adjudicated by an independent cardiologist committee. The primary composite outcome (time to first onset of kidney failure, a sustained decrease of ≥40% in eGFR from baseline, or death from renal causes) and key secondary outcome (time to first onset of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) were analyzed by history of AFF. RESULTS: Of 5,674 patients, 461 (8.1%) had a history of AFF. New-onset AFF occurred in 82 (3.2%) patients on finerenone and 117 (4.5%) patients on placebo (hazard ratio: 0.71; 95% confidence interval: 0.53-0.94; p = 0.016). The effect of finerenone on primary and key secondary kidney and cardiovascular outcomes was not significantly impacted by baseline AFF (interaction p value: 0.16 and 0.85, respectively). CONCLUSIONS: In patients with CKD and T2D, finerenone reduced the risk of new-onset AFF. The risk of kidney or cardiovascular events was reduced irrespective of history of AFF at baseline. (EudraCT 2015-000990-11 [A randomized, double-blind, placebo-controlled, parallel-group, multicenter, event-driven Phase III study to investigate the efficacy and safety of finerenone, in addition to standard of care, on the progression of kidney disease in subjects with type 2 diabetes mellitus and the clinical diagnosis of diabetic kidney disease]; Efficacy and Safety of Finerenone in Subjects With Type 2 Diabetes Mellitus and Diabetic Kidney Disease [FIDELIO-DKD]; NCT02540993)."},{"id":"d04b7066708c","type":"article","url":"https://hartvaat.nl/2021/07/13/ef-en-uitkomsten-bij-omecamtiv-mecarbil-galactic-hf/","title":"EF en uitkomsten bij omecamtiv mecarbil: GALACTIC-HF","title_en":"Effect of Ejection Fraction on Clinical Outcomes in Patients Treated With Omecamtiv Mecarbil in GALACTIC-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.065","source_url":"https://doi.org/10.1016/j.jacc.2021.04.065","authors":["John R Teerlink","Rafael Diaz","G Michael Felker","John J V McMurray","Marco Metra","Scott D Solomon","Tor Biering-Sørensen","Michael Böhm","Diana Bonderman","James C Fang","David E Lanfear","Mayanna Lund","Shin-Ichi Momomura","Eileen O'Meara","Piotr Ponikowski","Jindrich Spinar","Jose H Flores-Arredondo","Brian L Claggett","Stephen B Heitner","Stuart Kupfer","Siddique A Abbasi","Fady I Malik"],"significance":6,"published":"2021-07-13","source_date":"2021-07-13","image":"","kennis":[],"congress":"","summary_en":"This GALACTIC-HF analysis showed that omecamtiv mecarbil provides greater benefit in patients with lower ejection fractions, suggesting that the cardiac myosin activator is most effective in those with the most severely impaired contractility.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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":"GALACTIC-HF analyse naar het effect van ejectiefractie op klinische uitkomsten met omecamtiv mecarbil.","abstract_original":"BACKGROUND: In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure) (n = 8,256), the cardiac myosin activator, omecamtiv mecarbil, significantly reduced the primary composite endpoint (PCE) of time-to-first heart failure event or cardiovascular death in patients with heart failure and reduced ejection fraction (EF) (≤35%). OBJECTIVES: The purpose of this study was to evaluate the influence of baseline EF on the therapeutic effect of omecamtiv mecarbil. METHODS: Outcomes in patients treated with omecamtiv mecarbil were compared with placebo according to EF. RESULTS: The risk of the PCE in the placebo group was nearly 1.8-fold greater in the lowest EF (≤22%) compared with the highest EF (≥33%) quartile. Amongst the pre-specified subgroups, EF was the strongest modifier of the treatment effect of omecamtiv mecarbil on the PCE (interaction as continuous variable, p = 0.004). Patients receiving omecamtiv mecarbil had a progressively greater relative and absolute treatment effect as baseline EF decreased, with a 17% relative risk reduction for the PCE in patients with baseline EF ≤22% (n = 2,246; hazard ratio: 0.83; 95% confidence interval: 0.73 to 0.95) compared with patients with EF ≥33% (n = 1,750; hazard ratio: 0.99; 95% confidence interval: 0.84 to 1.16; interaction as EF by quartiles, p = 0.013). The absolute reduction in the PCE increased with decreasing EF (EF ≤22%; absolute risk reduction, 7.4 events per 100 patient-years; number needed to treat for 3 years = 11.8), compared with no reduction in the highest EF quartile. CONCLUSIONS: In heart failure patients with reduced EF, omecamtiv mecarbil produced greater therapeutic benefit as baseline EF decreased. These findings are consistent with the drug's mechanism of selectively improving systolic function and presents an important opportunity to improve the outcomes in a group of patients at greatest risk. (Registrational Study With Omecamtiv Mecarbil/AMG 423 to Treat Chronic Heart Failure With Reduced Ejection Fraction [GALACTIC-HF]; NCT02929329)."},{"id":"678e27ea6a26","type":"article","url":"https://hartvaat.nl/2021/07/13/10-jaars-mortaliteit-naar-compleetheid-van-revascularisatie-bij-drievaten-hoofds/","title":"10-jaars mortaliteit naar compleetheid van revascularisatie bij drievaten/hoofdstamlijden","title_en":"Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.046289","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.046289","authors":["Kuniaki Takahashi","Patrick W Serruys","Chao Gao","Masafumi Ono","Rutao Wang","Daniel J F M Thuijs","Michael J Mack","Nick Curzen","Friedrich-Wilhelm Mohr","Piroze Davierwala","Milan Milojevic","Joanna J Wykrzykowska","Robbert J de Winter","Faisal Sharif","Yoshinobu Onuma","Stuart J Head","Arie Pieter Kappetein","Marie-Claude Morice","David R Holmes"],"significance":7,"published":"2021-07-13","source_date":"2021-07-13","image":"","kennis":[],"congress":"","summary_en":"This 10-year analysis of all-cause mortality according to completeness of revascularization in three-vessel or left main disease showed that complete revascularization is associated with better long-term survival regardless of whether PCI or CABG was used.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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":"10-jaarsanalyse van totale mortaliteit naar compleetheid van revascularisatie bij drievaten- of linker-hoofdstamcoronairlijden.","abstract_original":"BACKGROUND: Ten-year all-cause death according to incomplete (IR) versus complete revascularization (CR) has not been fully investigated in patients with 3-vessel disease and left main coronary artery disease undergoing percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). METHODS: The SYNTAX Extended Survival study (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]) evaluated vital status up to 10 years in patients who were originally enrolled in the SYNTAX trial. In the present substudy, outcomes of the CABG CR group were compared with the CABG IR, PCI CR, and PCI IR groups. In addition, in the PCI cohort, the residual SYNTAX score (rSS) was used to quantify the extent of IR and to assess its association with fatal late outcome. The rSS of 0 suggests CR, whereas a rSS>0 identifies the degree of IR. RESULTS: IR was more frequently observed in patients with PCI versus CABG (56.6% versus 36.8%) and more common in those with 3-vessel disease than left main coronary artery disease in both the PCI arm (58.5% versus 53.8%) and the CABG arm (42.8% versus 27.5%). Patients undergoing PCI with CR had no significant difference in 10-year all-cause death compared with those undergoing CABG (22.2% for PCI with CR versus 24.3% for CABG with IR versus 23.8% for CABG with CR). In contrast, those with PCI and IR had a significantly higher risk of all-cause death at 10 years compared with CABG and CR (33.5% versus 23.7%; adjusted hazard ratio, 1.48 [95% CI, 1.15-1.91]). When patients with PCI were stratified according to the rSS, those with a rSS≤8 had no significant difference in all-cause death at 10 years as the other terciles (22.2% for rSS=0 versus 23.9% for rSS>0-4 versus 28.9% for rSS>4-8), whereas a rSS>8 had a significantly higher risk of 10-year all-cause death than those undergoing PCI with CR (50.1% versus 22.2%; adjusted hazard ratio, 3.40 [95% CI, 2.13-5.43]). CONCLUSIONS: IR is common after PCI, and the degree of incompleteness was associated with 10-year mortality. If it is unlikely that complete (or nearly complete; rSS<8) revascularization can be achieved with PCI in patients with 3-vessel disease, CABG should be considered. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00114972. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03417050."},{"id":"bc1e076f8062","type":"article","url":"https://hartvaat.nl/2021/07/13/late-rapid-tnt-uitkomsten-0-1-uur-hs-troponine-t-bij-verdenking-acs/","title":"Late RAPID-TnT uitkomsten: 0/1-uur hs-troponine T bij verdenking ACS","title_en":"Late Outcomes of the RAPID-TnT Randomized Controlled Trial: 0/1-Hour High-Sensitivity Troponin T Protocol in Suspected ACS.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["troponine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.055009","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.055009","authors":["Kristina Lambrakis","Cynthia Papendick","John K French","Stephen Quinn","Andrew Blyth","Anil Seshadri","Michael J R Edmonds","Anthony Chuang","Ehsan Khan","Adam J Nelson","Deborah Wright","Matthew Horsfall","Erin Morton","Jonathan Karnon","Tom Briffa","Louise A Cullen","Derek P Chew"],"significance":6,"published":"2021-07-13","source_date":"2021-07-13","image":"","kennis":[],"congress":"","summary_en":"Late outcomes of the RAPID-TnT trial confirmed that a 0/1-hour high-sensitivity troponin protocol for suspected ACS safely reduces emergency department evaluation time without missing clinically significant MI.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:25Z","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":"Langetermijnuitkomsten van de RAPID-TnT trial naar het 0/1-uur hs-troponine T-protocol bij verdenking ACS.","abstract_original":"BACKGROUND: High-sensitivity troponin assays are increasingly being adopted to expedite evaluation of patients with suspected acute coronary syndromes. Few direct comparisons have examined whether the enhanced performance of these assays at low concentrations leads to changes in care that improves longer-term outcomes. This study evaluated late outcomes of participants managed under an unmasked 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol compared with a 0/3-hour masked hs-cTnT protocol. METHODS: We conducted a multicenter prospective patient-level randomized comparison of care informed by unmasked 0/1-hour hs-cTnT protocol (reported to <5 ng/L) versus standard practice masked hs-cTnT testing (reported to ≤29 ng/L) assessed at 0/3 hours and followed participants for 12 months. Participants included were those presenting to metropolitan emergency departments with suspected acute coronary syndromes, without ECG evidence of coronary ischemia. The primary end point was time to all-cause death or myocardial infarction using Cox proportional hazards models adjusted for clustering within hospitals. RESULTS: Between August 2015 and April 2019, we randomized 3378 participants, of whom 108 withdrew, resulting in 12-month follow-up for 3270 participants (masked: 1632; unmasked: 1638). Among these, 2993 (91.5%) had an initial troponin concentration of ≤29 ng/L. Deployment of the 0/1-hour hs-cTnT protocol was associated with reductions in functional testing. Over 12-month follow-up, there was no difference in invasive coronary angiography (0/1-hour unmasked: 232/1638 [14.2%]; 0/3-hour masked: 202/1632 [12.4%]; P=0.13), although an increase was seen among patients with hs-cTnT levels within the masked range (0/1-hour unmasked arm: 168/1507 [11.2%]; 0/3-hour masked arm: 124/1486 [8.3%]; P=0.010). By 12 months, all-cause death and myocardial infarction did not differ between study arms overall (0/1-hour: 82/1638 [5.0%] versus 0/3-hour: 62/1632 [3.8%]; hazard ratio, 1.32 [95% CI, 0.95-1.83]; P=0.10). Among participants with initial troponin T concentrations ≤29 ng/L, unmasked hs-cTnT reporting was associated with an increase in death or myocardial infarction (0/1-hour: 55/1507 [3.7%] versus 0/3-hour: 34/1486 [2.3%]; hazard ratio, 1.60 [95% CI, 1.05-2.46]; P=0.030). CONCLUSIONS: Unmasked hs-cTnT reporting deployed within a 0/1-hour protocol did not reduce ischemic events over 12-month follow-up. Changes in practice associated with the implementation of this protocol may be associated with an increase in death and myocardial infarction among those with newly identified troponin elevations. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12615001379505."},{"id":"48521ad48389","type":"article","url":"https://hartvaat.nl/2021/07/10/tirzepatide-bij-diabetes-type-2-lancet-surpass-1-fase-3/","title":"Tirzepatide bij diabetes type 2: Lancet SURPASS-1 fase-3","title_en":"Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-type-2"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01324-6","source_url":"https://doi.org/10.1016/S0140-6736(21)01324-6","authors":["Julio Rosenstock","Carol Wysham","Juan P Frías","Shizuka Kaneko","Clare J Lee","Laura Fernández Landó","Huzhang Mao","Xuewei Cui","Chrisanthi A Karanikas","Vivian T Thieu"],"significance":9,"published":"2021-07-10","source_date":"2021-07-10","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The SURPASS-1 trial demonstrated that tirzepatide, a novel dual GIP/GLP-1 receptor agonist, produced superior HbA1c reduction and weight loss compared with placebo as monotherapy in type 2 diabetes. These first phase 3 results foreshadowed the transformative potential of dual incretin agonism.","created":"2026-07-03T10:29:17Z","updated":"2026-07-03T13:28:24Z","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 SURPASS-1 eerste fase-3-trial van tirzepatide bij diabetes type 2. Indrukwekkende HbA1c-verlaging en gewichtsreductie — begin van het tirzepatide-tijdperk.","abstract_original":"BACKGROUND: Despite advancements in care, many people with type 2 diabetes do not meet treatment goals; thus, development of new therapies is needed. We aimed to assess efficacy, safety, and tolerability of novel dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist tirzepatide monotherapy versus placebo in people with type 2 diabetes inadequately controlled by diet and exercise alone. METHODS: We did a 40-week, double-blind, randomised, placebo-controlled, phase 3 trial (SURPASS-1), at 52 medical research centres and hospitals in India, Japan, Mexico, and the USA. Adult participants (≥18 years) were included if they had type 2 diabetes inadequately controlled by diet and exercise alone and if they were naive to injectable diabetes therapy. Participants were randomly assigned (1:1:1:1) via computer-generated random sequence to once a week tirzepatide (5, 10, or 15 mg), or placebo. All participants, investigators, and the sponsor were masked to treatment assignment. The primary endpoint was the mean change in glycated haemoglobin (HbA1c) from baseline at 40 weeks. This study is registered with ClinicalTrials.gov, NCT03954834. FINDINGS: From June 3, 2019, to Oct 28, 2020, of 705 individuals assessed for eligibility, 478 (mean baseline HbA1c 7·9% [63 mmol/mol], age 54·1 years [SD 11·9], 231 [48%] women, diabetes duration 4·7 years, and body-mass index 31·9 kg/m2) were randomly assigned to tirzepatide 5 mg (n=121 [25%]), tirzepatide 10 mg (n=121 [25%]), tirzepatide 15 mg (n=121 [25%]), or placebo (n=115 [24%]). 66 (14%) participants discontinued the study drug and 50 (10%) discontinued the study prematurely. At 40 weeks, all tirzepatide doses were superior to placebo for changes from baseline in HbA1c, fasting serum glucose, bodyweight, and HbA1c targets of less than 7·0% (<53 mmol/mol) and less than 5·7% (<39 mmol/mol). Mean HbA1c decreased from baseline by 1·87% (20 mmol/mol) with tirzepatide 5 mg, 1·89% (21 mmol/mol) with tirzepatide 10 mg, and 2·07% (23 mmol/mol) with tirzepatide 15 mg versus +0·04% with placebo (+0·4 mmol/mol), resulting in estimated treatment differences versus placebo of -1·91% (-21 mmol/mol) with tirzepatide 5 mg, -1·93% (-21 mmol/mol) with tirzepatide 10 mg, and -2·11% (-23 mmol/mol) with tirzepatide 15 mg (all p<0·0001). More participants on tirzepatide than on placebo met HbA1c targets of less than 7·0% (<53 mmol/mol; 87-92% vs 20%) and 6·5% or less (≤48 mmol/mol; 81-86% vs 10%) and 31-52% of patients on tirzepatide versus 1% on placebo reached an HbA1c of less than 5·7% (<39 mmol/mol). Tirzepatide induced a dose-dependent bodyweight loss ranging from 7·0 to 9·5 kg. The most frequent adverse events with tirzepatide were mild to moderate and transient gastrointestinal events, including nausea (12-18% vs 6%), diarrhoea (12-14% vs 8%), and vomiting (2-6% vs 2%). No clinically significant (<54 mg/dL [<3 mmol/L]) or severe hypoglycaemia were reported with tirzepatide. One death occurred in the placebo group. INTERPRETATION: Tirzepatide showed robust improvements in glycaemic control and bodyweight, without increased risk of hypoglycaemia. The safety profile was consistent with GLP-1 receptor agonists, indicating a potential monotherapy use of tirzepatide for type 2 diabetes treatment. FUNDING: Eli Lilly and Company."},{"id":"d89f86948645","type":"article","url":"https://hartvaat.nl/2021/07/08/cv-uitkomsten-bij-diabetes-met-vastgesteld-of-hoog-risico-coronairlijden-dulaglu/","title":"CV-uitkomsten bij diabetes met vastgesteld of hoog-risico coronairlijden: dulaglutide","title_en":"Similar cardiovascular outcomes in patients with diabetes and established or high risk for coronary vascular disease treated with dulaglutide with and without baseline metformin.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","fidelio-dkd","figaro-dkd","obesitas","perifeer-vaatlijden","roken","select-trial","slaapapneu","soul-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa777","source_url":"https://doi.org/10.1093/eurheartj/ehaa777","authors":["Giulia Ferrannini","Hertzel Gerstein","Helen Martina Colhoun","Gilles R Dagenais","Rafael Diaz","Leanne Dyal","Mark Lakshmanan","Linda Mellbin","Jeffrey Probstfield","Matthew Casey Riddle","Jonathan Edward Shaw","Alvaro Avezum","Jan Neil Basile","William C Cushman","Petr Jansky","Mátyás Keltai","Fernando Lanas","Lawrence Alan Leiter","Patricio Lopez-Jaramillo","Prem Pais","Valdis Pīrāgs","Nana Pogosova","Peter Johann Raubenheimer","Wayne Huey-Herng Sheu","Lars Rydén"],"significance":6,"published":"2021-07-08","source_date":"2021-07-08","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This analysis showed that dulaglutide provides similar cardiovascular protection in diabetic patients with established versus high-risk-for coronary disease, supporting GLP-1 receptor agonist use for primary prevention in high-risk diabetes.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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":"Analyse die vergelijkbare cardiovasculaire uitkomsten aantoont met dulaglutide bij diabetes met vastgestelde versus hoog-risico coronaire vaatziekte.","abstract_original":"OBJECTIVE: Recent European Guidelines for Diabetes, Prediabetes and Cardiovascular Diseases introduced a shift in managing patients with type 2 diabetes at high risk for or established cardiovascular (CV) disease by recommending GLP-1 receptor agonists and SGLT-2 inhibitors as initial glucose-lowering therapy. This is questioned since outcome trials of these drug classes had metformin as background therapy. In this post hoc analysis, the effect of dulaglutide on CV events was investigated according to the baseline metformin therapy by means of a subgroup analysis of the Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial. RESEARCH DESIGN AND METHODS: Patients in REWIND (n = 9901; women: 46.3%; mean age: 66.2 years) had type 2 diabetes and either a previous CV event (31%) or high CV risk (69%). They were randomized (1:1) to sc. dulaglutide (1.5 mg/weekly) or placebo in addition to standard of care. The primary outcome was the first of a composite of nonfatal myocardial infarction, nonfatal stroke, and death from cardiovascular or unknown causes. Key secondary outcomes included a microvascular composite endpoint, all-cause death, and heart failure. The effect of dulaglutide in patients with and without baseline metformin was evaluated by a Cox regression hazard model with baseline metformin, dulaglutide assignment, and their interaction as independent variables. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by a Cox regression model with adjustments for factors differing at baseline between people with vs. without metformin, identified using the backward selection. RESULTS: Compared to patients with metformin at baseline (n = 8037; 81%), those without metformin (n = 1864; 19%) were older and slightly less obese and had higher proportions of women, prior CV events, heart failure, and renal disease. The primary outcome occurred in 976 (12%) participants with baseline metformin and in 281 (15%) without. There was no significant difference in the effect of dulaglutide on the primary outcome in patients with vs. without metformin at baseline [HR 0.92 (CI 0.81-1.05) vs. 0.78 (CI 0.61-0.99); interaction P = 0.18]. Findings for key secondary outcomes were similar in patients with and without baseline metformin. CONCLUSION: This analysis suggests that the cardioprotective effect of dulaglutide is unaffected by the baseline use of metformin therapy."},{"id":"5028ff9bf6c2","type":"article","url":"https://hartvaat.nl/2021/07/08/grace-2-0-score-bij-type-1-en-type-2-mi/","title":"GRACE 2.0-score bij type 1 en type 2 MI","title_en":"Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa375","source_url":"https://doi.org/10.1093/eurheartj/ehaa375","authors":["John Hung","Andreas Roos","Erik Kadesjö","David A McAllister","Dorien M Kimenai","Anoop S V Shah","Atul Anand","Fiona E Strachan","Keith A A Fox","Nicholas L Mills","Andrew R Chapman","Martin J Holzmann"],"significance":5,"published":"2021-07-08","source_date":"2021-07-08","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This analysis showed that the GRACE 2.0 risk score performs well for type 1 MI but has limited accuracy for type 2 MI, suggesting the need for separate risk models for demand-type myocardial infarction.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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":"Analyse van de prestatie van de GRACE 2.0-risicoscore bij patiënten met type 1 versus type 2 myocardinfarct.","abstract_original":"AIMS: The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain. METHODS AND RESULTS: In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland (n = 48 282) and a tertiary care hospital in Sweden (n = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong's test. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. At 1 year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE 2.0 score of 0.83 [95% confidence interval (CI) 0.82-0.85] and 0.85 (95% CI 0.81-0.89). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. The AUC was 0.73 (95% CI 0.70-0.77) and 0.73 (95% CI 0.66-0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P < 0.001 and P = 0.008, respectively). CONCLUSION: The GRACE 2.0 score provided good discrimination for all-cause death at 1 year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT01852123."},{"id":"ecbf034055c1","type":"article","url":"https://hartvaat.nl/2021/07/06/optimale-medicamenteuze-therapie-en-10-jaarsmortaliteit-na-revascularisatie/","title":"Optimale medicamenteuze therapie en 10-jaarsmortaliteit na revascularisatie","title_en":"Impact of Optimal Medical Therapy on 10-Year Mortality After Coronary Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["diabetes-en-hart","farmaco-economie","lipidenverlaging","niet-statine-therapie","obesitas","ouderen","perifeer-vaatlijden","roken","stride-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.087","source_url":"https://doi.org/10.1016/j.jacc.2021.04.087","authors":["Hideyuki Kawashima","Patrick W Serruys","Masafumi Ono","Hironori Hara","Neil O'Leary","Michael J Mack","David R Holmes","Marie-Claude Morice","Stuart J Head","Arie Pieter Kappetein","Daniel J F M Thuijs","Milan Milojevic","Thilo Noack","Friedrich-Wilhelm Mohr","Piroze M Davierwala","Faisal Sharif","John W McEvoy","Yoshinobu Onuma"],"significance":6,"published":"2021-07-06","source_date":"2021-07-06","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/"],"congress":"","summary_en":"This analysis showed that optimal medical therapy significantly impacts 10-year mortality after coronary revascularization regardless of whether PCI or CABG was performed, reinforcing that pharmacotherapy is the foundation of long-term post-revascularization care.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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":"Analyse naar de impact van optimale medicamenteuze therapie op 10-jaarsmortaliteit na coronaire revascularisatie.","abstract_original":"BACKGROUND: The benefit of optimal medical therapy (OMT) on 5-year outcomes in patients with 3-vessel disease and/or left main disease after percutaneous coronary intervention or coronary artery bypass grafting (CABG) was demonstrated in the randomized SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial. OBJECTIVES: The objective of this analysis is to assess the impact of the status of OMT at 5 years on 10-year mortality after percutaneous coronary intervention or CABG. METHODS: This is a subanalysis of the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which evaluated for up to 10 years the vital status of patients who were originally enrolled in the SYNTAX trial. OMT was defined as the combination of 4 types of medications: at least 1 antiplatelet drug, statin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and beta-blocker. After stratifying participants by the number of individual OMT agents at 5 years and randomized treatment, a landmark analysis was conducted to assess the association between treatment response and 10-year mortality. RESULTS: In 1,472 patients, patients on OMT at 5 years had a significantly lower mortality at 10 years compared with those on ≤2 types of medications (13.1% vs 19.9%; adjusted HR: 0.470; 95% CI: 0.292-0.757; P = 0.002) but had a mortality similar to those on 3 types of medications. Furthermore, patients undergoing CABG with the individual OMT agents, antiplatelet drug and statin, at 5 years had lower 10-year mortality than those without. CONCLUSIONS: In patients with 3-vessel and/or left main disease undergoing percutaneous coronary intervention or CABG, medication status at 5 years had a significant impact on 10-year mortality. Patients on OMT with guideline-recommended pharmacologic therapy at 5 years had a survival benefit. (Synergy Between PCI With Taxus and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; Taxus Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)."},{"id":"68e4c2127e54","type":"article","url":"https://hartvaat.nl/2021/07/06/mortaliteitsvoordeel-van-rivaroxaban-plus-aspirine-bij-chronisch-vaatlijden-comp/","title":"Mortaliteitsvoordeel van rivaroxaban plus aspirine bij chronisch vaatlijden: COMPASS","title_en":"Mortality Benefit of Rivaroxaban Plus Aspirin in Patients With Chronic Coronary or Peripheral Artery Disease.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.083","source_url":"https://doi.org/10.1016/j.jacc.2021.04.083","authors":["John W Eikelboom","Deepak L Bhatt","Keith A A Fox","Jacqueline Bosch","Stuart J Connolly","Sonia S Anand","Alvaro Avezum","Scott D Berkowitz","Kelley R H Branch","Gilles R Dagenais","Camilo Félix","Tomasz J Guzik","Robert G Hart","Aldo P Maggioni","Eva Muehlhofer","Mukul Sharma","Olga Shestakovska","Salim Yusuf"],"significance":7,"published":"2021-07-06","source_date":"2021-07-06","image":"","kennis":[],"congress":"","summary_en":"This COMPASS analysis quantified the mortality benefit of rivaroxaban plus aspirin in patients with chronic coronary or peripheral artery disease, showing that the dual-pathway strategy reduces both cardiovascular and all-cause death.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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":"COMPASS analyse die het mortaliteitsvoordeel van rivaroxaban plus aspirine kwantificeerde bij chronisch coronair of perifeer vaatlijden.","abstract_original":"BACKGROUND: The combination of 2.5 mg rivaroxaban twice daily and 100 mg aspirin once daily compared with 100 mg aspirin once daily reduces major adverse cardiovascular (CV) events in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD). OBJECTIVES: The aim of this work was to report the effects of the combination on overall and cause-specific mortality. METHODS: The COMPASS trial enrolled 27,395 patients of whom 18,278 were randomized to the combination (n = 9,152) or aspirin alone (n = 9,126). Deaths were adjudicated by a committee blinded to treatment allocation. Previously identified high-risk baseline features were polyvascular disease, chronic kidney disease, mild or moderate heart failure, and diabetes. RESULTS: During a median of 23 months of follow-up (maximum 47 months), 313 patients (3.4%) allocated to the combination and 378 patients (4.1%) allocated to aspirin alone died (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.71-0.96; P = 0.01). Compared with aspirin, the combination reduced CV death (160 [1.7%] vs 203 [2.2%]; HR: 0.78; 95% CI: 0.64-0.96; P = 0.02) but not non-CV death. There were fewer deaths following MI, stroke, and CV procedures, as well as fewer sudden cardiac, other, and unknown causes of CV deaths and coronary heart disease deaths. Patients with 0, 1, 2, and 3 or 4 high-risk features at baseline had 4.2, 4.8, 25.0, and 53.9 fewer deaths, respectively, per 1000 patients treated for 30 months. CONCLUSIONS: The combination of rivaroxaban and aspirin compared with aspirin reduced overall and CV mortality with consistent reductions in cause specific CV mortality in patients with chronic CAD or PAD. The absolute mortality benefits are greater with increasing baseline risk. (Cardiovascular Outcomes for People Using Anticoagulant Strategies [COMPASS]; NCT01776424)."},{"id":"56490ba03b1f","type":"article","url":"https://hartvaat.nl/2021/07/01/camkii-delta-remming-en-ventriculaire-remodellering-na-mi-jama-cardiology/","title":"CaMKII delta-remming en ventriculaire remodellering na MI: JAMA Cardiology","title_en":"Calcium/Calmodulin-Dependent Protein Kinase II Delta Inhibition and Ventricular Remodeling After Myocardial Infarction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["ventrikelfibrilleren"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.0676","source_url":"https://doi.org/10.1001/jamacardio.2021.0676","authors":["Andrew J Boyle","Carl Schultz","Joseph B Selvanayagam","Stuart Moir","Richard Kovacs","Nabil Dib","David Zlotnick","Mohammed Al-Omary","Stuart Sugito","Aravinda Selvarajah","Nicholas Collins","Grant McLachlan"],"significance":5,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial tested a CaMKII delta inhibitor for preventing ventricular remodeling after anterior STEMI, exploring targeted kinase inhibition as a post-MI cardioprotective strategy.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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 gerandomiseerde trial van een CaMKII delta-remmer op ventriculaire remodellering na MI.","abstract_original":"IMPORTANCE: After anterior ST-segment elevation myocardial infarction (STEMI), left ventricular (LV) remodeling results in heart failure and death. Calcium/calmodulin-dependent protein kinase II delta (CaMKIId) is a key molecular mediator of adverse LV remodeling. OBJECTIVE: To determine whether NP202, an orally active inhibitor of CaMKIId, prevents LV remodeling in patients after anterior STEMI with early residual LV dysfunction. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled multicenter clinical trial of NP202 vs placebo in patients after primary percutaneous coronary intervention (PCI) for anterior STEMI was performed from November 19, 2015, to August 1, 2018. The study was performed at 32 sites across the US, Australia, and New Zealand. Patients presenting with anterior STEMI who underwent PCI within 12 hours of symptom onset and left ventricular ejection fraction (LVEF) less than 45% on screening echocardiogram 48 hours after primary PCI were included in the study. Baseline cardiovascular magnetic resonance (CMR) imaging was performed within 5 days of the STEMI and before administration of the study drug. Follow-up CMR was performed after 3 months. Data were analyzed from November 19, 2015, to August 1, 2018. INTERVENTIONS: Patients were randomly assigned to NP202, 1000 mg, daily for 3 months vs corresponding placebo. MAIN OUTCOMES AND MEASURES: The primary end point was change in LV end-systolic volume index (LVESVi) on CMR. Secondary end points were change in LV end-diastolic volume index, change in LVEF, change in infarct size, and change in diastolic function. Safety and tolerability were also assessed. RESULTS: A total of 147 patients (mean [SD] age, 58 [11] years; 129 men [88%]; 130 White patients [88%]) who experienced anterior STEMI treated with primary PCI were randomized to receive NP202 (73 [49.7%]) or placebo (74 [50.3%]). Baseline LVEF was similar between groups. At baseline, patients randomized to NP202 had greater LVESVi (48.2 mL/m2) than that in the placebo group (41.3 mL/m2; P = .03). However, the groups were otherwise well matched. For the primary end point of change in LVESVi from baseline to 3 months, there was no significant difference between the placebo (median [interquartile range] change, -0.60 [-9.28 to 5.99] mL/m2) and NP202 groups (-3.53 [-9.24 to 4.81] mL/m2) (P = .78). There was also no difference in the secondary efficacy end points assessed by CMR. NP202 was well tolerated and demonstrated an acceptable safety profile. Major adverse cardiac and cerebrovascular event rates were similar between groups. Two deaths occurred in each group during the follow-up period. CONCLUSIONS AND RELEVANCE: Three months of treatment with NP202 after primary PCI for anterior STEMI with residual LV dysfunction did not improve LV remodeling. The drug was safe and well tolerated. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02557217."},{"id":"b858219379fc","type":"article","url":"https://hartvaat.nl/2021/07/01/dapagliflozine-naar-nierfunctie-en-albuminurie-bij-diabetes-declare/","title":"Dapagliflozine naar nierfunctie en albuminurie bij diabetes: DECLARE","title_en":"Effect of Dapagliflozin on Cardiovascular Outcomes According to Baseline Kidney Function and Albuminuria Status in Patients With Type 2 Diabetes: A Prespecified Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.0660","source_url":"https://doi.org/10.1001/jamacardio.2021.0660","authors":["Thomas A Zelniker","Itamar Raz","Ofri Mosenzon","Jamie P Dwyer","Hiddo H J L Heerspink","Avivit Cahn","Erica L Goodrich","Kyungah Im","Deepak L Bhatt","Lawrence A Leiter","Darren K McGuire","John P H Wilding","Ingrid Gause-Nilsson","Anna Maria Langkilde","Marc S Sabatine","Stephen D Wiviott"],"significance":7,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":[],"congress":"","summary_en":"This DECLARE analysis showed that dapagliflozin's cardiovascular benefit is consistent across baseline kidney function and albuminuria categories, supporting SGLT2 inhibitor use regardless of renal status in type 2 diabetes.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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 DECLARE analyse naar het effect van dapagliflozine op CV-uitkomsten gestratificeerd naar nierfunctie en albuminurie.","abstract_original":"IMPORTANCE: Sodium-glucose cotransporter 2 inhibitors, such as dapagliflozin, promote renal glucose excretion and reduce cardiovascular (CV) deaths and hospitalizations for heart failure (HHF) among patients with type 2 diabetes. The relative CV efficacy and safety of dapagliflozin according to baseline kidney function and albuminuria status are unknown. OBJECTIVE: To assess the CV efficacy and safety of dapagliflozin according to baseline estimated glomerular filtration rate (eGFR) and urinary albumin to creatinine ratio (UACR). DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the randomized clinical trial Dapagliflozin Effect on Cardiovascular Events-Thrombolysis in Myocardial Infarction 58 compared dapagliflozin vs placebo in 17 160 patients with type 2 diabetes and a baseline creatinine clearance of 60 mL/min or higher. Patients were categorized according to prespecified subgroups of baseline eGFR (<60 vs ≥60 mL/min/1.73 m2), urinary albumin to creatinine ratio (UACR; <30 vs ≥30 mg/g), and of chronic kidney disease (CKD) markers using these subgroups (0, 1, or 2). The study was conducted from May 2013 to September 2018. INTERVENTIONS: Dapagliflozin vs placebo. MAIN OUTCOMES AND MEASURES: The dual primary end points were major adverse cardiovascular events (myocardial infarction, stroke, and CV death) and the composite of CV death or HHF. RESULTS: At baseline, 1265 patients (7.4%) had an eGFR below 60 mL/min/1.73 m2, and 5199 patients (30.9%) had albuminuria. Among patients having data for both eGFR and UACR, 10 958 patients (65.1%) had an eGFR equal to or higher than 60 mL/min/1.73 m2 and an UACR below 30 mg/g (mean [SD] age, 63.7 [6.7] years; 40.1% women), 5336 patients (31.7%) had either an eGFR below 60 mL/min/1.73 m2 or albuminuria (mean [SD] age, 64.1 [7.1] years; 32.6% women), and 548 patients (3.3%) had both (mean [SD] age, 66.8 [6.9] years; 30.5% women). In the placebo group, patients with more CKD markers had higher event rates at 4 years as assessed using the Kaplan-Meier approach for the composite of CV death or HHF (3.9% for 0 markers, 8.3% for 1 marker, and 17.4% for 2 markers) and major adverse cardiovascular events (7.5% for 0 markers, 11.6% for 1 marker, and 18.9% for 2 markers). Estimates for relative risk reductions for the composite of CV death or HHF and for major adverse cardiovascular events were generally consistent across subgroups (both P > .24 for interaction), although greater absolute risk reductions were observed with more markers of CKD. The absolute risk difference for the composite of CV death or HHF was greater for patients with more markers of CKD (0 markers, -0.5%; 1 marker, -1.0%; and 2 markers, -8.3%; P = .02 for interaction). The numbers of amputations, cases of diabetic ketoacidosis, fractures, and major hypoglycemic events were balanced or numerically lower with dapagliflozin compared with placebo for patients with an eGFR below 60 mL/min/1.73 m2 and an UACR of 30 mg/g or higher. CONCLUSIONS AND RELEVANCE: The effect of dapagliflozin on the relative risk for CV events was consistent across eGFR and UACR groups, with the greatest absolute benefit for the composite of CV death or HHF observed among patients with both reduced eGFR and albuminuria. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01730534."},{"id":"1b4b2a65e24f","type":"article","url":"https://hartvaat.nl/2021/07/01/revacept-gpvi-antagonist-bij-pci-jama-cardiology/","title":"Revacept GPVI-antagonist bij PCI: JAMA Cardiology","title_en":"Efficacy and Safety of Revacept, a Novel Lesion-Directed Competitive Antagonist to Platelet Glycoprotein VI, in Patients Undergoing Elective Percutaneous Coronary Intervention for Stable Ischemic Heart Disease: The Randomized, Double-blind, Placebo-Controlled ISAR-PLASTER Phase 2 Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.0475","source_url":"https://doi.org/10.1001/jamacardio.2021.0475","authors":["Katharina Mayer","Ralph Hein-Rothweiler","Stefanie Schüpke","Marion Janisch","Isabell Bernlochner","Gjin Ndrepepa","Dirk Sibbing","Tommaso Gori","Oliver Borst","Stefan Holdenrieder","Danny Kupka","Tobias Petzold","Christian Bradaric","Rainer Okrojek","David M Leistner","Tobias D Trippel","Thomas Münzel","Ulf Landmesser","Burkert Pieske","Andreas M Zeiher","Meinrad P Gawaz","Alexander Hapfelmeier","Karl-Ludwig Laugwitz","Heribert Schunkert","Adnan Kastrati","Steffen Massberg"],"significance":6,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This trial of revacept, a novel competitive antagonist of platelet glycoprotein VI, during PCI tested a new antithrombotic mechanism that targets the collagen-platelet interaction at the site of vascular injury.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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 trial van revacept, een nieuw laesie-gericht competitief antagonist van GPVI, bij PCI.","abstract_original":"IMPORTANCE: The assessment of new antithrombotic agents with a favorable safety profile is clinically relevant. OBJECTIVE: To test the efficacy and safety of revacept, a novel, lesion-directed antithrombotic drug, acting as a competitive antagonist to platelet glycoprotein VI. DESIGN, SETTING, AND PARTICIPANTS: A phase 2 randomized clinical trial; patients were enrolled from 9 centers in Germany from November 20, 2017, to February 27, 2020; follow-up ended on March 27, 2020. The study included patients with stable ischemic heart disease (SIHD) undergoing elective percutaneous coronary intervention (PCI). INTERVENTIONS: Single intravenous infusion of revacept, 160 mg, revacept, 80 mg, or placebo prior to the start of PCI on top of standard antithrombotic therapy. MAIN OUTCOMES AND MEASURES: The primary end point was the composite of death or myocardial injury, defined as an increase in high-sensitivity cardiac troponin to at least 5 times the upper limit of normal within 48 hours from randomization. The safety end point was bleeding type 2 to 5 according to the Bleeding Academic Research Consortium criteria at 30 days. RESULTS: Of 334 participants (median age, 67.4 years; interquartile range, 60-75.1 years; 253 men [75.7%]; and 330 White participants [98.8%]), 120 were allocated to receive the 160-mg dose of revacept, 121 were allocated to receive the 80-mg dose, and 93 received placebo. The primary end point showed no significant differences between the revacept and placebo groups: 24.4%, 25.0%, and 23.3% in the revacept, 160 mg, revacept, 80 mg, and placebo groups, respectively (P = .98). The high dose of revacept was associated with a small but significant reduction of high-concentration collagen-induced platelet aggregation, with a median 26.5 AU × min (interquartile range, 0.5-62.2 AU × min) in the revacept, 160 mg, group; 43.5 AU × min (interquartile range, 22.8-99.5 AU × min) in the revacept, 80 mg, group; and 41.0 AU × min (interquartile range, 31.2-101.0 AU × min) in the placebo group (P = .02), while adenosine 5'-diphosphate-induced aggregation was not affected. Revacept did not increase Bleeding Academic Research Consortium type 2 or higher bleeding at 30 days compared with placebo: 5.0%, 5.9%, and 8.6% in the revacept, 160 mg, revacept, 80 mg, and placebo groups, respectively (P = .36). CONCLUSIONS AND RELEVANCE: Revacept did not reduce myocardial injury in patients with stable ischemic heart disease undergoing percutaneous coronary intervention. There were few bleeding events and no significant differences between treatment arms. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03312855."},{"id":"8d59aeff6444","type":"article","url":"https://hartvaat.nl/2021/07/01/transformatie-van-klinisch-onderzoek-door-patientbetrokkenheid-rate-af/","title":"Transformatie van klinisch onderzoek door patiëntbetrokkenheid: RATE-AF","title_en":"Transforming clinical research by involving and empowering patients- the RATE-AF randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab098","source_url":"https://doi.org/10.1093/eurheartj/ehab098","authors":["Karina V Bunting","Mary Stanbury","Otilia Tica","Dipak Kotecha"],"significance":5,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":[],"congress":"","summary_en":"This EHJ article highlighted the RATE-AF trial as a model for patient involvement and empowerment in cardiovascular clinical research, demonstrating how patient-centered trial design improves research quality and relevance.","created":"2026-07-03T10:29:16Z","updated":"2026-07-03T13:28:24Z","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":"EHJ analyse van RATE-AF als voorbeeld van patiëntbetrokkenheid bij klinisch onderzoek.","abstract_original":""},{"id":"cc96615a5791","type":"article","url":"https://hartvaat.nl/2021/07/01/empagliflozine-en-lv-volumes-en-functie-bij-hfref-jama-cardiology/","title":"Empagliflozine en LV-volumes en functie bij HFrEF: JAMA Cardiology","title_en":"Associations of Empagliflozin With Left Ventricular Volumes, Mass, and Function in Patients With Heart Failure and Reduced Ejection Fraction: A Substudy of the Empire HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.6827","source_url":"https://doi.org/10.1001/jamacardio.2020.6827","authors":["Massar Omar","Jesper Jensen","Mulham Ali","Peter H Frederiksen","Caroline Kistorp","Lars Videbæk","Mikael Kjær Poulsen","Christian D Tuxen","Sören Möller","Finn Gustafsson","Lars Køber","Morten Schou","Jacob Eifer Møller"],"significance":7,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that empagliflozin is associated with improvements in left ventricular volumes, mass, and function in HFrEF, providing echocardiographic evidence of reverse cardiac remodeling with SGLT2 inhibition.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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":"JAMA Cardiology analyse naar de associatie van empagliflozine met LV-volumes, massa en functie bij HFrEF.","abstract_original":"IMPORTANCE: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in patients with heart failure and a reduced ejection fraction (HFrEF). The association with cardiac remodeling has not been investigated. OBJECTIVE: To investigate the outcome of the SGLT2i empagliflozin, compared with placebo, on cardiac remodeling in patients with HFrEF. DESIGN, SETTING, AND PARTICIPANTS: This exploratory post hoc analysis included participants with stable HFrEF and ejection fractions of 40% or less, who were randomly enrolled in an investigator-initiated, multicenter, double-blind, placebo-controlled randomized clinical trial in Denmark. Enrollment commenced on June 29, 2017, and continued through September 10, 2019, with the last participant follow-up on December 20, 2019. INTERVENTIONS: Randomization (1:1) to empagliflozin (10 mg once daily) or matching placebo in addition to recommended heart failure therapy for 12 weeks. MAIN OUTCOMES AND MEASURES: Efficacy measures were changes from baseline to week 12 in left ventricular end-systolic and end-diastolic volume indexes, left atrial volume index, and left ventricular ejection fraction adjusted for age, sex, type 2 diabetes, and atrial fibrillation. Secondary efficacy measures included changes in left ventricular mass index, global longitudinal strain, and relative wall thickness. RESULTS: A total of 190 patients were randomized (95 each receiving empagliflozin and placebo), with a mean (SD) age of 64 (11) years; 162 were men (85.3%), 97 (51.1%) had ischemic HFrEF, 24 (12.6%) had type 2 diabetes, and the mean (SD) latest recorded left ventricular ejection fraction was 29% (8%). Of the 190, 186 completed the study. Empagliflozin significantly reduced left ventricular end-systolic volume index (-4.3 [95% CI, -8.5 to -0.1] mL/m2; P = .04), left ventricular end-diastolic volume index (-5.5 [95% CI, -10.6 to -0.4] mL/m2; P = .03), and left atrial volume index (-2.5 [95% CI, -4.8 to -0.1] mL/m2; P = .04) compared with placebo at 12 weeks' follow-up, with no change in left ventricular ejection fraction (1.2% [95% CI, -1.2% to 3.6%]; P = .32). These findings were consistent across subgroups. Of secondary efficacy measures, left ventricular mass index was significantly reduced by empagliflozin (-9.0 [95% CI, -17.2 to -0.8] g/m2; P = .03). CONCLUSIONS AND RELEVANCE: In this small, randomized, short-term study, empagliflozin was associated with modest reductions in left ventricular and left atrial volumes with no association with ejection fraction. Effects beyond 12 weeks of SGLT2i use require further study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03198585."},{"id":"176d843075d8","type":"article","url":"https://hartvaat.nl/2021/07/01/remote-post-ontslag-behandeling-na-mi-door-paramedici-versus-standaardzorg-jama-/","title":"Remote post-ontslag behandeling na MI door paramedici versus standaardzorg: JAMA Cardiology","title_en":"Remote Postdischarge Treatment of Patients With Acute Myocardial Infarction by Allied Health Care Practitioners vs Standard Care: The IMMACULATE Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.6721","source_url":"https://doi.org/10.1001/jamacardio.2020.6721","authors":["Mark Y Chan","Karen W L Koh","Sock-Cheng Poh","Stephanie Marchesseau","Devinder Singh","Yiying Han","Faclin Ng","Eleanor Lim","Joseph F Prabath","Chi-Hang Lee","Hui-Wen Sim","Ruth Chen","Leonardo Carvalho","Sock-Hwee Tan","Joshua P Y Loh","Jack W C Tan","Karishma Kuwelker","R M Amanullah","Chee-Tang Chin","James W L Yip","Choy-Yee Lee","Juvena Gan","Chew-Yong Lo","Hee-Hwa Ho","Derek J Hausenloy","Bee-Choo Tai","A Mark Richards"],"significance":6,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":[],"congress":"","summary_en":"This trial showed that remote post-discharge treatment by allied health practitioners after MI achieves comparable safety and efficacy to standard cardiologist-led care, supporting task-shifting for post-MI management.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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":"JAMA Cardiology trial naar remote post-ontslagbehandeling door paramedici versus standaardzorg na MI.","abstract_original":"IMPORTANCE: There are few data on remote postdischarge treatment of patients with acute myocardial infarction. OBJECTIVE: To compare the safety and efficacy of allied health care practitioner-led remote intensive management (RIM) with cardiologist-led standard care (SC). DESIGN, SETTING, AND PARTICIPANTS: This intention-to-treat feasibility trial randomized patients with acute myocardial infarction undergoing early revascularization and with N-terminal-pro-B-type natriuretic peptide concentration more than 300 pg/mL to RIM or SC across 3 hospitals in Singapore from July 8, 2015, to March 29, 2019. RIM participants underwent 6 months of remote consultations that included β-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB) dose adjustment by a centralized nurse practitioner team while SC participants were treated face-to-face by their cardiologists. MAIN OUTCOMES AND MEASURES: The primary safety end point was a composite of hypotension, bradycardia, hyperkalemia, or acute kidney injury requiring hospitalization. To assess the efficacy of RIM in dose adjustment of β-blockers and ACE-I/ARBs compared with SC, dose intensity scores were derived by converting comparable doses of different β-blockers and ACE-I/ARBs to a scale from 0 to 5. The primary efficacy end point was the 6-month indexed left ventricular end-systolic volume (LVESV) adjusted for baseline LVESV. RESULTS: Of 301 participants, 149 (49.5%) were randomized to RIM and 152 (50.5%) to SC. RIM and SC participants had similar mean (SD) age (55.3 [8.5] vs 54.7 [9.1] years), median (interquartile range) N-terminal-pro-B-type natriuretic peptide concentration (807 [524-1360] vs 819 [485-1320] pg/mL), mean (SD) baseline left ventricular ejection fraction (57.4% [11.1%] vs 58.1% [10.3%]), and mean (SD) indexed LVESV (32.4 [14.1] vs 30.6 [11.7] mL/m2); 15 patients [5.9%] had a left ventricular ejection fraction <40%. The primary safety end point occurred in 0 RIM vs 2 SC participants (1.4%) (P = .50). The mean β-blocker and ACE-I/ARB dose intensity score at 6 months was 3.03 vs 2.91 (adjusted mean difference, 0.12 [95% CI, -0.02 to 0.26; P = .10]) and 2.96 vs 2.77 (adjusted mean difference, 0.19 [95% CI, -0.02 to 0.40; P = .07]), respectively. The 6-month indexed LVESV was 28.9 vs 29.7 mL/m2 (adjusted mean difference, -0.80 mL/m2 [95% CI, -3.20 to 1.60; P = .51]). CONCLUSIONS AND RELEVANCE: Among low-risk patients with revascularization after myocardial infarction, RIM by allied health care professionals was feasible and safe. There were no differences in achieved medication doses or indices of left ventricular remodeling. Further studies of RIM in higher-risk cohorts are warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02468349."},{"id":"51bf54585cb5","type":"article","url":"https://hartvaat.nl/2021/07/01/cv-gevolgen-van-stoppen-met-laaggedoseerd-rivaroxaban-bij-chronisch-vaatlijden/","title":"CV-gevolgen van stoppen met laaggedoseerd rivaroxaban bij chronisch vaatlijden","title_en":"Cardiovascular consequences of discontinuing low-dose rivaroxaban in people with chronic coronary or peripheral artery disease.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["anticoagulantia","ouderen","perifeer-vaatlijden","roken","slaapapneu","stabiel-coronairlijden","ventrikelfibrilleren"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-318758","source_url":"https://doi.org/10.1136/heartjnl-2020-318758","authors":["Gilles R Dagenais","Leanne Dyal","Jacqueline J Bosch","Darryl P Leong","Victor Aboyans","Scott D Berkowitz","Deepak L Bhatt","Stuart J Connolly","Keith A A Fox","Eva Muehlhofer","Jeffrey L Probstfield","Petr Widimsky","Bernhard R Winkelmann","Salim Yusuf","John W Eikelboom"],"significance":6,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":[],"congress":"","summary_en":"This COMPASS analysis showed that discontinuing low-dose rivaroxaban in patients with chronic coronary or peripheral artery disease is associated with increased cardiovascular events, supporting the importance of treatment persistence.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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 cardiovasculaire gevolgen van het staken van laaggedoseerd rivaroxaban bij chronisch coronair of perifeer vaatlijden.","abstract_original":"OBJECTIVE: In patients with chronic coronary or peripheral artery disease enrolled in the Cardiovascular Outcomes for People Using Anticoagulation Strategies trial, randomised antithrombotic treatments were stopped after a median follow-up of 23 months because of benefits of the combination of rivaroxaban 2.5 mg two times per day and aspirin 100 mg once daily compared with aspirin 100 mg once daily. We assessed the effect of switching to non-study aspirin at the time of early stopping. METHODS: Incident composite of myocardial infarction, stroke or cardiovascular death was estimated per 100 person-years (py) during randomised treatment (n=18 278) and after study treatment discontinuation to non-study aspirin (n=14 068). RESULTS: During randomised treatment, the combination compared with aspirin reduced the composite (2.2 vs 2.9/100 py, HR: 0.76, 95% CI 0.66 to 0.86), stroke (0.5 vs 0.8/100 py, HR: 0.58, 95% CI 0.44 to 0.76) and cardiovascular death (0.9 vs 1.2/100 py, HR: 0.78, 95% CI 0.64 to 0.96). During 1.02 years after early stopping, participants originally randomised to the combination compared with those randomised to aspirin had similar rates of the composite (2.1 vs 2.0/100 py, HR: 1.08, 95% CI 0.84 to 1.39) and cardiovascular death (1.0 vs 0.8/100 py, HR: 1.26, 95% CI 0.85 to 1.86) but higher stroke rate (0.7 vs 0.4/100 py, HR: 1.74, 95% CI 1.05 to 2.87) including a significant increase in ischaemic stroke during the first 6 months after switching to non-study aspirin. CONCLUSION: Discontinuing study rivaroxaban and aspirin to non-study aspirin was associated with the loss of cardiovascular benefits and a stroke excess. TRIAL REGISTRATION NUMBER: NCT01776424."},{"id":"25011bdec80d","type":"article","url":"https://hartvaat.nl/2021/07/01/kbp-5074-en-bloeddruk-bij-gevorderde-ckd-block-ckd/","title":"KBP-5074 en bloeddruk bij gevorderde CKD: BLOCK-CKD","title_en":"Effect of KBP-5074 on Blood Pressure in Advanced Chronic Kidney Disease: Results of the BLOCK-CKD Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["chronische-nierziekte"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17073","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17073","authors":["George Bakris","Pablo E Pergola","Belkis Delgado","Diyan Genov","Tamar Doliashvili","Nam Vo","Y Fred Yang","James McCabe","Vincent Benn","Bertram Pitt"],"significance":6,"published":"2021-07-01","source_date":"2021-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The BLOCK-CKD study evaluated KBP-5074, a nonsteroidal MRA, for blood pressure lowering in advanced CKD, testing a novel mineralocorticoid receptor antagonist designed for safety in the renally impaired population.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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":"BLOCK-CKD studie naar KBP-5074 (niet-steroïdale MRA) op bloeddruk bij gevorderde CKD.","abstract_original":"[Figure: see text]."},{"id":"ae4967af9d54","type":"article","url":"https://hartvaat.nl/2021/06/26/aspirine-versus-clopidogrel-voor-chronische-monotherapie-na-pci-lancet-host-exam/","title":"Aspirine versus clopidogrel voor chronische monotherapie na PCI: Lancet HOST-EXAM","title_en":"Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aspirine","trombocytenaggregatieremmers"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)01063-1","source_url":"https://doi.org/10.1016/S0140-6736(21)01063-1","authors":["Bon-Kwon Koo","Jeehoon Kang","Kyung Woo Park","Tae-Min Rhee","Han-Mo Yang","Ki-Bum Won","Seung-Woon Rha","Jang-Whan Bae","Nam Ho Lee","Seung-Ho Hur","Junghan Yoon","Tae-Ho Park","Bum Soo Kim","Sang Wook Lim","Yoon Haeng Cho","Dong Woon Jeon","Sang-Hyun Kim","Jung-Kyu Han","Eun-Seok Shin","Hyo-Soo Kim"],"significance":9,"published":"2021-06-26","source_date":"2021-06-26","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/kleplijden/aortaregurgitatie/"],"congress":"","summary_en":"The HOST-EXAM trial showed that clopidogrel was superior to aspirin for chronic maintenance antiplatelet monotherapy after PCI, reducing the composite of cardiovascular death, MI, stroke, readmission for ACS, or stent thrombosis at 24 months. The result challenged aspirin as the default long-term antiplatelet agent after coronary stenting.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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":"Lancet HOST-EXAM trial die clopidogrel superieur toonde aan aspirine voor chronische monotherapie na PCI. Verandert de standaard langetermijn antiplaatjestherapie.","abstract_original":"BACKGROUND: Optimal antiplatelet monotherapy during the chronic maintenance period in patients who undergo coronary stenting is unknown. We aimed to compare head to head the efficacy and safety of aspirin and clopidogrel monotherapy in this population. METHODS: We did an investigator-initiated, prospective, randomised, open-label, multicentre trial at 37 study sites in South Korea. We enrolled patients aged at least 20 years who maintained dual antiplatelet therapy without clinical events for 6-18 months after percutaneous coronary intervention with drug-eluting stents (DES). We excluded patients with any ischaemic and major bleeding complications. Patients were randomly assigned (1:1) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater, in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02044250. FINDINGS: Between March 26, 2014, and May 29, 2018, we enrolled 5530 patients. 5438 (98·3%) patients were randomly assigned to either the clopidogrel group (2710 [49·8%]) or to the aspirin group (2728 [50·2%]). Ascertainment of the primary endpoint was completed in 5338 (98·2%) patients. During 24-month follow-up, the primary outcome occurred in 152 (5·7%) patients in the clopidogrel group and 207 (7·7%) in the aspirin group (hazard ratio 0·73 [95% CI 0·59-0·90]; p=0·0035). INTERPRETATION: Clopidogrel monotherapy, compared with aspirin monotherapy during the chronic maintenance period after percutaneous coronary intervention with DES significantly reduced the risk of the composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and BARC bleeding type 3 or greater. In patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention, clopidogrel monotherapy was superior to aspirin monotherapy in preventing future adverse clinical events. FUNDING: ChongKunDang, SamJin, HanMi, DaeWoong, and the South Korea Ministry of Health and Welfare."},{"id":"85ad7df68f15","type":"article","url":"https://hartvaat.nl/2021/06/26/echografie-renale-denervatie-bij-triple-pilresistente-hypertensie-lancet-radianc/","title":"Echografie renale denervatie bij triple-pilresistente hypertensie: Lancet RADIANCE-HTN TRIO","title_en":"Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, 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(21)00788-1","source_url":"https://doi.org/10.1016/S0140-6736(21)00788-1","authors":["Michel Azizi","Kintur Sanghvi","Manish Saxena","Philippe Gosse","John P Reilly","Terry Levy","Lars C Rump","Alexandre Persu","Jan Basile","Michael J Bloch","Joost Daemen","Melvin D Lobo","Felix Mahfoud","Roland E Schmieder","Andrew S P Sharp","Michael A Weber","Marc Sapoval","Pete Fong","Atul Pathak","Pierre Lantelme","David Hsi","Sripal Bangalore","Adam Witkowski","Joachim Weil","Benjamin Kably","Neil C Barman","Helen Reeve-Stoffer","Leslie Coleman","Candace K McClure","Ajay J Kirtane"],"significance":9,"published":"2021-06-26","source_date":"2021-06-26","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"The RADIANCE-HTN TRIO trial demonstrated that ultrasound-based renal denervation significantly reduced daytime ambulatory systolic blood pressure compared with a sham procedure in patients with resistant hypertension on a standardized triple combination pill. This was the first positive renal denervation trial in true resistant hypertension.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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":"Lancet RADIANCE-HTN TRIO trial die ultrageluid renale denervatie onderzocht bij hypertensie resistent tegen een drievoudige medicatiepil. Eerste RDN-trial bij patiënten op gestandaardiseerde triple therapie.","abstract_original":"BACKGROUND: Endovascular renal denervation reduces blood pressure in patients with mild-to-moderate hypertension, but its efficacy in patients with true resistant hypertension has not been shown. We aimed to assess the efficacy and safety of endovascular ultrasound renal denervation in patients with hypertension resistant to three or more antihypertensive medications. METHODS: In a randomised, international, multicentre, single-blind, sham-controlled trial done at 28 tertiary centres in the USA and 25 in Europe, we included patients aged 18-75 years with office blood pressure of at least 140/90 mm Hg despite three or more antihypertensive medications including a diuretic. Eligible patients were switched to a once daily, fixed-dose, single-pill combination of a calcium channel blocker, an angiotensin receptor blocker, and a thiazide diuretic. After 4 weeks of standardised therapy, patients with daytime ambulatory blood pressure of at least 135/85 mm Hg were randomly assigned (1:1) by computer (stratified by centres) to ultrasound renal denervation or a sham procedure. Patients and outcome assessors were masked to randomisation. Addition of antihypertensive medications was allowed if specified blood pressure thresholds were exceeded. The primary endpoint was the change in daytime ambulatory systolic blood pressure at 2 months in the intention-to-treat population. Safety was also assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02649426. FINDINGS: Between March 11, 2016, and March 13, 2020, 989 participants were enrolled and 136 were randomly assigned to renal denervation (n=69) or a sham procedure (n=67). Full adherence to the combination medications at 2 months among patients with urine samples was similar in both groups (42 [82%] of 51 in the renal denervation group vs 47 [82%] of 57 in the sham procedure group; p=0·99). Renal denervation reduced daytime ambulatory systolic blood pressure more than the sham procedure (-8·0 mm Hg [IQR -16·4 to 0·0] vs -3·0 mm Hg [-10·3 to 1·8]; median between-group difference -4·5 mm Hg [95% CI -8·5 to -0·3]; adjusted p=0·022); the median between-group difference was -5·8 mm Hg (95% CI -9·7 to -1·6; adjusted p=0·0051) among patients with complete ambulatory blood pressure data. There were no differences in safety outcomes between the two groups. INTERPRETATION: Compared with a sham procedure, ultrasound renal denervation reduced blood pressure at 2 months in patients with hypertension resistant to a standardised triple combination pill. If the blood pressure lowering effect and safety of renal denervation are maintained in the long term, renal denervation might be an alternative to the addition of further antihypertensive medications in patients with resistant hypertension. FUNDING: ReCor Medical."},{"id":"45294f103fe1","type":"article","url":"https://hartvaat.nl/2021/06/15/prevalentie-van-linkeratriumtrombus-bij-geanticoaguleerde-af-patienten/","title":"Prevalentie van linkeratriumtrombus bij geanticoaguleerde AF-patiënten","title_en":"Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["abelacimab"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.036","source_url":"https://doi.org/10.1016/j.jacc.2021.04.036","authors":["Antony Lurie","Jia Wang","Kyra J Hinnegan","William F McIntyre","Emilie P Belley-Côté","Guy Amit","Jeff S Healey","Stuart J Connolly","Jorge A Wong"],"significance":6,"published":"2021-06-15","source_date":"2021-06-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This study documented the prevalence of left atrial thrombus in AF patients despite guideline-directed anticoagulation, showing that a clinically relevant proportion harbors thrombus even on DOACs, informing pre-procedure screening decisions.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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 de prevalentie van linkeratriumtrombus bij AF-patiënten ondanks adequate anticoagulatie.","abstract_original":"BACKGROUND: The prevalence of left atrial (LA) thrombus in patients with atrial fibrillation (AF) or atrial flutter (AFL) on guideline-directed anticoagulation is not well known, yet this may inform transesophageal echocardiogram (TEE) use before cardioversion or catheter ablation. OBJECTIVES: The purpose of this study was to quantify LA thrombus prevalence among patients with AF/AFL on guideline-directed anticoagulation and to identify high-risk subgroups. METHODS: EMBASE, MEDLINE, and CENTRAL were systematically searched from inception to July 2020 for studies reporting on LA thrombus prevalence among patients with AF/AFL undergoing TEE following at least 3 weeks of continuous therapeutic oral anticoagulation with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs). Meta-analysis was performed using random effects models. RESULTS: Thirty-five studies describing 14,653 patients were identified. The mean-weighted LA thrombus prevalence was 2.73% (95% confidence interval [CI]: 1.95% to 3.80%). LA thrombus prevalence was similar for VKA- and DOAC-treated patients (2.80%; 95% CI: 1.86% to 4.21% vs. 3.12%; 95% CI: 1.92% to 5.03%; p = 0.674). Patients with nonparoxysmal AF/AFL had a 4-fold higher LA thrombus prevalence compared with paroxysmal patients (4.81%; 95% CI: 3.35% to 6.86% vs. 1.03%; 95% CI: 0.52% to 2.03%; p < 0.001). LA thrombus prevalence was higher among patients undergoing cardioversion versus ablation (5.55%; 95% CI: 3.15% to 9.58% vs. 1.65%; 95% CI: 1.07% to 2.53%; p < 0.001). Patients with CHA2DS2-VASc scores ≥3 had a higher LA thrombus prevalence compared with patients with scores ≤2 (6.31%; 95% CI: 3.72% to 10.49% vs. 1.06%; 95% CI: 0.45% to 2.49%; p < 0.001). CONCLUSIONS: LA thrombus prevalence is high in subgroups of anticoagulated patients with AF/AFL, who may benefit from routine pre-procedural TEE use before cardioversion or catheter ablation."},{"id":"eb80c30d5c50","type":"article","url":"https://hartvaat.nl/2021/06/15/plasma-renine-activiteit-na-renale-sympathische-denervatie/","title":"Plasma-renine-activiteit na renale sympathische denervatie","title_en":"Changes in Plasma Renin Activity After Renal Artery Sympathetic Denervation.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["renale-denervatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.044","source_url":"https://doi.org/10.1016/j.jacc.2021.04.044","authors":["Felix Mahfoud","Raymond R Townsend","David E Kandzari","Kazuomi Kario","Roland E Schmieder","Konstantinos Tsioufis","Stuart Pocock","Shukri David","Kiritkumar Patel","Anjani Rao","Antony Walton","Jason E Bloom","Thomas Weber","Markus Suppan","Lucas Lauder","Sidney A Cohen","Pamela McKenna","Martin Fahy","Michael Böhm","Michael A Weber"],"significance":5,"published":"2021-06-15","source_date":"2021-06-15","image":"","kennis":[],"congress":"","summary_en":"This study characterized changes in plasma renin activity after renal denervation, providing neurohormonal evidence for the mechanism of blood pressure lowering through sympathetic ablation.","created":"2026-07-03T10:29:15Z","updated":"2026-07-03T13:28:23Z","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 veranderingen in plasma-renine-activiteit na renale arterie sympathische denervatie.","abstract_original":"BACKGROUND: The renin-angiotensin-aldosterone system plays a key role in blood pressure (BP) regulation and is the target of several antihypertensive medications. Renal denervation (RDN) is thought to interrupt the sympathetic-mediated neurohormonal pathway as part of its mechanism of action to reduce BP. OBJECTIVES: The purpose of this study was to evaluate plasma renin activity (PRA) and aldosterone before and after RDN and to assess whether these baseline neuroendocrine markers predict response to RDN. METHODS: Analyses were conducted in patients with confirmed absence of antihypertensive medication. Aldosterone and PRA levels were compared at baseline and 3 months post-procedure for RDN and sham control groups. Patients in the SPYRAL HTN-OFF MED Pivotal trial were separated into 2 groups, those with baseline PRA ≥0.65 ng/ml/h (n = 110) versus <0.65 ng/ml/h (n = 116). Follow-up treatment differences between RDN and sham control groups were adjusted for baseline values using multivariable linear regression models. RESULTS: Baseline PRA was similar between RDN and control groups (1.0 ± 1.1 ng/ml/h vs. 1.1 ± 1.1 ng/ml/h; p = 0.37). Change in PRA at 3 months from baseline was significantly greater for RDN compared with control subjects (-0.2 ± 1.0 ng/ml/h; p = 0.019 vs. 0.1 ± 0.9 ng/ml/h; p = 0.14), p = 0.001 for RDN versus control subjects, and similar differences were seen for aldosterone: RDN compared with control subjects (-1.2 ± 6.4 ng/dl; p = 0.04 vs. 0.4 ± 5.4 ng/dl; p = 0.40), p = 0.011. Treatment differences at 3 months in 24-h and office systolic blood pressure (SBP) for RDN versus control patients were significantly greater for patients with baseline PRA ≥0.65 ng/ml/h versus <0.65 ng/ml/h, despite similar baseline BP. Differences in office SBP changes according to baseline PRA were also observed earlier at 2 weeks post-RDN. CONCLUSIONS: Plasma renin activity and aldosterone levels for RDN patients were significantly reduced at 3 months when compared with baseline as well as when compared with sham control. Higher baseline PRA levels were associated with a significantly greater reduction in office and 24-h SBP. (SPYRAL PIVOTAL - SPYRAL HTN-OFF MED Study; NCT02439749)."},{"id":"0775dfe05825","type":"article","url":"https://hartvaat.nl/2021/06/14/gestandaardiseerde-inspanningstraining-bij-pah-en-cteph-haalbaarheid-en-veilighe/","title":"Gestandaardiseerde inspanningstraining bij PAH en CTEPH: haalbaarheid en veiligheid","title_en":"Standardized exercise training is feasible, safe, and effective in pulmonary arterial and chronic thromboembolic pulmonary hypertension: results from a large European multicentre randomized controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa696","source_url":"https://doi.org/10.1093/eurheartj/ehaa696","authors":["Ekkehard Grünig","Alison MacKenzie","Andrew J Peacock","Christina A Eichstaedt","Nicola Benjamin","Robert Nechwatal","Silvia Ulrich","Stéphanie Saxer","Maurizio Bussotti","Marinella Sommaruga","Stefano Ghio","Lina Gumbiene","Eglė Palevičiūtė","Elena Jurevičienė","Antonio Cittadini","Anna A Stanziola","Alberto M Marra","Gabor Kovacs","Horst Olschewski","Joan-Albert Barberà","Isabel Blanco","Martijn A Spruit","Frits M E Franssen","Anton Vonk Noordegraaf","Abílio Reis","Mário Santos","Sofia Gonçalves Viamonte","Heleen Demeyer","Marion Delcroix","Eduardo Bossone","Martin Johnson"],"significance":6,"published":"2021-06-14","source_date":"2021-06-14","image":"","kennis":[],"congress":"","summary_en":"This multicenter randomized trial confirmed that standardized exercise training is feasible, safe, and effective in patients with PAH and CTEPH, supporting supervised rehabilitation as standard of care in pulmonary hypertension management.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:23Z","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 die aantoont dat gestandaardiseerde inspanningstraining haalbaar, veilig en effectief is bij PAH en CTEPH.","abstract_original":"AIMS: This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS AND RESULTS: For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17-33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18-51 m; P < 0.0001). Exercise training was feasible, safe, and well-tolerated. Secondary endpoints showed improvements in quality of life (short-form health survey 36 mental health 7.3 ± 2.5, P = 0.004), WHO-functional class (training vs. control: improvement 9:1, worsening 4:3; χ2P = 0.027) and peak oxygen consumption (0.9 ± 0.5 mL/min/kg, P = 0.048) compared with the control group. CONCLUSION: This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries."},{"id":"4f440a6af32c","type":"article","url":"https://hartvaat.nl/2021/06/08/interventies-bij-secundaire-mitralisklepinsufficientie-jama-klinisch-overzicht/","title":"Interventies bij secundaire mitralisklepinsufficiëntie: JAMA klinisch overzicht","title_en":"Interventions for Patients With Secondary Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.2741","source_url":"https://doi.org/10.1001/jama.2021.2741","authors":["Sameer Hirji","Adam S Cifu","Tsuyoshi Kaneko"],"significance":7,"published":"2021-06-08","source_date":"2021-06-08","image":"","kennis":[],"congress":"","summary_en":"This JAMA clinical review provided a comprehensive overview of interventions for secondary mitral regurgitation, integrating evidence from COAPT, MITRA-FR, and contemporary guidelines to inform clinical decision-making.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:22Z","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 klinisch overzicht over interventies voor secundaire mitralisklepinsufficiëntie. Integreert COAPT en MITRA-FR.","abstract_original":""},{"id":"b425af3b253a","type":"article","url":"https://hartvaat.nl/2021/06/08/10-jaarsfollow-up-na-revascularisatie-bij-oudere-patienten-met-complex-coronairl/","title":"10-jaarsfollow-up na revascularisatie bij oudere patiënten met complex coronairlijden","title_en":"10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["stabiel-coronairlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.04.016","source_url":"https://doi.org/10.1016/j.jacc.2021.04.016","authors":["Masafumi Ono","Patrick W Serruys","Hironori Hara","Hideyuki Kawashima","Chao Gao","Rutao Wang","Kuniaki Takahashi","Neil O'Leary","Joanna J Wykrzykowska","Faisal Sharif","Jan J Piek","Scot Garg","Michael J Mack","David R Holmes","Marie-Claude Morice","Stuart J Head","Arie Pieter Kappetein","Daniel J F M Thuijs","Thilo Noack","Piroze M Davierwala","Friedrich W Mohr","David J Cohen","Yoshinobu Onuma"],"significance":6,"published":"2021-06-08","source_date":"2021-06-08","image":"","kennis":[],"congress":"","summary_en":"This 10-year follow-up after revascularization in elderly patients with complex coronary disease provided the longest comparative data for PCI versus CABG in the older population, informing revascularization decisions at advanced age.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:22Z","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":"10-jaars follow-up na revascularisatie bij oudere patiënten met complex coronairlijden.","abstract_original":"BACKGROUND: The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear. OBJECTIVES: The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD). METHODS: In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models. RESULTS: Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; pinteraction = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; pinteraction = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients. CONCLUSIONS: Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050) (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)."},{"id":"2f35a9a87302","type":"article","url":"https://hartvaat.nl/2021/06/03/linker-hartoorsluiting-tijdens-hartchirurgie-ter-preventie-van-cva-nejm-laaos-ii/","title":"Linker-hartoorsluiting tijdens hartchirurgie ter preventie van CVA: NEJM LAAOS III","title_en":"Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2101897","source_url":"https://doi.org/10.1056/NEJMoa2101897","authors":["Richard P Whitlock","Emilie P Belley-Cote","Domenico Paparella","Jeff S Healey","Katheryn Brady","Mukul Sharma","Wilko Reents","Petr Budera","Andony J Baddour","Petr Fila","P J Devereaux","Alexander Bogachev-Prokophiev","Andreas Boening","Kevin H T Teoh","Georgios I Tagarakis","Mark S Slaughter","Alistair G Royse","Shay McGuinness","Marco Alings","Prakash P Punjabi","C David Mazer","Richard J Folkeringa","Andrea Colli","Álvaro Avezum","Juliet Nakamya","Kumar Balasubramanian","Jessica Vincent","Pierre Voisine","Andre Lamy","Salim Yusuf","Stuart J Connolly"],"significance":10,"published":"2021-06-03","source_date":"2021-06-03","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The LAAOS III trial demonstrated that surgical left atrial appendage occlusion performed during cardiac surgery significantly reduced the risk of ischemic stroke or systemic embolism in patients with atrial fibrillation. This simple addition to planned cardiac surgery provides lasting stroke protection as an adjunct to anticoagulation.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:22Z","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 NEJM LAAOS III trial die aantoonde dat chirurgische sluiting van het linker hartoor tijdens hartchirurgie het CVA-risico vermindert bij AF-patiënten. Veranderde de chirurgische praktijk.","abstract_original":"BACKGROUND: Surgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedure can be performed during cardiac surgery undertaken for other reasons. METHODS: We conducted a multicenter, randomized trial involving participants with atrial fibrillation and a CHA2DS2-VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating greater risk of stroke) who were scheduled to undergo cardiac surgery for another indication. The participants were randomly assigned to undergo or not undergo occlusion of the left atrial appendage during surgery; all the participants were expected to receive usual care, including oral anticoagulation, during follow-up. The primary outcome was the occurrence of ischemic stroke (including transient ischemic attack with positive neuroimaging) or systemic embolism. The participants, research personnel, and primary care physicians (other than the surgeons) were unaware of the trial-group assignments. RESULTS: The primary analysis population included 2379 participants in the occlusion group and 2391 in the no-occlusion group, with a mean age of 71 years and a mean CHA2DS2-VASc score of 4.2. The participants were followed for a mean of 3.8 years. A total of 92.1% of the participants received the assigned procedure, and at 3 years, 76.8% of the participants continued to receive oral anticoagulation. Stroke or systemic embolism occurred in 114 participants (4.8%) in the occlusion group and in 168 (7.0%) in the no-occlusion group (hazard ratio, 0.67; 95% confidence interval, 0.53 to 0.85; P = 0.001). The incidence of perioperative bleeding, heart failure, or death did not differ significantly between the trial groups. CONCLUSIONS: Among participants with atrial fibrillation who had undergone cardiac surgery, most of whom continued to receive ongoing antithrombotic therapy, the risk of ischemic stroke or systemic embolism was lower with concomitant left atrial appendage occlusion performed during the surgery than without it. (Funded by the Canadian Institutes of Health Research and others; LAAOS III ClinicalTrials.gov number, NCT01561651.)."},{"id":"97181797b9b4","type":"article","url":"https://hartvaat.nl/2021/06/01/implanteerbare-versus-verlengde-externe-ecg-monitoring-voor-af-na-ischemisch-cva/","title":"Implanteerbare versus verlengde externe ECG-monitoring voor AF na ischemisch CVA: JAMA","title_en":"Effect of Implantable vs Prolonged External Electrocardiographic Monitoring on Atrial Fibrillation Detection in Patients With Ischemic Stroke: The PER DIEM Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.6128","source_url":"https://doi.org/10.1001/jama.2021.6128","authors":["Brian H Buck","Michael D Hill","F Russell Quinn","Ken S Butcher","Bijoy K Menon","Sajad Gulamhusein","Muzaffar Siddiqui","Shelagh B Coutts","Thomas Jeerakathil","Eric E Smith","Khurshid Khan","Phillip A Barber","Glen Jickling","Lucy Reyes","Supriya Save","Paige Fairall","Lori Piquette","Noreen Kamal","Derek S Chew","Andrew M Demchuk","Ashfaq Shuaib","Derek V Exner"],"significance":7,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This JAMA trial compared implantable versus prolonged external ECG monitoring for AF detection after ischemic stroke, evaluating the optimal monitoring strategy for identifying occult arrhythmia as a cause of cryptogenic stroke.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:22Z","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 trial die implanteerbare vergeleek met verlengde externe ECG-monitoring voor AF-detectie na ischemisch CVA.","abstract_original":"IMPORTANCE: The relative rates of detection of atrial fibrillation (AF) or atrial flutter from evaluating patients with prolonged electrocardiographic monitoring with an external loop recorder or implantable loop recorder after an ischemic stroke are unknown. OBJECTIVE: To determine, in patients with a recent ischemic stroke, whether 12 months of implantable loop recorder monitoring detects more occurrences of AF compared with conventional external loop recorder monitoring for 30 days. DESIGN, SETTING, AND PARTICIPANTS: Investigator-initiated, open-label, randomized clinical trial conducted at 2 university hospitals and 1 community hospital in Alberta, Canada, including 300 patients within 6 months of ischemic stroke and without known AF from May 2015 through November 2017; final follow-up was in December 2018. INTERVENTIONS: Participants were randomly assigned 1:1 to prolonged electrocardiographic monitoring with either an implantable loop recorder (n = 150) or an external loop recorder (n = 150) with follow-up visits at 30 days, 6 months, and 12 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the development of definite AF or highly probable AF (adjudicated new AF lasting ≥2 minutes within 12 months of randomization). There were 8 prespecified secondary outcomes including time to event analysis of new AF, recurrent ischemic stroke, intracerebral hemorrhage, death, and device-related serious adverse events within 12 months. RESULTS: Among the 300 patients who were randomized (median age, 64.1 years [interquartile range, 56.1 to 73.7 years]; 121 were women [40.3%]; and 66.3% had a stroke of undetermined etiology with a median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score of 4 [interquartile range, 3 to 5]), 273 (91.0%) completed cardiac monitoring lasting 24 hours or longer and 259 (86.3%) completed both the assigned monitoring and 12-month follow-up visit. The primary outcome was observed in 15.3% (23/150) of patients in the implantable loop recorder group and 4.7% (7/150) of patients in the external loop recorder group (between-group difference, 10.7% [95% CI, 4.0% to 17.3%]; risk ratio, 3.29 [95% CI, 1.45 to 7.42]; P = .003). Of the 8 specified secondary outcomes, 6 were not significantly different. There were 5 patients (3.3%) in the implantable loop recorder group who had recurrent ischemic stroke vs 8 patients (5.3%) in the external loop recorder group (between-group difference, -2.0% [95% CI, -6.6% to 2.6%]), 1 (0.7%) vs 1 (0.7%), respectively, who had intracerebral hemorrhage (between-group difference, 0% [95% CI, -1.8% to 1.8%]), 3 (2.0%) vs 3 (2.0%) who died (between-group difference, 0% [95% CI, -3.2% to 3.2%]), and 1 (0.7%) vs 0 (0%) who had device-related serious adverse events. CONCLUSIONS AND RELEVANCE: Among patients with ischemic stroke and no prior evidence of AF, implantable electrocardiographic monitoring for 12 months, compared with prolonged external monitoring for 30 days, resulted in a significantly greater proportion of patients with AF detected over 12 months. Further research is needed to compare clinical outcomes associated with these monitoring strategies and relative cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02428140."},{"id":"b2def1c866c4","type":"article","url":"https://hartvaat.nl/2021/06/01/continue-cardiale-monitoring-versus-standaardzorg-bij-cryptogeen-cva-jama/","title":"Continue cardiale monitoring versus standaardzorg bij cryptogeen CVA: JAMA","title_en":"Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease: The STROKE-AF Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.6470","source_url":"https://doi.org/10.1001/jama.2021.6470","authors":["Richard A Bernstein","Hooman Kamel","Christopher B Granger","Jonathan P Piccini","Pramod P Sethi","Jeffrey M Katz","Carola Alfaro Vives","Paul D Ziegler","Noreli C Franco","Lee H Schwamm"],"significance":7,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This JAMA trial showed that long-term continuous cardiac monitoring significantly increases AF detection in patients with ischemic stroke attributed to large- or small-vessel disease, a population not traditionally considered high-risk for AF.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:22Z","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 trial die langdurige continue cardiale monitoring vergeleek met standaardzorg voor AF-detectie bij cryptogeen CVA.","abstract_original":"IMPORTANCE: Patients with ischemic stroke attributed to large- or small-vessel disease are not considered at high risk for atrial fibrillation (AF), and the AF incidence rate in this population is unknown. OBJECTIVES: To determine whether long-term cardiac monitoring is more effective than usual care for AF detection in patients with stroke attributed to large- or small-vessel disease through 12 months of follow-up. DESIGN, SETTING, AND PARTICIPANTS: The STROKE-AF trial was a randomized (1:1), multicenter (33 sites in the US) clinical trial that enrolled 496 patients between April 2016 and July 2019, with primary end point follow-up through August 2020. Eligible patients were aged 60 years or older or aged 50 to 59 years with at least 1 additional stroke risk factor and had an index stroke attributed to large- or small-vessel disease within 10 days prior to insertable cardiac monitor (ICM) insertion. INTERVENTIONS: Patients randomized to the intervention group (n = 242) received ICM insertion within 10 days of the index stroke; patients in the control group (n = 250) received site-specific usual care consisting of external cardiac monitoring, such as 12-lead electrocardiograms, Holter monitoring, telemetry, or event recorders. MAIN OUTCOMES AND MEASURES: Incident AF lasting more than 30 seconds through 12 months. RESULTS: Among 492 patients who were randomized (mean [SD] age, 67.1 [9.4] years; 185 [37.6%] women), 417 (84.8%) completed 12 months of follow-up. The median (interquartile range) CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score was 5 (4-6). AF detection at 12 months was significantly higher in the ICM group vs the control group (27 patients [12.1%] vs 4 patients [1.8%]; hazard ratio, 7.4 [95% CI, 2.6-21.3]; P < .001). Among the 221 patients in the ICM group who received an ICM, 4 (1.8%) had ICM procedure-related adverse events (1 site infection, 2 incision site hemorrhages, and 1 implant site pain). CONCLUSIONS AND RELEVANCE: Among patients with stroke attributed to large- or small-vessel disease, monitoring with an ICM compared with usual care detected significantly more AF over 12 months. However, further research is needed to understand whether identifying AF in these patients is of clinical importance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02700945."},{"id":"9bef8786b63a","type":"article","url":"https://hartvaat.nl/2021/06/01/dieet-en-natriumreductie-op-cardiale-schade-en-inflammatie-dash-sodium/","title":"Dieet en natriumreductie op cardiale schade en inflammatie: DASH-Sodium","title_en":"Effects of Diet and Sodium Reduction on Cardiac Injury, Strain, and Inflammation: The DASH-Sodium Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["colcot-trial","voeding-hart"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.03.320","source_url":"https://doi.org/10.1016/j.jacc.2021.03.320","authors":["Stephen P Juraschek","Lara C Kovell","Lawrence J Appel","Edgar R Miller","Frank M Sacks","Alex R Chang","Robert H Christenson","Heather Rebuck","Kenneth J Mukamal"],"significance":7,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This DASH-Sodium analysis showed that combining the DASH diet with sodium reduction produces additive reductions in cardiac injury biomarkers (troponin), cardiac strain (NT-proBNP), and inflammation, providing a mechanistic basis for dietary cardiovascular protection.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:22Z","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":"DASH-Sodium trial analyse naar de effecten van dieet en natriumreductie op cardiale schade (troponine), strain en inflammatie.","abstract_original":"BACKGROUND: The DASH (Dietary Approaches to Stop Hypertension) diet has been determined to have beneficial effects on cardiac biomarkers. The effects of sodium reduction on cardiac biomarkers, alone or combined with the DASH diet, are unknown. OBJECTIVES: The purpose of this study was to determine the effects of sodium reduction and the DASH diet, alone or combined, on biomarkers of cardiac injury, strain, and inflammation. METHODS: DASH-Sodium was a controlled feeding study in adults with systolic blood pressure (BP) 120 to 159 mm Hg and diastolic BP 80 to 95 mm Hg, randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks. Body weight was kept constant. At the 2,100 kcal level, the 3 sodium levels were low (50 mmol/day), medium (100 mmol/day), and high (150 mmol/day). Outcomes were 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) (measure of cardiac injury), N-terminal pro-B-type natriuretic peptide (NT-proBNP) (measure of strain), and high-sensitivity C-reactive protein (hs-CRP) (measure of inflammation), collected at baseline and at the end of each feeding period. RESULTS: Of the original 412 participants, the mean age was 48 years; 56% were women, and 56% were Black. Mean baseline systolic/diastolic BP was 135/86 mm Hg. DASH (vs. control) reduced hs-cTnI by 18% (95% confidence interval [CI]: -27% to -7%) and hs-CRP by 13% (95% CI: -24% to -1%), but not NT-proBNP. In contrast, lowering sodium from high to low levels reduced NT-proBNP independently of diet (19%; 95% CI: -24% to -14%), but did not alter hs-cTnI and mildly increased hs-CRP (9%; 95% CI: 0.4% to 18%). Combining DASH with sodium reduction lowered hs-cTnI by 20% (95% CI: -31% to -7%) and NT-proBNP by 23% (95% CI: -32% to -12%), whereas hs-CRP was not significantly changed (-7%; 95% CI: -22% to 9%) compared with the high sodium-control diet. CONCLUSIONS: Combining a DASH dietary pattern with sodium reduction can lower 2 distinct mechanisms of subclinical cardiac damage: injury and strain, whereas DASH alone reduced inflammation. (Dietary Patterns, Sodium Intake and Blood Pressure [DASH - Sodium]; NCT00000608)."},{"id":"e3364ac04762","type":"article","url":"https://hartvaat.nl/2021/06/01/katheterablatie-of-antiaritmica-als-eerstelijnstherapie-bij-af-jama-cardiology-m/","title":"Katheterablatie of antiaritmica als eerstelijnstherapie bij AF: JAMA Cardiology meta-analyse","title_en":"Assessment of Catheter Ablation or Antiarrhythmic Drugs for First-line Therapy of Atrial Fibrillation: A Meta-analysis of Randomized Clinical Trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.0852","source_url":"https://doi.org/10.1001/jamacardio.2021.0852","authors":["Mohit K Turagam","Daniel Musikantow","William Whang","Jacob S Koruth","Marc A Miller","Marie-Noelle Langan","Aamir Sofi","Subbarao Choudry","Srinivas R Dukkipati","Vivek Y Reddy"],"significance":8,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis of randomized trials confirmed that catheter ablation as first-line therapy for atrial fibrillation is superior to antiarrhythmic drugs for maintaining sinus rhythm, with potential benefits on cardiovascular outcomes. The pooled data supported the shift toward earlier ablation.","created":"2026-07-03T10:29:14Z","updated":"2026-07-03T13:28:22Z","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 Cardiology meta-analyse van gerandomiseerde trials die katheterablatie vergeleek met antiaritmica als eerstelijns AF-therapie. Consolideert EARLY-AF en STOP AF First.","abstract_original":"IMPORTANCE: Early rhythm control of atrial fibrillation (AF) with either antiarrhythmic drugs (AADs) or catheter ablation has been reported to improve cardiovascular outcomes compared with usual care; however, the optimal therapeutic modality to achieve early rhythm control is unclear. OBJECTIVE: To assess the safety and efficacy of AF ablation as first-line therapy when compared with AADs in patients with paroxysmal AF. DATA SOURCES: PubMed/MEDLINE, Scopus, Google Scholar, and various major scientific conference sessions from January 1, 2000, through November 23, 2020. STUDY SELECTION: Randomized clinical trials (RCTs) published in English that had at least 12 months of follow-up and compared clinical outcomes of ablation vs AADs as first-line therapy in adults with AF. The quality of individual studies was assessed using the Cochrane risk of bias tool. Six RCTs met inclusion criteria, including 1212 patients. DATA EXTRACTION AND SYNTHESIS: Two investigators independently extracted data. Reporting was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Analysis was performed using a random-effects model with the Mantel-Haenszel method, and results are presented as 95% CIs. MAIN OUTCOMES AND MEASURES: Main outcomes were safety and efficacy of AF ablation as first-line therapy when compared with AADs. Trials were evaluated as having low risk of selection and attrition biases, high risk of performance bias, and with unclear risk for detection biases due to unblinding and open-label designs. RESULTS: A total of 6 RCTs involving 1212 patients with AF were included (609 were randomized to AF ablation and 603 to drug therapy; mean [SD] age, 56 [11] years). Compared with AADs, catheter ablation use was associated with reductions in recurrent atrial arrhythmia (32.3% vs 53%; risk ratio [RR], 0.62; 95% CI, 0.51-0.74; P < .001; I2 = 40%), with a number needed to treat with ablation to prevent 1 arrhythmia of 5. Use of ablation was also associated with reduced symptomatic atrial arrhythmia (11.8% vs 26.4%; RR, 0.44; 95% CI, 0.27-0.72; P = .001; I2 = 54%) and hospitalization (5.6% vs 18.7%; RR, 0.32; 95% CI, 0.19-0.53; P < .001) with no significant difference in serious adverse events between the groups (4.2% vs 2.8%; RR, 1.52; 95% CI, 0.81-2.85; P = .19). CONCLUSIONS AND RELEVANCE: In this meta-analysis of randomized clinical trials including first-line therapy of patients with paroxysmal AF, catheter ablation compared with antiarrhythmic drugs was associated with reductions in recurrence of atrial arrhythmias and hospitalizations, with no difference in major adverse events."},{"id":"dcea9a445ce5","type":"article","url":"https://hartvaat.nl/2021/06/01/dapagliflozine-bij-hfref-naar-geslacht-dapa-hf-pre-gespecificeerde-analyse/","title":"Dapagliflozine bij HFrEF naar geslacht: DAPA-HF pre-gespecificeerde analyse","title_en":"Efficacy and Safety of Dapagliflozin in Men and Women With Heart Failure With Reduced Ejection Fraction: A Prespecified Analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf","dapa-hf","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.0379","source_url":"https://doi.org/10.1001/jamacardio.2021.0379","authors":["Jawad H Butt","Kieran F Docherty","Mark C Petrie","Morten Schou","Mikhail N Kosiborod","Eileen O'Meara","Tzvetana Katova","Charlotta E A Ljungman","Mirta Diez","Modele O Ogunniyi","Anna Maria Langkilde","Mikaela Sjöstrand","Daniel Lindholm","Olof Bengtsson","Felipe A Martinez","Piotr Ponikowski","Marc S Sabatine","Scott D Solomon","Pardeep S Jhund","John J V McMurray","Lars Køber"],"significance":7,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This DAPA-HF analysis confirmed that dapagliflozin is equally effective and safe in women and men with HFrEF, providing reassurance about sex-specific outcomes in a drug class tested predominantly in male-majority trials.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:22Z","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 Cardiology DAPA-HF analyse naar werkzaamheid en veiligheid van dapagliflozine bij mannen versus vrouwen met HFrEF.","abstract_original":"IMPORTANCE: Women may respond differently to certain treatments for heart failure (HF) with reduced ejection fraction (HFrEF) than men. OBJECTIVE: To investigate the efficacy and safety of dapagliflozin compared with placebo in men and women with HFrEF enrolled in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial (DAPA-HF). DESIGN, SETTING, AND PARTICIPANTS: Prespecified subgroup analysis of a phase 3 randomized clinical trial conducted at 410 sites in 20 countries. Patients with New York Heart Association functional class II through IV with an ejection fraction of 40% or less and elevated N-terminal pro-B-type natriuretic peptide were eligible. Data were analyzed between June 2020 and January 2021. INTERVENTIONS: Addition of once-daily 10 mg of dapagliflozin or placebo to guideline-recommended therapy. MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of an episode of worsening HF (HF hospitalization or urgent HF visit requiring intravenous therapy) or cardiovascular death. RESULTS: A total of 4744 patients were randomized in DAPA-HF, of whom 1109 were women (23.4%). Compared with placebo, dapagliflozin reduced the risk of worsening HF events or cardiovascular death to a similar extent in both men and women (hazard ratios, 0.73 [95% CI, 0.63-0.85] and 0.79 [95% CI, 0.59-1.06], respectively; P for interaction = .67). Consistent benefits were observed for the components of the primary outcome and all-cause mortality. Compared with placebo, dapagliflozin increased the proportion of patients with a meaningful improvement in symptoms (Kansas City Cardiomyopathy Questionnaire total symptom score of ≥5 points; men, 59% vs 50%; women, 57% vs 54%; P for interaction = .14) and decreased the proportion with worsening symptoms (Kansas City Cardiomyopathy Questionnaire total symptom score decrease of ≥5 points; men, 25% vs 34%; women, 27% vs 31%; P for interaction = .15), irrespective of sex. Results were consistent for the Kansas City Cardiomyopathy Questionnaire clinical summary score and overall summary score. Study drug discontinuation and serious adverse events were not more frequent in the dapagliflozin group than in the placebo group in either men or women. CONCLUSIONS AND RELEVANCE: Dapagliflozin reduced the risk of worsening HF, cardiovascular death, and all-cause death and improved symptoms, physical function, and health-related quality of life similarly in men and women with heart failure and reduced ejection fraction. In addition, dapagliflozin was safe and well-tolerated irrespective of sex. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03036124."},{"id":"e307dac8f7c8","type":"article","url":"https://hartvaat.nl/2021/06/01/geisoleerde-diastolische-hypertensie-cohort-en-meta-analyse-voor-behandeldrempel/","title":"Geïsoleerde diastolische hypertensie: cohort en meta-analyse voor behandeldrempel","title_en":"A cohort study and meta-analysis of isolated diastolic hypertension: searching for a threshold to guide treatment.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab111","source_url":"https://doi.org/10.1093/eurheartj/ehab111","authors":["Alan P Jacobsen","Mahmoud Al Rifai","Kelly Arps","Seamus P Whelton","Matthew J Budoff","Khurram Nasir","Michael J Blaha","Bruce M Psaty","Roger S Blumenthal","Wendy S Post","John W McEvoy"],"significance":7,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This cohort study and meta-analysis investigated whether isolated diastolic hypertension (as defined by the ACC/AHA 130/80 threshold) is associated with cardiovascular risk sufficient to warrant treatment, addressing a common clinical dilemma.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T18:38:49Z","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":"Cohortstudie en meta-analyse die een behandeldrempel zoekt voor geïsoleerde diastolische hypertensie.","abstract_original":"AIMS: Whether isolated diastolic hypertension (IDH), as defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline, is associated with cardiovascular disease (CVD) has been disputed. We aimed to further study the associations of IDH with (i) subclinical CVD in the form of coronary artery calcium (CAC), (ii) incident systolic hypertension, and (iii) CVD events. METHODS AND RESULTS: We used multivariable-adjusted logistic and Cox regression to test whether IDH by 2017 ACC/AHA criteria (i.e. systolic blood pressure <130 mmHg and diastolic blood pressure ≥80 mmHg) was associated with the above outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA). In a random-effects meta-analysis of the association between IDH and CVD events, we combined the MESA results with those from seven other previously published cohort studies. Among the 5104 MESA participants studied, 7.5% had IDH by the 2017 ACC/AHA criteria. There was no association between IDH and CAC [e.g. adjusted prevalence odds ratio for CAC >0 of 0.88 (95% CI 0.66, 1.17)]. Similarly, while IDH was associated with incident systolic hypertension, there was no statistically significant associations with incident CVD [hazard ratio 1.19 (95% CI 0.77, 1.84)] or death [hazard ratio 0.94 (95% CI 0.65, 1.36)] over 13 years in MESA. In a stratified meta-analysis of eight cohort studies (10 037 843 participants), the 2017 IDH definition was also not consistently associated with CVD and the relative magnitude of any potential association was noted to be numerically small [e.g. depending on inclusion criteria applied in the stratification, the adjusted hazard ratios ranged from 1.04 (95% CI 0.98, 1.10) to 1.09 (95% 1.03, 1.15)]. CONCLUSION: The lack of consistent excess in CAC or CVD suggests that emphasis on healthy lifestyle rather than drug therapy is sufficient among the millions of middle-aged or older adults who now meet the 2017 ACC/AHA criteria for IDH, though they require follow-up for incident systolic hypertension. These findings may not extrapolate to adults younger than 40 years, motivating further study in this age group."},{"id":"19300925fc32","type":"article","url":"https://hartvaat.nl/2021/06/01/klinische-uitkomsten-en-respons-op-vericiguat-naar-index-hf-event-victoria/","title":"Klinische uitkomsten en respons op vericiguat naar index HF-event: VICTORIA","title_en":"Clinical Outcomes and Response to Vericiguat According to Index Heart Failure Event: Insights From the VICTORIA Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.6455","source_url":"https://doi.org/10.1001/jamacardio.2020.6455","authors":["Carolyn S P Lam","Anna Giczewska","Karen Sliwa","Frank Edelmann","Jens Refsgaard","Edimar Bocchi","Justin A Ezekowitz","Adrian F Hernandez","Christopher M O'Connor","Lothar Roessig","Mahesh J Patel","Burkert Pieske","Kevin J Anstrom","Paul W Armstrong"],"significance":6,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This VICTORIA analysis showed that vericiguat's benefit varies by the index heart failure event type, with patients recently hospitalized for heart failure deriving the greatest absolute benefit.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:21Z","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":"VICTORIA analyse naar klinische uitkomsten en respons op vericiguat gestratificeerd naar het index hartfalen-event.","abstract_original":"IMPORTANCE: The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH. OBJECTIVE: To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTS: Analysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020. INTERVENTION: Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS: Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms. CONCLUSIONS AND RELEVANCE: Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02861534."},{"id":"5eb2e10fe0b8","type":"article","url":"https://hartvaat.nl/2021/06/01/metabole-effecten-van-empagliflozine-bij-hf-empire-hf-metabolic-gerandomiseerde-/","title":"Metabole effecten van empagliflozine bij HF: Empire HF Metabolic gerandomiseerde trial","title_en":"Metabolic Effects of Empagliflozin in Heart Failure: A Randomized, Double-Blind, and Placebo-Controlled Trial (Empire HF Metabolic).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","emperor-trials"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.053463","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.053463","authors":["Jesper Jensen","Massar Omar","Caroline Kistorp","Christian Tuxen","Ida Gustafsson","Lars Køber","Finn Gustafsson","Jens Faber","Julie L Forman","Jacob E Møller","Morten Schou"],"significance":6,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"The Empire HF Metabolic trial characterized the metabolic effects of empagliflozin in heart failure, showing favorable shifts in ketone body utilization and energy metabolism that may underlie the cardiac benefit of SGLT2 inhibitors.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:21Z","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":"Empire HF Metabolic gerandomiseerde trial naar de metabole effecten van empagliflozine bij hartfalen. Mechanistisch onderzoek.","abstract_original":""},{"id":"63b5a02c4004","type":"article","url":"https://hartvaat.nl/2021/06/01/aanhoudend-voordeel-van-gedragsinterventies-voor-hypertensie-gerandomiseerde-tri/","title":"Aanhoudend voordeel van gedragsinterventies voor hypertensie: gerandomiseerde trial","title_en":"Sustained Benefit of Alternate Behavioral Interventions to Improve Hypertension Control: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["select-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15192","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15192","authors":["Maria Antonia Rodriguez","Binhuan Wang","Sangmin Hyoung","Jennifer Friedberg","Judith Wylie-Rosett","Yixin Fang","John P Allegrante","Stuart R Lipsitz","Sundar Natarajan"],"significance":6,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial demonstrated sustained blood pressure improvement with alternative behavioral interventions (motivational interviewing, health coaching), showing that lifestyle modification benefits persist beyond the active intervention period.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:21Z","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":"Gerandomiseerde trial die het aanhoudende voordeel aantoont van alternatieve gedragsinterventies voor hypertensiecontrole.","abstract_original":"[Figure: see text]."},{"id":"b1fe79ac240d","type":"article","url":"https://hartvaat.nl/2021/06/01/cd34-antilichaam-sirolimus-eluting-combo-stent-versus-orsiro-gerandomiseerde-tri/","title":"CD34-antilichaam sirolimus-eluting Combo stent versus Orsiro: gerandomiseerde trial","title_en":"Randomized Clinical Comparison of the Dual-Therapy CD34 Antibody-Covered Sirolimus-Eluting Combo Stent With the Sirolimus-Eluting Orsiro Stent in Patients Treated With Percutaneous Coronary Intervention: The SORT OUT X Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.052766","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.052766","authors":["Lars Jakobsen","Evald H Christiansen","Phillip Freeman","Johnny Kahlert","Karsten Veien","Michael Maeng","Bent Raungaard","Julia Ellert","Anton B Villadsen","Steen D Kristensen","Ole Ahlehoff","Martin K Christensen","Christian J Terkelsen","Hans Erik Bøtker","Jens Aaroe","Troels Thim","Leif Thuesen","Ahmed Aziz","Ashkan Eftekhari","Rebekka V Jensen","Nicolaj B Støttrup","Jeppe G Rasmussen","Anders Junker","Svend E Jensen","Henrik S Hansen","Lisette O Jensen"],"significance":5,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared a dual-therapy CD34 antibody-coated sirolimus stent (Combo) with the Orsiro stent, testing whether combining endothelial capture with drug elution improves stent outcomes.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:21Z","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":"Gerandomiseerde vergelijking van een duale-therapie CD34-antilichaam sirolimus-eluting stent met de sirolimus-eluting Orsiro stent.","abstract_original":"BACKGROUND: Target lesion failure remains an issue with contemporary drug-eluting stents. Thus, the dual-therapy sirolimus-eluting and CD34+ antibody-coated Combo stent (DTS) was designed to further improve early healing. This study aimed to investigate whether the DTS is noninferior to the sirolimus-eluting Orsiro stent (SES) in an all-comers patient population. METHODS: The SORT OUT X (Combo Stent Versus Orsiro Stent) trial, was a large-scale, randomized, multicenter, single-blind, 2-arm, noninferiority trial with registry-based follow-up. The primary end point target lesion failure was a composite of cardiac death, myocardial infarction, or target lesion revascularization within 12 months, analyzed using intention-to-treat. The trial was powered for assessing target lesion failure noninferiority of the DTS compared with the SES with a predetermined noninferiority margin of 0.021. RESULTS: A total of 3146 patients were randomized to treatment with the DTS (1578 patients; 2008 lesions) or SES (1568 patients; 1982 lesions). At 12 months, intention-to-treat analysis showed that 100 patients (6.3%) assigned the DTS and 58 patients (3.7%) assigned the SES met the primary end point (absolute risk difference, 2.6% [upper limit of 1-sided 95% CI, 4.1%]; P (noninferiority)=0.76). The SES was superior to the DTS (incidence rate ratios for target lesion failure, 1.74 [95% CI, 1.26-2.41]; P=0.00086). The difference was explained mainly by a higher incidence of target lesion revascularization in the DTS group compared with the SES group (53 [3.4%] vs. 24 [1.5%]; incidence rate ratio, 2.22 [95% CI, 1.37-3.61]; P=0.0012). CONCLUSIONS: The DTS did not confirm noninferiority to the SES for target lesion failure at 12 months in an all-comer population. The SES was superior to the DTS mainly because the DTS was associated with an increased risk of target lesion revascularization. However, rates of death, cardiac death, and myocardial infarction at 12 months did not differ significantly between the 2 stent groups. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03216733."},{"id":"a1ad44916b06","type":"article","url":"https://hartvaat.nl/2021/06/01/diagnostiek-van-hartfalen-in-de-huisartsenpraktijk-ipd-meta-analyse/","title":"Diagnostiek van hartfalen in de huisartsenpraktijk: IPD meta-analyse","title_en":"Diagnosing heart failure in primary care: individual patient data meta-analysis of two European prospective studies.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13311","source_url":"https://doi.org/10.1002/ehf2.13311","authors":["Andrea K Roalfe","Clare J Taylor","Johannes C Kelder","Arno W Hoes","F D Richard Hobbs"],"significance":7,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This individual patient data meta-analysis evaluated natriuretic peptide thresholds for diagnosing heart failure in primary care, providing evidence-based cut-points for the clinical decision to refer for specialist assessment.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:21Z","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 patiëntdata meta-analyse van twee Europese prospectieve studies naar hartfalendiagnostiek in de eerste lijn.","abstract_original":"AIMS: Natriuretic peptides are helpful in detecting chronic heart failure (HF) in primary care; however, there are a lack of data evaluating thresholds recommended by clinical guidelines. This study assesses the diagnostic accuracy of N-terminal pro-B-type natriuretic peptide (NT-proBNP) using combined individual patient data from two studies in the UK and the Netherlands. METHODS AND RESULTS: Random effects methods were used to estimate the performance characteristics of NT-proBNP thresholds recommended by the European Society of Cardiology (ESC) and the UK National Institute for Health and Care Excellence (NICE) guidelines. New onset HF was diagnosed in 313 of 1073 (29.2%) participants. Age, sex, and atrial fibrillation-adjusted NT-proBNP was a better predictor of HF with reduced ejection fraction (HFrEF) than HF preserved ejection fraction (HFpEF), with area under receiver operating characteristic curve of 0.82 95% CI (0.78 to 0.86) vs. 0.71 (0.66 to 0.75). In persons aged 70 years and over, the ESC threshold at 125 ng/L for detection of all-cause HF had summary negative predictive value (NPV) of 84.9% (81.6 to 88.2), positive predictive value (PPV) 68.1% (63.1 to 73.3), sensitivity 74.9% (69.5 to 80.3), and specificity 80.1% (76.9 to 83.4); the NICE threshold at 400 ng/L had summary NPV of 74.7% (72.1 to 77.2), PPV 81.8% (73.3 to 89.5), sensitivity 43.5% (37.2 to 49.8), and specificity 94.5% (92.3 to 96.7). CONCLUSIONS: N-terminal pro-B-type natriuretic peptide is better at detecting HFrEF than HFpEF in a primary care setting. In persons aged 70 and over, the ESC threshold of 125 ng/L is more accurate at detecting and excluding HF than the higher level suggested in NICE guidelines. More prospective data are required to establish the optimal NP threshold for detecting chronic HF in general practice."},{"id":"9c85c9b9c02f","type":"article","url":"https://hartvaat.nl/2021/06/01/inspanningstraining-en-hs-troponine-t-bij-hfref/","title":"Inspanningstraining en hs-troponine T bij HFrEF","title_en":"Exercise training and high-sensitivity cardiac troponin T in patients with heart failure with reduced ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bloeddrukbehandeling","step-hfpef","summit-trial","troponine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13310","source_url":"https://doi.org/10.1002/ehf2.13310","authors":["Elias Koppen","Torbjørn Omland","Alf Inge Larsen","Trine Karlsen","Axel Linke","Eva Prescott","Martin Halle","Håvard Dalen","Charles Delagardelle","Torstein Hole","Emeline M van Craenenbroeck","Paul Beckers","Øyvind Ellingsen","Patrick Feiereisen","Torstein Valborgland","Vibeke Videm"],"significance":5,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that exercise training reduces high-sensitivity troponin T levels in HFrEF patients, suggesting that regular physical activity decreases subclinical myocardial injury in the heart failure population.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:21Z","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":"Studie naar het effect van inspanningstraining op hoog-sensitief troponine T bij HFrEF-patiënten.","abstract_original":"AIMS: Whether an exercise training intervention is associated with reduction in long-term high-sensitivity cardiac troponin T (hs-cTnT) concentration (a biomarker of subclinical myocardial injury) in patients with heart failure with reduced ejection fraction (HFrEF) is unknown. The aims were to determine (i) the effect of a 12 week endurance exercise training intervention with different training intensities on hs-cTnT in stable patients with HFrEF (left ventricular ejection fraction ≤ 35%) and (ii) associations between hs-cTnT and peak oxygen uptake (VO2peak ). METHODS AND RESULTS: In this sub-study of the SMARTEX-HF trial originally including 261 patients from nine European centres, 213 eligible patients were included after withdrawals and appropriate exclusions [19% women, mean age 61.2 years (standard deviation: 11.9)], randomized to high-intensity interval training (HIIT; n = 77), moderate continuous training (MCT; n = 63), or a recommendation of regular exercise (RRE; n = 73). Hs-cTnT measurements and clinical data acquired before (BL) and after a 12 week exercise training intervention (12 weeks) and at 1 year follow-up (1 year) were analysed using multivariable mixed models. Baseline hs-cTnT was above the 99th percentile upper reference limit of 14 ng/L in 35 (48%), 35 (56%), and 49 (64%) patients in the RRE, MCT, and HIIT groups, respectively. Median hs-cTnT was 16 ng/L at BL, 14 ng/L at 12 weeks, and 14 ng/L at 1 year. Hs-cTnT was statistically significantly reduced at 12 weeks in a model adjusted for randomization group, centre and VO2peak , and after further adjustment in the final model that also included age, sex, creatinine concentrations, N-terminal pro-brain natriuretic peptide, smoking, and heart failure treatment. The mean reduction from BL to 12 weeks in the final model was 1.1 ng/L (95% confidence interval: 1.0-1.2 ng/L, P < 0.001), and the reduction was maintained at 1 year with a mean reduction from BL to 1 year of 1.1 ng/L (95% confidence interval: 1.0-1.1 ng/L, P = 0.025). Randomization group was not associated with hs-cTnT at any time point (overall test: P = 0.20, MCT vs. RRE: P = 0.81, HIIT vs. RRE: P = 0.095, interaction time × randomization group: P = 0.88). Independent of time point, higher VO2peak correlated with lower hs-cTnT (mean reduction over all time points: 0.2 ng/L per increasing mL·kg-1 ·min-1 , P = 0.002), without between-group differences (P = 0.19). CONCLUSIONS: In patients with stable HFrEF, a 12 week exercise intervention was associated with reduced hs-cTnT in all groups when adjusted for clinical variables. Higher VO2peak correlated with lower hs-cTnT, suggesting a positive long-term effect of increasing VO2peak on subclinical myocardial injury in HFrEF, independent of training programme."},{"id":"fc7d3d312c3d","type":"article","url":"https://hartvaat.nl/2021/06/01/sglt2-remmers-versus-arni-bij-hfref-meta-analyse/","title":"SGLT2-remmers versus ARNI bij HFrEF: meta-analyse","title_en":"SGLT2i versus ARNI in heart failure with reduced ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13313","source_url":"https://doi.org/10.1002/ehf2.13313","authors":["Yuling Yan","Bin Liu","Jun Du","Jing Wang","Xiaodong Jing","Yajie Liu","Songbai Deng","Jianlin Du","Qiang She"],"significance":7,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This meta-analysis indirectly compared SGLT2 inhibitors with sacubitril-valsartan (ARNI) in HFrEF, finding comparable effect sizes on key outcomes and supporting both as essential components of contemporary heart failure therapy.","created":"2026-07-03T10:29:13Z","updated":"2026-07-03T13:28:21Z","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 SGLT2-remmers vergeleek met ARNI bij HFrEF. Indirecte vergelijking van de twee nieuwste HF-therapiepijlers.","abstract_original":"AIMS: This study aimed to determine the effects of sodium-glucose cotransporter-2 inhibitor (SGLT2i) in heart failure with reduced ejection fraction (HFrEF), compare the effect of SGLT2i with angiotensin receptor neprilysin inhibitor (ARNI), and find whether combination of SGLT2i and ARNI is better than monotherapy. METHODS AND RESULTS: Embase, Medline, and Cochrane Central Registry of Controlled Trials were searched for randomized controlled trials evaluating SGLT2i or ARNI in HFrEF. And a total of six trials were included. SGLT2i was found to significantly reduce the risk of cardiovascular death or hospitalization for heart failure by 27% [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.67-0.80], hospitalization for heart failure by 31% (HR 0.69, 95% CI 0.62-0.77), cardiovascular death by 16% (HR 0.84, 95% CI 0.74-0.95), and all-cause death by 16% (HR 0.84, 95% CI 0.75-0.94) in HFrEF only with a statistically higher risk of genital infection (risk ratio (RR) 2.78, 95% CI 1.46-5.29). The reduction in cardiovascular death or hospitalization for heart failure was of similar magnitude in patients with or without diabetes mellitus (HR 0.71, 95% CI 0.64-0.80 vs. HR 0.75, 95% CI 0.65-0.87) using SGLT2i. Indirect treatment comparison showed that SGLT2i and ARNI had similar effects on primary outcome (HR 0.93, 95% CI 0.82-1.06). And combination of SGLT2i and ARNI achieved a better prognosis performance (HR 0.68, 95% CI 0.53-0.89) compared with ARNI monotherapy. CONCLUSIONS: SGLT2i could safely reduce cardiovascular death or hospitalization for heart failure in HFrEF regardless of diabetes mellitus status. SGLT2i and ARNI demonstrate similar effects, while combination of SGLT2i and ARNI results in a better cardiovascular protective effect."},{"id":"4a8bed98487f","type":"article","url":"https://hartvaat.nl/2021/06/01/serumkalium-en-prognose-bij-symptomatisch-hf/","title":"Serumkalium en prognose bij symptomatisch HF","title_en":"Serum potassium levels provide prognostic information in symptomatic heart failure beyond traditional clinical variables.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13295","source_url":"https://doi.org/10.1002/ehf2.13295","authors":["Camila Cristiane Toledo","Pedro Vellosa Schwartzmann","Luis Miguel Silva","Gabriel da Silva Ferreira","Fernando Bianchini Cardoso","Vinicius Citelli Ribeiro","Layde Rosane Paim","Lígia M Antunes-Correa","Andrei Carvalho Sposito","Jose Roberto Matos Souza","Rodrigo Modolo","Wilson Nadruz","Luis Sergio Fernandes de Carvalho","Otávio R Coelho-Filho"],"significance":5,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"This study showed that serum potassium levels provide prognostic information in symptomatic heart failure beyond traditional clinical and biochemical variables, supporting potassium monitoring for risk stratification.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:21Z","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":"Studie die aantoont dat serumkaliumspiegels prognostische informatie bieden bij symptomatisch hartfalen voorbij traditionele klinische variabelen.","abstract_original":"AIMS: Despite of recent advances in the pharmacological treatment, heart failure (HF) maintains significant morbidity and mortality rates. While serum potassium disorders are common and associated with adverse outcomes, the exact recommended potassium level for patients with HF are not entirely established. We aimed to investigate the prognostic role of potassium levels on a cohort of patients with symptomatic chronic HF. METHODS AND RESULTS: Patients with symptomatic chronic HF were identified at the referral to 6 min walking test (6MWT) and were prospectively followed up for cardiovascular events. Clinical and laboratorial data were retrospectively obtained. The primary endpoint was the composite of cardiovascular death, hospitalization due to HF, and heart transplantation. The cohort included 178 patients with HF with the mean age of 51 ± 12.76 years, 39% were female, 85% of non-ischaemic cardiomyopathy, and 38% had New York Heart Association Class III with a relatively high Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score (12.91 ± 6.6). The mean left ventricular ejection fraction was 39.98 ± 15.79%, and the mean 6MWT distance was 353 ± 136 m. After a median follow-up of 516 days, there were 22 major cardiovascular events (4 cardiovascular deaths, 13 HF admissions, and 5 heart transplants). Patients were stratified according to cut-point level of serum potassium of 4.7 mmol/L to predict combined cardiac events based on receiver operating characteristic analysis. Individuals with higher potassium levels had worse renal function (glomerular filtration rate, K ≤ 4.7: 102.8 ± 32.2 mL/min/1.73 m2 vs. K > 4.7: 85.42 ± 36.2 mL/min/1.73 m2 , P = 0.004), higher proportion of New York Heart Association Class III patients (K ≤ 4.7: 28% vs. K > 4.7: 48%, P = 0.0029), and also higher MAGGIC score (K ≤ 4.7: 12.08 ± 5.7 vs. K > 4.7: 14.9 ± 7.9, P = 0.0089), without significant differences on the baseline pharmacological HF treatment. Both potassium levels [hazard ratio (HR) 4.26, 95% confidence interval (CI) 1.59-11.421, P = 0.003] and 6MWT distance (HR 0.99, 95% CI 0.993-0.999, P = 0.01) were independently associated with the primary outcome. After adjustments for MAGGIC score and 6MWT distance, potassium levels > 4.7 mmol/L maintained a significant association with outcomes (HR 3.57, 95% CI 1.305-9.807, P = 0.013). Patients with K > 4.7 mmol/L were more likely to present clinical events during the follow-up (log rank = 0.005). Adding potassium levels to the model including 6MWT and MAGGIC significantly improved the prediction of events over 2 years (integrated discrimination index 0.105, 95% CI 0.018-0.281, P = 0.012 and net reclassification index 0.447, 95% CI 0.077-0.703, P = 0.028). CONCLUSIONS: Potassium levels were independently associated with worse outcomes in patients with chronic symptomatic HF, also improving the accuracy model for prognostic prediction when added to MAGGIC score and 6MWT distance. The potassium levels above 4.7 mmol/L might identify those patients at an increased risk of cardiovascular events."},{"id":"d54fccd3d80d","type":"article","url":"https://hartvaat.nl/2021/06/01/palliatieve-zorg-bij-ph-met-congenitaal-hartlijden-expertopinie/","title":"Palliatieve zorg bij PH met congenitaal hartlijden: expertopinie","title_en":"Palliative care in pulmonary hypertension associated with congenital heart disease: systematic review and expert opinion.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13263","source_url":"https://doi.org/10.1002/ehf2.13263","authors":["Andrew Constantine","Robin Condliffe","Paul Clift","Robert Tulloh","Konstantinos Dimopoulos"],"significance":5,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review and expert opinion addressed palliative care in pulmonary hypertension associated with congenital heart disease, filling a gap in end-of-life care guidance for this severe condition.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:20Z","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":"Systematische review en expertopinie over palliatieve zorg bij pulmonale hypertensie met aangeboren hartafwijkingen.","abstract_original":"AIMS: Pulmonary arterial hypertension (PAH) is common amongst patients with congenital heart disease (CHD). It is a severe and complex condition that adversely affects quality of life and prognosis. While quality of life questionnaires are routinely used in clinical pulmonary hypertension practice, little is known on how to interpret their results and manage PAH-CHD patients with evidence of impaired health-related quality of life, especially those with advanced disease and palliative care needs. METHODS AND RESULTS: We performed a systematic review of studies concerning palliative care for people with PAH-CHD, also reviewing the health-related quality of life literature pertaining to these patients. Of 330 papers identified through initial screening, 17 were selected for inclusion. Underutilization of advance care planning and palliative care resources was common. Where palliative care input was sought, this was frequently late in the course of the disease. No studies provided evidence-based clinical criteria for triggering referral to palliative care, a framework for providing tailored care in this patient group, or how to manage the risk of sudden cardiac death and implantable cardioverter defibrillators in advanced PAH-CHD. We synthesize this information into eight important areas, including the impact of PAH-CHD on quality of life, barriers to and benefits of palliative care involvement, advance care planning discussions, and end-of-life care issues in this complex patient group, and provide expert consensus on best practice in this field. CONCLUSIONS: This paper presents the results of a systematic review and expert statements on the preferred palliative care strategy for patients with PAH-CHD."},{"id":"c2514ad7fde3","type":"article","url":"https://hartvaat.nl/2021/06/01/roken-en-hartfalen-mendeliaanse-randomisatie-en-mediatie-analyse/","title":"Roken en hartfalen: Mendeliaanse randomisatie en mediatie-analyse","title_en":"Smoking and heart failure: a Mendelian randomization and mediation analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13248","source_url":"https://doi.org/10.1002/ehf2.13248","authors":["Yunlong Lu","Zhouming Xu","Marios K Georgakis","Zhen Wang","Hefeng Lin","Liangrong Zheng"],"significance":6,"published":"2021-06-01","source_date":"2021-06-01","image":"","kennis":[],"congress":"","summary_en":"This Mendelian randomization study provided causal evidence that smoking increases heart failure risk, with mediation analysis showing that the effect operates partially through coronary artery disease and pulmonary impairment.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:20Z","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":"Mendeliaanse randomisatie die het causale verband tussen roken en hartfalen onderzocht met mediatie-analyse.","abstract_original":"AIMS: We performed a Mendelian randomization (MR) study to elucidate the associations of ever smoking, lifelong smoking duration, and smoking cessation with heart failure (HF) risk. METHODS AND RESULTS: We extracted genetic variants associated with smoking initiation, age at initiation of regular smoking, cigarettes per day, and smoking cessation from the genome-wide association study and Sequencing Consortium of Alcohol and Nicotine use (1.2 million individuals), as well as a composite lifetime smoking index from the UK Biobank (462 690 individuals). The associations between smoking phenotypes and HF were explored in the Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium (47 309 cases; 930 014 controls) employing inverse variance-weighted meta-analysis and multivariable MR. The mediation effects of coronary artery disease and atrial fibrillation on smoking-HF risk were explored using mediation analysis. The odds ratios (ORs) for HF were 1.28 [95% confidence interval (CI), 1.22-1.36; P = 1.5 × 10-18 ] for ever regular smokers compared with never smokers and 1.25 (95% CI, 1.09-1.44; P = 1.6 × 10-3 ) for current smokers vs. former smokers. Genetic liability to smoking more cigarettes per day (OR, 1.37; 95% CI, 1.20-1.58; P = 6.4 × 10-6 ) and a higher composite lifetime smoking index (OR, 1.49; 95% CI, 1.31-1.70; P = 2.5 × 10-9 ) were associated with a higher risk of HF. The results were robust and consistent in all sensitivity analyses and multivariable MR after adjusting for HF risk factors, and their associations were independent of coronary artery disease and atrial fibrillation. CONCLUSIONS: Genetic liability to ever smoking and a higher lifetime smoking burden are associated with a higher risk of HF."},{"id":"d71f453643de","type":"article","url":"https://hartvaat.nl/2021/05/27/vergelijkende-effectiviteit-van-aspirinedoseringen-bij-cvd-nejm-adaptable/","title":"Vergelijkende effectiviteit van aspirinedoseringen bij CVD: NEJM ADAPTABLE","title_en":"Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts"],"tags":["farmaco-economie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2102137","source_url":"https://doi.org/10.1056/NEJMoa2102137","authors":["W Schuyler Jones","Hillary Mulder","Lisa M Wruck","Michael J Pencina","Sunil Kripalani","Daniel Muñoz","David L Crenshaw","Mark B Effron","Richard N Re","Kamal Gupta","R David Anderson","Carl J Pepine","Eileen M Handberg","Brittney R Manning","Sandeep K Jain","Saket Girotra","Danielle Riley","Darren A DeWalt","Jeff Whittle","Ythan H Goldberg","Veronique L Roger","Rachel Hess","Catherine P Benziger","Peter Farrehi","Li Zhou","Daniel E Ford","Kevin Haynes","Jeffrey J VanWormer","Kirk U Knowlton","Jennifer L Kraschnewski","Tamar S Polonsky","Dan J Fintel","Faraz S Ahmad","James C McClay","James R Campbell","Douglas S Bell","Gregg C Fonarow","Steven M Bradley","Anuradha Paranjape","Matthew T Roe","Holly R Robertson","Lesley H Curtis","Amber G Sharlow","Lisa G Berdan","Bradley G Hammill","Debra F Harris","Laura G Qualls","Guillaume Marquis-Gravel","Madelaine F Modrow","Gregory M Marcus","Thomas W Carton","Elizabeth Nauman","Lemuel R Waitman","Abel N Kho","Elizabeth A Shenkman","Kathleen M McTigue","Rainu Kaushal","Frederick A Masoudi","Elliott M Antman","Desiree R Davidson","Kevin Edgley","James G Merritt","Linda S Brown","Doris N Zemon","Thomas E McCormick","Jacqueline D Alikhaani","Kenneth C Gregoire","Russell L Rothman","Robert A Harrington","Adrian F Hernandez"],"significance":9,"published":"2021-05-27","source_date":"2021-05-27","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"The ADAPTABLE trial, the first large pragmatic trial comparing aspirin doses in cardiovascular disease, found no significant difference between 81 mg and 325 mg daily for preventing cardiovascular events or causing major bleeding. The results support low-dose aspirin as the standard for secondary prevention.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:20Z","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":"NEJM ADAPTABLE pragmatische trial die 81 mg versus 325 mg aspirine vergeleek bij vastgestelde cardiovasculaire ziekte. Geen verschil — eerste grote pragmatische aspirinedoseringstrial.","abstract_original":"BACKGROUND: The appropriate dose of aspirin to lower the risk of death, myocardial infarction, and stroke and to minimize major bleeding in patients with established atherosclerotic cardiovascular disease is a subject of controversy. METHODS: Using an open-label, pragmatic design, we randomly assigned patients with established atherosclerotic cardiovascular disease to a strategy of 81 mg or 325 mg of aspirin per day. The primary effectiveness outcome was a composite of death from any cause, hospitalization for myocardial infarction, or hospitalization for stroke, assessed in a time-to-event analysis. The primary safety outcome was hospitalization for major bleeding, also assessed in a time-to-event analysis. RESULTS: A total of 15,076 patients were followed for a median of 26.2 months (interquartile range [IQR], 19.0 to 34.9). Before randomization, 13,537 (96.0% of those with available information on previous aspirin use) were already taking aspirin, and 85.3% of these patients were previously taking 81 mg of daily aspirin. Death, hospitalization for myocardial infarction, or hospitalization for stroke occurred in 590 patients (estimated percentage, 7.28%) in the 81-mg group and 569 patients (estimated percentage, 7.51%) in the 325-mg group (hazard ratio, 1.02; 95% confidence interval [CI], 0.91 to 1.14). Hospitalization for major bleeding occurred in 53 patients (estimated percentage, 0.63%) in the 81-mg group and 44 patients (estimated percentage, 0.60%) in the 325-mg group (hazard ratio, 1.18; 95% CI, 0.79 to 1.77). Patients assigned to 325 mg had a higher incidence of dose switching than those assigned to 81 mg (41.6% vs. 7.1%) and fewer median days of exposure to the assigned dose (434 days [IQR, 139 to 737] vs. 650 days [IQR, 415 to 922]). CONCLUSIONS: In this pragmatic trial involving patients with established cardiovascular disease, there was substantial dose switching to 81 mg of daily aspirin and no significant differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg of aspirin daily. (Funded by the Patient-Centered Outcomes Research Institute; ADAPTABLE ClinicalTrials.gov number, NCT02697916.)."},{"id":"7188603b9ffd","type":"article","url":"https://hartvaat.nl/2021/05/25/gedragsinterventies-voor-gezond-gewicht-in-de-zwangerschap-jama-uspstf-evidence-/","title":"Gedragsinterventies voor gezond gewicht in de zwangerschap: JAMA USPSTF evidence report","title_en":"Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"preventie","category_label":"Preventie","professions":["huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.4230","source_url":"https://doi.org/10.1001/jama.2021.4230","authors":["Amy G Cantor","Rebecca M Jungbauer","Marian McDonagh","Ian Blazina","Nicole E Marshall","Chandler Weeks","Rongwei Fu","Erin S LeBlanc","Roger Chou"],"significance":6,"published":"2021-05-25","source_date":"2021-05-25","image":"","kennis":[],"congress":"","summary_en":"This USPSTF evidence report evaluated counseling and behavioral interventions for healthy gestational weight gain, informing recommendations on lifestyle management during pregnancy for cardiovascular and metabolic health.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:20Z","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":"JAMA USPSTF evidence report over gedragsinterventies voor gezond gewicht en gewichtstoename in de zwangerschap.","abstract_original":"IMPORTANCE: Counseling and active behavioral interventions to limit excess gestational weight gain (GWG) during pregnancy may improve health outcomes for women and infants. The 2009 National Academy of Medicine (NAM; formerly the Institute of Medicine) recommendations for healthy GWG vary according to prepregnancy weight category. OBJECTIVE: To review and synthesize the evidence on benefits and harms of behavioral interventions to promote healthy weight gain during pregnancy to inform the US Preventive Services Task Force recommendation. DATA SOURCES: Ovid MEDLINE and the Cochrane Library to March 2020, with surveillance through February 2021. STUDY SELECTION: Randomized clinical trials and nonrandomized controlled intervention studies focused on diet, exercise, and/or behavioral counseling interventions on GWG. DATA EXTRACTION AND SYNTHESIS: Independent data abstraction and study quality rating with dual review. MAIN OUTCOMES AND MEASURES: Gestational weight-related outcomes; maternal and infant morbidity and mortality; harms. RESULTS: Sixty-eight studies (N = 25 789) were included. Sixty-seven studies evaluated interventions during pregnancy, and 1 evaluated an intervention prior to pregnancy. GWG interventions were associated with reductions in risk of gestational diabetes (43 trials, n = 19 752; relative risk [RR], 0.87 [95% CI, 0.79 to 0.95]; absolute risk difference [ARD], -1.6%) and emergency cesarean delivery (14 trials, n = 7520; RR, 0.85 [95% CI, 0.74 to 0.96]; ARD, -2.4%). There was no significant association between GWG interventions and risk of gestational hypertension, cesarean delivery, or preeclampsia. GWG interventions were associated with decreased risk of macrosomia (25 trials, n = 13 990; RR, 0.77 [95% CI, 0.65 to 0.92]; ARD, -1.9%) and large for gestational age (26 trials, n = 13 000; RR, 0.89 [95% CI, 0.80 to 0.99]; ARD, -1.3%) but were not associated with preterm birth. Intervention participants experienced reduced weight gain across all prepregnancy weight categories (55 trials, n = 20 090; pooled mean difference, -1.02 kg [95% CI, -1.30 to -0.75]) and demonstrated lower likelihood of GWG in excess of NAM recommendations (39 trials, n = 14 271; RR, 0.83 [95% CI, 0.77 to 0.89]; ARD, -7.6%). GWG interventions were associated with reduced postpartum weight retention at 12 months (10 trials, n = 3957; mean difference, -0.63 kg [95% CI, -1.44 to -0.01]). Data on harms were limited. CONCLUSIONS AND RELEVANCE: Counseling and active behavioral interventions to limit GWG were associated with decreased risk of gestational diabetes, emergency cesarean delivery, macrosomia, and large for gestational age. GWG interventions were also associated with modest reductions in mean GWG and decreased likelihood of exceeding NAM recommendations for GWG."},{"id":"7bb9c3a099d6","type":"article","url":"https://hartvaat.nl/2021/05/21/extrapulmonale-vein-driver-mapping-bij-persisterend-af-bij-obese-patienten/","title":"Extrapulmonale vein driver mapping bij persisterend AF bij obese patiënten","title_en":"Extra-pulmonary vein driver mapping and ablation for persistent atrial fibrillation in obese patients.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["obesitas"],"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/euaa314","source_url":"https://doi.org/10.1093/europace/euaa314","authors":["Xiaofeng Hu","Weifeng Jiang","Shaohui Wu","Kai Xu","Daoliang Zhang","Yu Zhang","Xu Liu","Mu Qin"],"significance":5,"published":"2021-05-21","source_date":"2021-05-21","image":"","kennis":[],"congress":"","summary_en":"This study evaluated extrapulmonary vein driver mapping and ablation for persistent AF in obese patients, testing whether obesity-specific AF substrate requires targeted ablation beyond standard PVI.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:20Z","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 naar extrapulmonale vein driver mapping en ablatie bij persisterend AF bij obese patiënten.","abstract_original":"AIMS: The aim of this study was to determine whether driver ablation effectively treats persistent atrial fibrillation (AF) in obese patients. METHODS AND RESULTS: We randomly assigned 124 persistent AF obese patients to two groups, one undergoing conventional ablation (n = 62) and the other undergoing driver ablation (n = 62). Sixty-two non-obese patients with persistent AF undergoing driver ablation served as matched controls. Bipolar electrogram dispersion was analysed for driver mapping. Epicardial adipose tissue (EAT) volume was measured using cardiac computed tomography. Obese patients had a higher proportion of driver regions in the posterior wall (56.5% vs. 32.3%, P = 0.007). Driver complexity, measured as the average number and area of driver regions, was higher in the obese group than in the non-obese group (3.5 ± 1.0 vs. 2.9 ± 0.9, P < 0.001; 15.5% ± 4.2% vs. 9.8 ± 2.6%, P < 0.001, respectively). Left atrial EAT volume correlated better with the proportion of area of driver regions than did body mass index (BMI) and total EAT (BMI: r2 = 0.250, P < 0.001; total EAT: r2 = 0.379, P < 0.001; and left atrial EAT: r2 = 0.439, P < 0.001). The rate of AF termination was significantly higher in the driver ablation group than in the conventional ablation group (82.9% vs. 22.8%, P < 0.001). During the follow-up period of 16.9 ± 6.5 months, patients in the driver ablation group had significantly better AF-free survival (91.91% vs. 79.0%, log rank test, P = 0.026) and AF/atrial tachycardia-free survival (83.9% vs. 64.5%, log rank test, P = 0.011) than did patients in the conventional ablation group. CONCLUSION: Obesity is associated with increased driver complexity. Driver ablation improves long-term outcomes in obese patients with persistent AF."},{"id":"f80a7093f52b","type":"article","url":"https://hartvaat.nl/2021/05/21/high-power-short-duration-versus-conventionele-rf-ablatie-bij-af-meta-analyse/","title":"High-power short-duration versus conventionele RF-ablatie bij AF: meta-analyse","title_en":"High-power short duration vs. conventional radiofrequency ablation of 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/euaa327","source_url":"https://doi.org/10.1093/europace/euaa327","authors":["Venkatesh Ravi","Abhushan Poudyal","Qurrat-Ul-Ain Abid","Timothy Larsen","Kousik Krishnan","Parikshit S Sharma","Richard G Trohman","Henry D Huang"],"significance":6,"published":"2021-05-21","source_date":"2021-05-21","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that high-power short-duration RF ablation for AF achieves comparable efficacy and safety to conventional lower-power approaches with shorter procedure times, supporting the accelerated protocol.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:20Z","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":"Systematische review en meta-analyse van high-power short-duration versus conventionele RF-ablatie bij AF.","abstract_original":"AIMS: We sought to compare the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation (RFA) with conventional RFA in patients with atrial fibrillation (AF). METHODS AND RESULTS: MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 15 May 2020 for relevant studies comparing HPSD vs. conventional RFA in patients undergoing initial catheter ablation for AF. A total of 15 studies involving 3718 adult patients were included in our meta-analysis (2357 in HPSD RFA and 1361 in conventional RFA). Freedom from atrial arrhythmia was higher in HPSD RFA when compared with conventional RFA [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.10-1.90; P = 0.009]. Acute PV reconnection was lower (OR 0.56, P = 0.005) and first-pass isolation was higher (OR 3.58, P < 0.001) with HPSD RFA. There was no difference in total complications between the two groups (P = 0.19). Total procedure duration [mean difference (MD) -37.35 min, P < 0.001], fluoroscopy duration (MD -5.23 min, P = 0.001), and RF ablation time (MD -16.26 min, P < 0.001) were all significantly lower in HPSD RFA. High-power short-duration RFA also demonstrated higher freedom from atrial arrhythmia in the subgroup analysis of patients with paroxysmal AF (OR 1.80, 95% CI 1.29-2.50; P < 0.001), studies with ≥50 W protocol in the HPSD RFA group (OR 1.53, 95% CI 1.08-2.18; P = 0.02] and studies with contact force sensing catheter use (OR 1.65, 95% CI 1.21-2.25; P = 0.002). CONCLUSION: High-power short-duration RFA was associated with better procedural effectiveness when compared with conventional RFA with comparable safety and shorter procedural duration."},{"id":"2ed1986bdb19","type":"article","url":"https://hartvaat.nl/2021/05/21/katheterablatie-versus-medicatie-bij-persisterend-en-langdurig-persisterend-af-l/","title":"Katheterablatie versus medicatie bij persisterend en langdurig persisterend AF: langetermijn","title_en":"Long-term observation of catheter ablation vs. pharmacotherapy in the management of persistent and long-standing persistent atrial fibrillation (CAPA 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/euaa356","source_url":"https://doi.org/10.1093/europace/euaa356","authors":["Gang Wu","He Huang","Lin Cai","Yanzong Yang","Xu Liu","Bo Yu","Yanhong Tang","Hong Jiang","Congxin Huang"],"significance":6,"published":"2021-05-21","source_date":"2021-05-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This long-term observation compared catheter ablation with pharmacotherapy for persistent and longstanding persistent AF, providing extended follow-up data on rhythm control strategies in the most challenging AF phenotypes.","created":"2026-07-03T10:29:12Z","updated":"2026-07-03T13:28:20Z","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":"Langetermijnobservatie van katheterablatie versus medicamenteuze therapie bij persisterend en langdurig persisterend AF.","abstract_original":"AIMS: The roles of radiofrequency catheter ablation (RFCA) and pharmacotherapy in treating persistent and long-standing persistent atrial fibrillation (AF) have not been sufficiently investigated. We conducted a multicentre, randomized, controlled trial to compare the effects of RFCA and pharmacotherapy on the prognosis of these patients. METHODS AND RESULTS: A total of 648 patients with persistent and long-standing persistent AF were enrolled from 30 centres and randomized to either the ablation group (n = 327) or the pharmacotherapy group (n = 321). After 54.2 ± 10.6 months of follow-up, the primary endpoints occurred significantly more rarely in the ablation group than in the pharmacotherapy group (10.4% vs. 17.4%; hazard ratio 0.59, 95% confidence interval 0.48-0.75; P < 0.001). The incidence of stroke/transient ischaemic attack (TIA) was significantly lower in the ablation group (4.2% vs. 7.2%, P < 0.001). Likewise, the incidence of new-onset congestive heart failure (CHF) was lower in the ablation group (2.8% vs. 7.2%, P < 0.001). More patients had sinus rhythm in the ablation group than in the pharmacotherapy group (60.6% vs. 20.9%, P < 0.001), but fewer patients were on antiarrhythmic drugs (24.4% vs. 41.6%, P < 0.001) and warfarin (60.8% vs. 83.9%, P = 0.001). Both the 6-min walk distance and the quality of life (QoL) were improved in the ablation group at the end of follow-up. CONCLUSION: In patients with persistent and long-standing persistent AF, RFCA-based treatment was superior to pharmacotherapy in decreasing stroke/TIA and new-onset CHF and improving QoL."},{"id":"d62ec7758b61","type":"article","url":"https://hartvaat.nl/2021/05/21/firm-ablatie-versus-pvi-bij-paroxysmaal-af-gerandomiseerde-resultaten/","title":"FIRM-ablatie versus PVI bij paroxysmaal AF: gerandomiseerde resultaten","title_en":"Focal Impulse and Rotor Modulation Ablation vs. Pulmonary Vein isolation for the treatment of paroxysmal Atrial Fibrillation: results from the FIRMAP 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/euaa378","source_url":"https://doi.org/10.1093/europace/euaa378","authors":["Roland R Tilz","Corinna Lenz","Philipp Sommer","Meyer-Saraei Roza","Anne E Sarver","Christopher G Williams","Christian Heeger","Gerhard Hindricks","Julia Vogler","Charlotte Eitel"],"significance":6,"published":"2021-05-21","source_date":"2021-05-21","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that Focal Impulse and Rotor Modulation (FIRM) ablation does not improve outcomes over standard PVI for paroxysmal AF, a negative result for rotor-guided ablation technology.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:20Z","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":"Gerandomiseerde trial die Focal Impulse and Rotor Modulation (FIRM) ablatie vergeleek met PVI bij paroxysmaal AF.","abstract_original":"AIMS: Pulmonary vein isolation (PVI) is the gold standard for atrial fibrillation (AF) ablation. Recently, catheter ablation targeting rotors or focal sources has been developed for treatment of AF. This study sought to compare the safety and effectiveness of Focal Impulse and Rotor Modulation (FIRM)-guided ablation as the sole ablative strategy with PVI in patients with paroxysmal AF. METHODS AND RESULTS: We conducted a multicentre, randomized trial to determine whether FIRM-guided radiofrequency ablation without PVI (FIRM group) was non-inferior to PVI (PVI group) for treatment of paroxysmal AF. The two primary efficacy end points were (i) acute success defined as elimination of AF rotors (FIRM group) or isolation of all pulmonary veins (PVI group) and (ii) long-term success defined as single-procedure freedom from AF/atrial tachycardia (AT) recurrence 12 months after ablation. The study was closed early by the sponsor. At the time of study closure, any pending follow-up visits were waived. A total of 51 patients (mean age 63 ± 10.6 years, 57% male) were enrolled. All PVs were successfully isolated in the PVI group and all rotors were successfully eliminated in the FIRM group. Single-procedure effectiveness was 31.3% (5/16) in the FIRM group and 80% (8/10) in the PVI group at 12 months. Three vascular access complications occurred in the FIRM group. CONCLUSION: These partial study effectiveness results reinforce the importance of PVI in paroxysmal AF patients and indicate that FIRM-guided ablation alone (without PVI) is not an effective strategy for treatment of paroxysmal AF in most patients."},{"id":"47778bc63a48","type":"article","url":"https://hartvaat.nl/2021/05/20/intensieve-versus-standaard-bloeddrukcontrole-nejm-sprint-definitief-rapport/","title":"Intensieve versus standaard bloeddrukcontrole: NEJM SPRINT definitief rapport","title_en":"Final Report of a Trial of Intensive versus Standard Blood-Pressure Control.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1901281","source_url":"https://doi.org/10.1056/NEJMoa1901281","authors":["Cora E Lewis","Lawrence J Fine","Srinivasan Beddhu","Alfred K Cheung","William C Cushman","Jeffrey A Cutler","Gregory W Evans","Karen C Johnson","Dalane W Kitzman","Suzanne Oparil","Mahboob Rahman","David M Reboussin","Michael V Rocco","Kaycee M Sink","Joni K Snyder","Paul K Whelton","Jeff D Williamson","Jackson T Wright","Walter T Ambrosius"],"significance":10,"published":"2021-05-20","source_date":"2021-05-20","image":"","kennis":[],"congress":"","summary_en":"The final SPRINT report, including post-trial follow-up, confirmed the durable benefit of intensive systolic blood pressure control (target <120 mmHg) versus standard treatment (target <140 mmHg) in reducing cardiovascular events and mortality. The sustained benefit after treatment cessation strengthened the case for aggressive blood pressure targets.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:20Z","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":"NEJM SPRINT definitief rapport met de finale resultaten inclusief post-trial follow-up. Bevestigt het duurzame voordeel van intensieve bloeddrukcontrole.","abstract_original":"BACKGROUND: In a previously reported randomized trial of standard and intensive systolic blood-pressure control, data on some outcome events had yet to be adjudicated and post-trial follow-up data had not yet been collected. METHODS: We randomly assigned 9361 participants who were at increased risk for cardiovascular disease but did not have diabetes or previous stroke to adhere to an intensive treatment target (systolic blood pressure, <120 mm Hg) or a standard treatment target (systolic blood pressure, <140 mm Hg). The primary outcome was a composite of myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes. Additional primary outcome events occurring through the end of the intervention period (August 20, 2015) were adjudicated after data lock for the primary analysis. We also analyzed post-trial observational follow-up data through July 29, 2016. RESULTS: At a median of 3.33 years of follow-up, the rate of the primary outcome and all-cause mortality during the trial were significantly lower in the intensive-treatment group than in the standard-treatment group (rate of the primary outcome, 1.77% per year vs. 2.40% per year; hazard ratio, 0.73; 95% confidence interval [CI], 0.63 to 0.86; all-cause mortality, 1.06% per year vs. 1.41% per year; hazard ratio, 0.75; 95% CI, 0.61 to 0.92). Serious adverse events of hypotension, electrolyte abnormalities, acute kidney injury or failure, and syncope were significantly more frequent in the intensive-treatment group. When trial and post-trial follow-up data were combined (3.88 years in total), similar patterns were found for treatment benefit and adverse events; however, rates of heart failure no longer differed between the groups. CONCLUSIONS: Among patients who were at increased cardiovascular risk, targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of major adverse cardiovascular events and lower all-cause mortality than targeting a systolic blood pressure of less than 140 mm Hg, both during receipt of the randomly assigned therapy and after the trial. Rates of some adverse events were higher in the intensive-treatment group. (Funded by the National Institutes of Health; SPRINT ClinicalTrials.gov number, NCT01206062.)."},{"id":"4fa963e39710","type":"article","url":"https://hartvaat.nl/2021/05/18/diabetes-factoren-en-ticagrelor-plus-aspirine-themis-en-themis-pci/","title":"Diabetes-factoren en ticagrelor plus aspirine: THEMIS en THEMIS-PCI","title_en":"Diabetes-Related Factors and the Effects of Ticagrelor Plus Aspirin in the THEMIS and THEMIS-PCI Trials.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.03.298","source_url":"https://doi.org/10.1016/j.jacc.2021.03.298","authors":["Lawrence A Leiter","Deepak L Bhatt","Darren K McGuire","Hwee Teoh","Kim Fox","Tabassome Simon","Shamir R Mehta","Eli I Lev","Róbert G Kiss","Anthony J Dalby","Héctor Bueno","Wilhelm Ridderstråle","Anders Himmelmann","Jayne Prats","Yuyin Liu","Jane J Lee","John Amerena","Mikhail N Kosiborod","Philippe Gabriel Steg"],"significance":6,"published":"2021-05-18","source_date":"2021-05-18","image":"","kennis":[],"congress":"","summary_en":"This THEMIS subanalysis examined diabetes-specific factors that modify the benefit of adding ticagrelor to aspirin, identifying which diabetic patients derive the greatest net clinical advantage from intensified antiplatelet therapy.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"THEMIS subanalyse naar diabetes-gerelateerde factoren en het effect van ticagrelor plus aspirine.","abstract_original":"BACKGROUND: THEMIS (The Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study) (n = 19,220) and its pre-specified THEMIS-PCI (The Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study-Percutaneous Coronary Intervention) (n = 11,154) subanalysis showed, in individuals with type 2 diabetes mellitus (median duration 10.0 years; HbA1c 7.1%) and stable coronary artery disease without prior myocardial infarction (MI) or stroke, that ticagrelor plus aspirin (compared with placebo plus aspirin) produced a favorable net clinical benefit (composite of all-cause mortality, MI, stroke, fatal bleeding, and intracranial bleeding) if the patients had a previous percutaneous coronary intervention. OBJECTIVES: In these post hoc analyses, the authors examined whether the primary efficacy outcome (cardiovascular death, MI, stroke: 3-point major adverse cardiovascular events [MACE]), primary safety outcome (Thrombolysis In Myocardial Infarction-defined major bleeding) and net clinical benefit varied with diabetes-related factors. METHODS: Outcomes were analyzed across baseline diabetes duration, HbA1c, and antihyperglycemic medications. RESULTS: In THEMIS, the incidence of 3-point MACE increased with diabetes duration (6.7% for ≤5 years, 11.1% for >20 years) and HbA1c (6.4% for ≤6.0%, 11.8% for >10.0%). The relative benefits of ticagrelor plus aspirin on 3-point MACE reduction (hazard ratio [HR]: 0.90; p = 0.04) were generally consistent across subgroups. Major bleeding event rate (overall: 1.6%) did not vary by diabetes duration or HbA1c and was increased similarly by ticagrelor across all subgroups (HR: 2.32; p < 0.001). These findings were mirrored in THEMIS-PCI. The efficacy and safety of ticagrelor plus aspirin did not differ by baseline antihyperglycemic therapy. In THEMIS-PCI, but not THEMIS, ticagrelor generally produced favorable net clinical benefit across diabetes duration, HbA1c, and antihyperglycemic medications. CONCLUSION: Ticagrelor plus aspirin yielded generally consistent and favorable net clinical benefit across the diabetes-related factors in THEMIS-PCI but not in the overall THEMIS population."},{"id":"b7f4daee9fc5","type":"article","url":"https://hartvaat.nl/2021/05/11/digitale-interventie-voor-depressie-bij-hypertensie-diabetes-in-brazilie-en-peru/","title":"Digitale interventie voor depressie bij hypertensie/diabetes in Brazilië en Peru: JAMA","title_en":"Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.4348","source_url":"https://doi.org/10.1001/jama.2021.4348","authors":["Ricardo Araya","Paulo Rossi Menezes","Heloísa Garcia Claro","Lena R Brandt","Kate L Daley","Julieta Quayle","Francisco Diez-Canseco","Tim J Peters","Daniela Vera Cruz","Mauricio Toyama","Suzana Aschar","Liliana Hidalgo-Padilla","Hellen Martins","Victoria Cavero","Thais Rocha","George Scotton","Ivan F de Almeida Lopes","Mark Begale","David C Mohr","J Jaime Miranda"],"significance":6,"published":"2021-05-11","source_date":"2021-05-11","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This JAMA trial showed that a digital mental health intervention improves depressive symptoms in patients with comorbid hypertension or diabetes in Latin America, demonstrating scalable technology-based treatment for the depression-cardiovascular comorbidity.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T18:38:49Z","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 trial van een digitale interventie voor depressie bij patiënten met comorbide hypertensie of diabetes in Latijns-Amerika.","abstract_original":"IMPORTANCE: Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. OBJECTIVE: To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. DESIGN, SETTING, AND PARTICIPANTS: Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). INTERVENTIONS: An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). MAIN OUTCOMES AND MEASURES: The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. RESULTS: Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. CONCLUSIONS AND RELEVANCE: In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima)."},{"id":"3f82b542dbbb","type":"article","url":"https://hartvaat.nl/2021/05/11/geindividualiseerde-voedingsondersteuning-bij-gehospitaliseerd-chronisch-hf/","title":"Geïndividualiseerde voedingsondersteuning bij gehospitaliseerd chronisch HF","title_en":"Individualized Nutritional Support for Hospitalized Patients With Chronic Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","chronische-nierziekte","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.03.232","source_url":"https://doi.org/10.1016/j.jacc.2021.03.232","authors":["Lara Hersberger","Anna Dietz","Helene Bürgler","Annika Bargetzi","Laura Bargetzi","Nina Kägi-Braun","Pascal Tribolet","Filomena Gomes","Claus Hoess","Vojtech Pavlicek","Stefan Bilz","Sarah Sigrist","Michael Brändle","Christoph Henzen","Robert Thomann","Jonas Rutishauser","Drahomir Aujesky","Nicolas Rodondi","Jacques Donzé","Zeno Stanga","Beat Mueller","Philipp Schuetz"],"significance":6,"published":"2021-05-11","source_date":"2021-05-11","image":"","kennis":[],"congress":"","summary_en":"This study showed that individualized nutritional support during hospitalization for chronic heart failure improves clinical outcomes, supporting targeted nutrition assessment and intervention as part of inpatient heart failure management.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar geïndividualiseerde voedingsondersteuning bij gehospitaliseerde patiënten met chronisch hartfalen.","abstract_original":"BACKGROUND: Deterioration of nutritional status during hospitalization in patients with chronic heart failure increases mortality. Whether nutritional support during hospitalization reduces these risks, or on the contrary, may be harmful due to an increase in salt and fluid intake, remains unclear. OBJECTIVES: The purpose of this trial was to study the effect of nutritional support on mortality in patients hospitalized with chronic heart failure who are at nutritional risk. METHODS: A total of 645 patients with chronic heart failure (36% [n = 234] with acute decompensation) participated in the investigator-initiated, open-label EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients) trial. Patients were randomized to protocol-guided individualized nutritional support to reach energy, protein, and micronutrient goals (intervention group) or standard hospital food (control group). The primary endpoint was all-cause mortality at 30 days. RESULTS: Mortality over 180 days increased with higher severity of malnutrition (odds ratio per 1-point increase in Nutritional Risk Screening 2002 score: 1.65; 95% confidence interval [CI]: 1.21 to 2.24; p = 0.001). By 30 days, 27 of 321 intervention group patients (8.4%) died, compared with 48 of 324 (14.8%) control group patients (odds ratio: 0.44; 95% CI: 0.26 to 0.75; p = 0.002). Patients at high nutritional risk showed the most benefit from nutritional support. Mortality effects remained significant at 180-day follow-up. Intervention group patients also had a lower risk for major cardiovascular events at 30 days (17.4% vs. 26.9%; odds ratio: 0.50; 95% CI: 0.34 to 0.75; p = 0.001). CONCLUSIONS: Among hospitalized patients with chronic heart failure at high nutritional risk, individualized nutritional support reduced the risk for mortality and major cardiovascular events compared with standard hospital food. These data support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population. (Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial [EFFORT]; NCT02517476)."},{"id":"e3bfd10dfe89","type":"article","url":"https://hartvaat.nl/2021/05/05/intensieve-bloeddruk-en-aortastijfheid-sprint-heart/","title":"Intensieve bloeddruk en aortastijfheid: SPRINT-HEART","title_en":"Effect of Intensive Blood Pressure Control on Aortic Stiffness in the SPRINT-HEART.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16676","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16676","authors":["Bharathi Upadhya","Nicholas M Pajewski","Michael V Rocco","W Gregory Hundley","Gerard Aurigemma","Craig A Hamilton","Jeffrey T Bates","Jiang He","Jing Chen","Michel Chonchol","Steve P Glasser","Adriana M Hung","Roberto Pisoni","Henry Punzi","Mark A Supiano","Robert Toto","Addison Taylor","Dalane W Kitzman"],"significance":6,"published":"2021-05-05","source_date":"2021-05-05","image":"","kennis":[],"congress":"","summary_en":"This SPRINT-HEART analysis showed that intensive blood pressure control reduces aortic stiffness, demonstrating that aggressive blood pressure management has direct vascular benefits beyond hemodynamic lowering.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT-HEART analyse naar het effect van intensieve bloeddrukcontrole op aortastijfheid.","abstract_original":"[Figure: see text]."},{"id":"4fd8db379553","type":"article","url":"https://hartvaat.nl/2021/05/05/bloeddrukvariabiliteit-en-uitkomsten-bij-hfpef/","title":"Bloeddrukvariabiliteit en uitkomsten bij HFpEF","title_en":"Visit-to-Visit Blood Pressure Variability and Clinical Outcomes in Patients With Heart Failure With Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16757","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16757","authors":["Fang-Fei Wei","Yuanyuan Zhou","Lutgarde Thijs","Ruicong Xue","Bin Dong","Xin He","Weihao Liang","Yuzhong Wu","Jingzhou Jiang","Weiping Tan","Jiangui He","Jan A Staessen","Yugang Dong","Jingjing Zhao","Chen Liu"],"significance":5,"published":"2021-05-05","source_date":"2021-05-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This study showed that visit-to-visit blood pressure variability is associated with worse clinical outcomes in HFpEF, identifying blood pressure instability as a prognostic factor in this population.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar visit-to-visit bloeddrukvariabiliteit en klinische uitkomsten bij HFpEF.","abstract_original":"[Figure: see text]."},{"id":"e29d884e8a7d","type":"article","url":"https://hartvaat.nl/2021/05/05/chronische-milde-slaaprestrictie-verhoogt-bloeddruk-bij-vrouwen-aha-go-red/","title":"Chronische milde slaaprestrictie verhoogt bloeddruk bij vrouwen: AHA Go Red","title_en":"Sustained Mild Sleep Restriction Increases Blood Pressure in Women: An Update From the American Heart Association Go Red for Women Strategically Focused Research Network.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16370","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16370","authors":["Nour Makarem","Faris M Zuraikat","Samantha E Scaccia","Arindam RoyChoudhury","Marie-Pierre St-Onge"],"significance":6,"published":"2021-05-05","source_date":"2021-05-05","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This AHA Go Red for Women study showed that sustained mild sleep restriction increases blood pressure in women, establishing inadequate sleep as a sex-specific modifiable cardiovascular risk factor.","created":"2026-07-03T10:29:11Z","updated":"2026-07-03T13:28:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AHA Go Red for Women studie die aantoont dat chronische milde slaaprestrictie de bloeddruk verhoogt bij vrouwen.","abstract_original":""},{"id":"9c6a32100154","type":"article","url":"https://hartvaat.nl/2021/05/05/veroorzaken-betablokkers-depressie-systematische-review-en-meta-analyse/","title":"Veroorzaken bètablokkers depressie? Systematische review en meta-analyse","title_en":"Do β-Blockers Cause Depression?: Systematic Review and Meta-Analysis of Psychiatric Adverse Events During β-Blocker Therapy.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts"],"tags":["stress-psychosociaal"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16590","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16590","authors":["Thomas G Riemer","Linda E Villagomez Fuentes","Engi A E Algharably","Marie S Schäfer","Eva Mangelsen","Marc-Alexander Fürtig","Nadine Bittner","Annalena Bär","Laila Zaidi Touis","Kristian Wachtell","Tomislav Majic","Martin J Dinges","Reinhold Kreutz"],"significance":8,"published":"2021-05-05","source_date":"2021-05-05","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This systematic review and meta-analysis found no significant association between beta-blocker therapy and increased risk of depression, debunking a widely held clinical belief. The evidence addressed one of the most common reasons patients and clinicians avoid beta-blockers.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar psychiatrische bijwerkingen van bètablokkers. Geen significant verhoogd depressierisico — ontkracht een veelvoorkomende mythe.","abstract_original":"[Figure: see text]."},{"id":"f4b9f9e63f82","type":"article","url":"https://hartvaat.nl/2021/05/05/furosemide-voor-versneld-bloeddrukherstel-postpartum-bij-hypertensieve-zwangersc/","title":"Furosemide voor versneld bloeddrukherstel postpartum bij hypertensieve zwangerschap: RCT","title_en":"Furosemide for Accelerated Recovery of Blood Pressure Postpartum in women with a hypertensive disorder of pregnancy: A Randomized Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["diuretica","furosemide","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16133","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16133","authors":["Joana Lopes Perdigao","Jennifer Lewey","Adi Hirshberg","Nathanael Koelper","Sindhu K Srinivas","Michal A Elovitz","Lisa D Levine"],"significance":6,"published":"2021-05-05","source_date":"2021-05-05","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This randomized trial tested whether furosemide accelerates postpartum blood pressure recovery in women with hypertensive disorders of pregnancy, evaluating a simple pharmacological strategy for the post-delivery period.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial van furosemide voor versneld postpartum bloeddrukherstel bij hypertensieve zwangerschapsaandoeningen.","abstract_original":"[Figure: see text]."},{"id":"dc8bda035cdd","type":"article","url":"https://hartvaat.nl/2021/05/01/bloeddrukverlaging-voor-primaire-en-secundaire-preventie-over-alle-niveaus-lance/","title":"Bloeddrukverlaging voor primaire en secundaire preventie over alle niveaus: Lancet BPLTTC meta-analyse","title_en":"Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["primaire-preventie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)00590-0","source_url":"https://doi.org/10.1016/S0140-6736(21)00590-0","authors":[],"significance":10,"published":"2021-05-01","source_date":"2021-05-01","image":"","kennis":[],"congress":"","summary_en":"This individual-participant-data meta-analysis from the BPLTTC demonstrated that pharmacological blood pressure lowering reduces cardiovascular events across all baseline blood pressure levels, including in individuals with normal or high-normal pressure. The findings support a strategy of treating based on absolute cardiovascular risk rather than blood pressure thresholds alone.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark Lancet BPLTTC meta-analyse die aantoont dat bloeddrukverlaging CV-events vermindert over alle bloeddrukniveaus, inclusief normaal-hoog. Verandert het preventieparadigma.","abstract_original":"BACKGROUND: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. METHODS: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. FINDINGS: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/89 mm Hg in participants without previous cardiovascular disease (n=186 988). There was substantial spread in participants' blood pressure at baseline, with 31 239 (19·8%) of participants with previous cardiovascular disease and 14 928 (8·0%) of individuals without previous cardiovascular disease having a systolic blood pressure of less than 130 mm Hg. The relative effects of blood pressure-lowering treatment were proportional to the intensity of systolic blood pressure reduction. After a median 4·15 years' follow-up (Q1-Q3 2·97-4·96), 42 324 participants (12·3%) had at least one major cardiovascular event. In participants without previous cardiovascular disease at baseline, the incidence rate for developing a major cardiovascular event per 1000 person-years was 31·9 (95% CI 31·3-32·5) in the comparator group and 25·9 (25·4-26·4) in the intervention group. In participants with previous cardiovascular disease at baseline, the corresponding rates were 39·7 (95% CI 39·0-40·5) and 36·0 (95% CI 35·3-36·7), in the comparator and intervention groups, respectively. Hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event were 0·91, 95% CI 0·89-0·94 for partipants without previous cardiovascular disease and 0·89, 0·86-0·92, for those with previous cardiovascular disease. In stratified analyses, there was no reliable evidence of heterogeneity of treatment effects on major cardiovascular events by baseline cardiovascular disease status or systolic blood pressure categories. INTERPRETATION: In this large-scale analysis of randomised trials, a 5 mm Hg reduction of systolic blood pressure reduced the risk of major cardiovascular events by about 10%, irrespective of previous diagnoses of cardiovascular disease, and even at normal or high-normal blood pressure values. These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment. Physicians communicating the indication for blood pressure lowering treatment to their patients should emphasise its importance on reducing cardiovascular risk rather than focusing on blood pressure reduction itself. FUNDING: British Heart Foundation, UK National Institute for Health Research, and Oxford Martin School."},{"id":"f22698e54d0a","type":"article","url":"https://hartvaat.nl/2021/05/01/screening-op-af-bij-ouderen-jama-cardiology-gerandomiseerde-trial/","title":"Screening op AF bij ouderen: JAMA Cardiology gerandomiseerde trial","title_en":"Screening for Atrial Fibrillation in the Older Population: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["atleten"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.0038","source_url":"https://doi.org/10.1001/jamacardio.2021.0038","authors":["David J Gladstone","Rolf Wachter","Katharina Schmalstieg-Bahr","F Russell Quinn","Eva Hummers","Noah Ivers","Tamara Marsden","Andrea Thornton","Angie Djuric","Johanna Suerbaum","Doris von Grünhagen","William F McIntyre","Alexander P Benz","Jorge A Wong","Fatima Merali","Sam Henein","Chris Nichol","Stuart J Connolly","Jeff S Healey"],"significance":7,"published":"2021-05-01","source_date":"2021-05-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial of systematic AF screening in the older population evaluated the yield and downstream clinical impact of screening for previously undiagnosed atrial fibrillation.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial van AF-screening bij de oudere populatie.","abstract_original":"IMPORTANCE: Atrial fibrillation (AF) is a major cause of preventable strokes. Screening asymptomatic individuals for AF may increase anticoagulant use for stroke prevention. OBJECTIVE: To evaluate 2 home-based AF screening interventions. DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized clinical trial recruited individuals from primary care practices aged 75 years or older with hypertension and without known AF. From April 5, 2015, to March 26, 2019, 856 participants were enrolled from 48 practices. INTERVENTIONS: The control group received standard care (routine clinical follow-up plus a pulse check and heart auscultation at baseline and 6 months). The screening group received a 2-week continuous electrocardiographic (cECG) patch monitor to wear at baseline and at 3 months, in addition to standard care. The screening group also received automated home blood pressure (BP) machines with oscillometric AF screening capability to use twice-daily during the cECG monitoring periods. MAIN OUTCOMES AND MEASURES: With intention-to-screen analysis, the primary outcome was AF detected by cECG monitoring or clinically within 6 months. Secondary outcomes included anticoagulant use, device adherence, and AF detection by BP monitors. RESULTS: Of the 856 participants, 487 were women (56.9%); mean (SD) age was 80.0 (4.0) years. Median cECG wear time was 27.4 of 28 days (interquartile range [IQR], 18.4-28.0 days). In the primary analysis, AF was detected in 23 of 434 participants (5.3%) in the screening group vs 2 of 422 (0.5%) in the control group (relative risk, 11.2; 95% CI, 2.7-47.1; P = .001; absolute difference, 4.8%; 95% CI, 2.6%-7.0%; P < .001; number needed to screen, 21). Of those with cECG-detected AF, median total time spent in AF was 6.3 hours (IQR, 4.2-14.0 hours; range 1.3 hours-28 days), and median duration of the longest AF episode was 5.7 hours (IQR, 2.9-12.9 hours). Anticoagulation was initiated in 15 of 20 patients (75.0%) with cECG-detected AF. By 6 months, anticoagulant therapy had been prescribed for 18 of 434 participants (4.1%) in the screening group vs 4 of 422 (0.9%) in the control group (relative risk, 4.4; 95% CI, 1.5-12.8; P = .007; absolute difference, 3.2%; 95% CI, 1.1%-5.3%; P = .003). Twice-daily AF screening using the home BP monitor had a sensitivity of 35.0% (95% CI, 15.4%-59.2%), specificity of 81.0% (95% CI, 76.7%-84.8%), positive predictive value of 8.9% (95% CI, 4.9%-15.5%), and negative predictive value of 95.9% (95% CI, 94.5%-97.0%). Adverse skin reactions requiring premature discontinuation of cECG monitoring occurred in 5 of 434 participants (1.2%). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, among older community-dwelling individuals with hypertension, AF screening with a wearable cECG monitor was well tolerated, increased AF detection 10-fold, and prompted initiation of anticoagulant therapy in most cases. Compared with continuous ECG, intermittent oscillometric screening with a BP monitor was an inferior strategy for detecting paroxysmal AF. Large trials with hard clinical outcomes are now needed to evaluate the potential benefits and harms of AF screening. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02392754."},{"id":"0dfe7fc4c749","type":"article","url":"https://hartvaat.nl/2021/05/01/time-to-clinical-benefit-van-dapagliflozine-bij-hfref-dapa-hf/","title":"Time to clinical benefit van dapagliflozine bij HFrEF: DAPA-HF","title_en":"Time to Clinical Benefit of Dapagliflozin and Significance of Prior Heart Failure Hospitalization in Patients With Heart Failure With Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.7585","source_url":"https://doi.org/10.1001/jamacardio.2020.7585","authors":["David D Berg","Pardeep S Jhund","Kieran F Docherty","Sabina A Murphy","Subodh Verma","Silvio E Inzucchi","Lars Køber","Mikhail N Kosiborod","Anna Maria Langkilde","Felipe A Martinez","Olof Bengtsson","Piotr Ponikowski","Mikaela Sjöstrand","Scott D Solomon","John J V McMurray","Marc S Sabatine"],"significance":7,"published":"2021-05-01","source_date":"2021-05-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This DAPA-HF analysis showed that dapagliflozin achieves clinical benefit within weeks of initiation in HFrEF, with earlier benefit in patients with prior heart failure hospitalization, supporting prompt SGLT2 inhibitor initiation.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology DAPA-HF analyse naar de snelheid waarmee dapagliflozine klinisch voordeel bereikt bij HFrEF en het belang van eerdere HF-hospitalisatie.","abstract_original":"IMPORTANCE: Dapagliflozin has been shown to reduce the risk of cardiovascular death or worsening heart failure (HF) in patients with chronic HF and reduced ejection fraction (HFrEF). However, clinical inertia often underlies deferred initiation of effective therapies. OBJECTIVE: To examine timing of onset of clinical benefit with dapagliflozin and magnitude as a function of proximity to prior HF hospitalization. DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis of a completed multinational trial. The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure trial was a double-blind, placebo-controlled randomized clinical trial of dapagliflozin in patients with chronic HFrEF (n = 4744). From February 2017 to August 2018, the study enrolled patients in New York Heart Association classes II through IV and with left ventricular ejection fraction of 40% or less; the median (range) follow-up time was 18.2 (0-27.8) months. Hazard ratios (HRs) were calculated for the primary efficacy outcome with dapagliflozin vs placebo by time following randomization. Efficacy and safety of dapagliflozin were assessed according to the timing of the most recent HF hospitalization prior to trial enrollment. EXPOSURES: None. MAIN OUTCOMES AND MEASURES: Composite of cardiovascular death or worsening HF. RESULTS: A total of 4744 patients were included (1109 women [23.4%]; mean [SD] age, 66.3 [10.9] years). The reduction in the primary outcome with dapagliflozin was rapidly apparent, with a sustained statistically significant benefit by 28 days after randomization (HR at 28 days, 0.51 [95% CI, 0.28-0.94]; P = .03). A total of 2251 patients (47.4%) had been previously hospitalized for HF, and 1301 (27.4%) had been hospitalized within 12 months prior to enrollment. Among patients treated with placebo, there was a stepwise gradient of risk for the primary outcome according to timing of most recent HF hospitalization, with 2-year Kaplan-Meier rates of 21.1%, 25.3%, and 33.8% (adjusted P = .003) for patients with a prior HF hospitalization never, more than 12 months ago, and 12 or fewer months ago, respectively. Across these subgroups, dapagliflozin reduced the relative risk of the primary outcome by 16% (HR, 0.84 [95% CI, 0.69-1.01]), 27% (HR, 0.73 [95% CI, 0.54-0.99]), and 36% (HR, 0.64 [95% CI, 0.51-0.80]), respectively (P = .07 for trend). Accordingly, patients with a more recent HF hospitalization tended to experience greater absolute risk reductions with dapagliflozin at 2 years: 2.1% (95% CI, -1.9% to 6.1%), 4.1% (95% CI, -3.6% to 11.7%), and 9.9% (95% CI, 3.3%-16.5%), respectively (P = .05 for trend). CONCLUSIONS AND RELEVANCE: In this study, treatment with dapagliflozin was associated with rapid reduction in the risk of cardiovascular death or worsening HF, with a sustained statistically significant benefit emerging very early after randomization. Patients with a more recent HF hospitalization were at particularly high risk and experienced greater relative and absolute risk reductions with dapagliflozin. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03036124."},{"id":"3587e088f934","type":"article","url":"https://hartvaat.nl/2021/05/01/mcp-1-en-cardiovasculaire-mortaliteit-populatie-gebaseerde-meta-analyse/","title":"MCP-1 en cardiovasculaire mortaliteit: populatie-gebaseerde meta-analyse","title_en":"Association of Circulating Monocyte Chemoattractant Protein-1 Levels With Cardiovascular Mortality: A Meta-analysis of Population-Based Studies.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.5392","source_url":"https://doi.org/10.1001/jamacardio.2020.5392","authors":["Marios K Georgakis","James A de Lemos","Colby Ayers","Biqi Wang","Harry Björkbacka","Tiberiu A Pana","Barbara Thorand","Caroline Sun","Lana Fani","Rainer Malik","Josée Dupuis","Gunnar Engström","Marju Orho-Melander","Olle Melander","S Matthijs Boekholdt","Astrid Zierer","Mohamed A Elhadad","Wolfgang Koenig","Christian Herder","Ron C Hoogeveen","Maryam Kavousi","Christie M Ballantyne","Annette Peters","Phyo K Myint","Jan Nilsson","Emelia J Benjamin","Martin Dichgans"],"significance":5,"published":"2021-05-01","source_date":"2021-05-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that circulating MCP-1 (monocyte chemoattractant protein-1) is independently associated with cardiovascular mortality in population-based studies, supporting its role as an inflammatory risk biomarker.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van populatiestudies naar de associatie van monocyt-chemoattractant proteïne-1 met cardiovasculaire mortaliteit.","abstract_original":"IMPORTANCE: Human genetics and studies in experimental models support a key role of monocyte-chemoattractant protein-1 (MCP-1) in atherosclerosis. Yet, the associations of circulating MCP-1 levels with risk of coronary heart disease and cardiovascular death in the general population remain largely unexplored. OBJECTIVE: To explore whether circulating levels of MCP-1 are associated with risk of incident coronary heart disease, myocardial infarction, and cardiovascular mortality in the general population. DATA SOURCES AND SELECTION: Population-based cohort studies, identified through a systematic review, that have examined associations of circulating MCP-1 levels with cardiovascular end points. DATA EXTRACTION AND SYNTHESIS: Using a prespecified harmonized analysis plan, study-specific summary data were obtained from Cox regression models after excluding individuals with overt cardiovascular disease at baseline. Derived hazard ratios (HRs) were synthesized using random-effects meta-analyses. MAIN OUTCOMES AND MEASURES: Incident coronary heart disease (myocardial infarction, coronary revascularization, and unstable angina), nonfatal myocardial infarction, and cardiovascular death (from cardiac or cerebrovascular causes). RESULTS: The meta-analysis included 7 cohort studies involving 21 401 individuals (mean [SD] age, 53.7 [10.2] years; 10 012 men [46.8%]). Mean (SD) follow-up was 15.3 (4.5) years (326 392 person-years at risk). In models adjusting for age, sex, and race/ethnicity, higher MCP-1 levels at baseline were associated with increased risk of coronary heart disease (HR per 1-SD increment in MCP-1 levels: 1.06 [95% CI, 1.01-1.11]; P = .01), nonfatal myocardial infarction (HR, 1.07 [95% CI, 1.01-1.13]; P = .02), and cardiovascular death (HR, 1.12 [95% CI, 1.05-1.20]; P < .001). In analyses comparing MCP-1 quartiles, these associations followed dose-response patterns. After additionally adjusting for vascular risk factors, the risk estimates were attenuated, but the associations of MCP-1 levels with cardiovascular death remained statistically significant, as did the association of MCP-1 levels in the upper quartile with coronary heart disease. There was no significant heterogeneity; the results did not change in sensitivity analyses excluding events occurring in the first 5 years after MCP-1 measurement, and the risk estimates were stable after additional adjustments for circulating levels of interleukin-6 and high-sensitivity C-reactive protein. CONCLUSIONS AND RELEVANCE: Higher circulating MCP-1 levels are associated with higher long-term cardiovascular mortality in community-dwelling individuals free of overt cardiovascular disease. These findings provide further support for a key role of MCP-1-signaling in cardiovascular disease."},{"id":"46cbf3317ec0","type":"article","url":"https://hartvaat.nl/2021/05/01/vroegtijdig-permanent-staken-van-apixaban-of-warfarine-bij-af/","title":"Vroegtijdig permanent staken van apixaban of warfarine bij AF","title_en":"Premature permanent discontinuation of apixaban or warfarin in patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-317229","source_url":"https://doi.org/10.1136/heartjnl-2020-317229","authors":["Anthony P Carnicelli","Sana M Al-Khatib","Denis Xavier","Frederik Dalgaard","Peter D Merrill","Daniel M Wojdyla","Basil S Lewis","Michael Hanna","John H Alexander","Renato D Lopes","Lars Wallentin","Christopher B Granger"],"significance":6,"published":"2021-05-01","source_date":"2021-05-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This ARISTOTLE analysis showed that premature discontinuation of both apixaban and warfarin is associated with worse outcomes in AF, with similar rates of permanent discontinuation but different reasons across the two agents.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het vroegtijdig permanent staken van apixaban versus warfarine bij AF-patiënten en de gevolgen.","abstract_original":"AIMS: The ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial randomised patients with atrial fibrillation at risk of stroke to apixaban or warfarin. We sought to describe patients from ARISTOTLE who prematurely permanently discontinued study drug. METHODS/RESULTS: We performed a posthoc analysis of patients from ARISTOTLE who prematurely permanently discontinued study drug during the study or follow-up period. Discontinuation rates and reasons for discontinuation were described. Death, thromboembolism (stroke, transient ischaemic attack, systemic embolism), myocardial infarction and major bleeding rates were stratified by ≤30 days or >30 days after discontinuation. A total of 4063/18 140 (22.4%) patients discontinued study drug at a median of 7.3 (2.2, 15.2) months after randomisation. Patients with discontinuation were more likely to be female and had a higher prevalence of cardiovascular disease, diabetes, renal impairment and anaemia. Premature permanent discontinuation was more common in those randomised to warfarin than apixaban (23.4% vs 21.4%; p=0.002). The most common reasons for discontinuation were patient request (46.1%) and adverse event (34.9%), with no significant difference between treatment groups. The cumulative incidence of clinical events ≤30 days after premature permanent discontinuation for all-cause death, thromboembolism, myocardial infarction, and major bleeding was 5.8%, 2.6%, 0.9%, and 3.0%, respectively. No significant difference was seen between treatment groups with respect to clinical outcomes after discontinuation. CONCLUSION: Premature permanent discontinuation of study drug in ARISTOTLE was common, less frequent in patients receiving apixaban than warfarin and was followed by high 30-day rates of death, thromboembolism and major bleeding. Initiatives are needed to reduce discontinuation of oral anticoagulation."},{"id":"7fde6c0921e2","type":"article","url":"https://hartvaat.nl/2021/04/27/screening-op-hypertensie-bij-volwassenen-uspstf-evidence-update-2021/","title":"Screening op hypertensie bij volwassenen: USPSTF evidence update 2021","title_en":"Screening for Hypertension in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.21669","source_url":"https://doi.org/10.1001/jama.2020.21669","authors":["Janelle M Guirguis-Blake","Corinne V Evans","Elizabeth M Webber","Erin L Coppola","Leslie A Perdue","Meghan Soulsby Weyrich"],"significance":7,"published":"2021-04-27","source_date":"2021-04-27","image":"","kennis":[],"congress":"","summary_en":"This updated USPSTF evidence review confirmed that screening for hypertension in adults followed by appropriate treatment reduces cardiovascular events and mortality, supporting the continued recommendation for routine blood pressure screening.","created":"2026-07-03T10:29:10Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"USPSTF 2021 geactualiseerde evidence report over screening op hypertensie bij volwassenen.","abstract_original":"IMPORTANCE: Hypertension is a major risk factor for cardiovascular disease and can be modified through lifestyle and pharmacological interventions to reduce cardiovascular events and mortality. OBJECTIVE: To systematically review the benefits and harms of screening and confirmatory blood pressure measurements in adults, to inform the US Preventive Services Task Force. DATA SOURCES: MEDLINE, PubMed, Cochrane Collaboration Central Registry of Controlled Trials, and CINAHL; surveillance through March 26, 2021. STUDY SELECTION: Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies for effectiveness of screening; accuracy studies for screening and confirmatory measurements (ambulatory blood pressure monitoring as the reference standard); RCTs and nonrandomized controlled intervention studies and observational studies for harms of screening and confirmation. DATA EXTRACTION AND SYNTHESIS: Independent critical appraisal and data abstraction; meta-analyses and qualitative syntheses. MAIN OUTCOMES AND MEASURES: Mortality; cardiovascular events; quality of life; sensitivity, specificity, positive and negative predictive values; harms of screening. RESULTS: A total of 52 studies (N = 215 534) were identified in this systematic review. One cluster RCT (n = 140 642) of a multicomponent intervention including hypertension screening reported fewer annual cardiovascular-related hospital admissions for cardiovascular disease in the intervention group compared with the control group (difference, 3.02 per 1000 people; rate ratio, 0.91 [95% CI, 0.86-0.97]). Meta-analysis of 15 studies (n = 11 309) of initial office-based blood pressure screening showed a pooled sensitivity of 0.54 (95% CI, 0.37-0.70) and specificity of 0.90 (95% CI, 0.84-0.95), with considerable clinical and statistical heterogeneity. Eighteen studies (n = 57 128) of various confirmatory blood pressure measurement modalities were heterogeneous. Meta-analysis of 8 office-based confirmation studies (n = 53 183) showed a pooled sensitivity of 0.80 (95% CI, 0.68-0.88) and specificity of 0.55 (95% CI, 0.42-0.66). Meta-analysis of 4 home-based confirmation studies (n = 1001) showed a pooled sensitivity of 0.84 (95% CI, 0.76-0.90) and a specificity of 0.60 (95% CI, 0.48-0.71). Thirteen studies (n = 5150) suggested that screening was associated with no decrement in quality of life or psychological distress; evidence on absenteeism was mixed. Ambulatory blood pressure measurement was associated with temporary sleep disturbance and bruising. CONCLUSIONS AND RELEVANCE: Screening using office-based blood pressure measurement had major accuracy limitations, including misdiagnosis; however, direct harms of measurement were minimal. Research is needed to determine optimal screening and confirmatory algorithms for clinical practice."},{"id":"2bb523083dba","type":"article","url":"https://hartvaat.nl/2021/04/27/screening-op-hypertensie-bij-volwassenen-uspstf-herbevestiging-2021/","title":"Screening op hypertensie bij volwassenen: USPSTF herbevestiging 2021","title_en":"Screening for Hypertension in Adults: US Preventive Services Task Force Reaffirmation Recommendation Statement.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.4987","source_url":"https://doi.org/10.1001/jama.2021.4987","authors":["Alex H Krist","Karina W Davidson","Carol M Mangione","Michael Cabana","Aaron B Caughey","Esa M Davis","Katrina E Donahue","Chyke A Doubeni","Martha Kubik","Li Li","Gbenga Ogedegbe","Lori Pbert","Michael Silverstein","James Stevermer","Chien-Wen Tseng","John B Wong"],"significance":7,"published":"2021-04-27","source_date":"2021-04-27","image":"","kennis":[],"congress":"","summary_en":"The 2021 USPSTF reaffirmed the recommendation for screening for hypertension in adults, maintaining a Grade A recommendation for office blood pressure measurement as part of routine care.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"USPSTF 2021 herbevestiging van de aanbeveling voor screening op hypertensie bij volwassenen.","abstract_original":"IMPORTANCE: Hypertension is a prevalent condition that affects approximately 45% of the adult US population and is the most commonly diagnosed condition at outpatient office visits. Hypertension is a major contributing risk factor for heart failure, myocardial infarction, stroke, and chronic kidney disease. OBJECTIVE: To reaffirm its 2015 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertension in adults, the accuracy of office blood pressure measurement for initial screening, and the accuracy of various confirmatory blood pressure measurement methods. POPULATION: Adults 18 years or older without known hypertension. EVIDENCE ASSESSMENT: Using a reaffirmation deliberation process, the USPSTF concludes with high certainty that screening for hypertension in adults has substantial net benefit. RECOMMENDATION: The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (A recommendation)."},{"id":"69db8bb658c1","type":"article","url":"https://hartvaat.nl/2021/04/27/groepsmedisch-consult-en-microfinanciering-bij-diabetes-hypertensie-in-kenia/","title":"Groepsmedisch consult en microfinanciering bij diabetes/hypertensie in Kenia","title_en":"Group Medical Visit and Microfinance Intervention for Patients With Diabetes or Hypertension in Kenya.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["anemie-ckd","diabetes-en-hart"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.03.002","source_url":"https://doi.org/10.1016/j.jacc.2021.03.002","authors":["Rajesh Vedanthan","Jemima H Kamano","Stavroula A Chrysanthopoulou","Richard Mugo","Benjamin Andama","Gerald S Bloomfield","Cleophas W Chesoli","Allison K DeLong","David Edelman","Eric A Finkelstein","Carol R Horowitz","Simon Manyara","Diana Menya","Violet Naanyu","Vitalis Orango","Sonak D Pastakia","Thomas W Valente","Joseph W Hogan","Valentin Fuster"],"significance":6,"published":"2021-04-27","source_date":"2021-04-27","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This study tested a combined group medical visit and microfinance intervention for patients with diabetes or hypertension in Kenya, addressing social determinants of health through an integrated care delivery model.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T18:38:49Z","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 naar een groepsmedisch consult en microfinancieringsinterventie bij diabetes of hypertensie in Kenia.","abstract_original":"BACKGROUND: Incorporating social determinants of health into care delivery for chronic diseases is a priority. OBJECTIVES: The goal of this study was to evaluate the impact of group medical visits and/or microfinance on blood pressure reduction. METHODS: The authors conducted a cluster randomized trial with 4 arms and 24 clusters: 1) usual care (UC); 2) usual care plus microfinance (MF); 3) group medical visits (GMVs); and 4) GMV integrated into MF (GMV-MF). The primary outcome was 1-year change in systolic blood pressure (SBP). Mixed-effects intention-to-treat models were used to evaluate the outcomes. RESULTS: A total of 2,890 individuals (69.9% women) were enrolled (708 UC, 709 MF, 740 GMV, and 733 GMV-MF). Average baseline SBP was 157.5 mm Hg. Mean SBP declined -11.4, -14.8, -14.7, and -16.4 mm Hg in UC, MF, GMV, and GMV-MF, respectively. Adjusted estimates and multiplicity-adjusted 98.3% confidence intervals showed that, relative to UC, SBP reduction was 3.9 mm Hg (-8.5 to 0.7), 3.3 mm Hg (-7.8 to 1.2), and 2.3 mm Hg (-7.0 to 2.4) greater in GMV-MF, GMV, and MF, respectively. GMV and GMV-MF tended to benefit women, and MF and GMV-MF tended to benefit poorer individuals. Active participation in GMV-MF was associated with greater benefit. CONCLUSIONS: A strategy combining GMV and MF for individuals with diabetes or hypertension in Kenya led to clinically meaningful SBP reductions associated with cardiovascular benefit. Although the significance threshold was not met in pairwise comparison hypothesis testing, confidence intervals for GMV-MF were consistent with impacts ranging from substantive benefit to neutral effect relative to UC. Incorporating social determinants of health into care delivery for chronic diseases has potential to improve outcomes. (Bridging Income Generation With Group Integrated Care [BIGPIC]; NCT02501746)."},{"id":"8dfe1dc7dd5a","type":"article","url":"https://hartvaat.nl/2021/04/27/patientselectie-voor-intensieve-bloeddrukbehandeling-naar-voordeel-en-bijwerking/","title":"Patiëntselectie voor intensieve bloeddrukbehandeling naar voordeel en bijwerkingen","title_en":"Patient Selection for Intensive Blood Pressure Management Based on Benefit and Adverse Events.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.02.058","source_url":"https://doi.org/10.1016/j.jacc.2021.02.058","authors":["Adam P Bress","Tom Greene","Catherine G Derington","Jincheng Shen","Yizhe Xu","Yiyi Zhang","Jian Ying","Brandon K Bellows","William C Cushman","Paul K Whelton","Nicholas M Pajewski","David Reboussin","Srinivasan Beddu","Rachel Hess","Jennifer S Herrick","Zugui Zhang","Paul Kolm","Robert W Yeh","Sanjay Basu","William S Weintraub","Andrew E Moran"],"significance":7,"published":"2021-04-27","source_date":"2021-04-27","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This analysis developed a framework for identifying patients who benefit most from intensive blood pressure treatment based on the balance between cardiovascular event prevention and adverse effects, supporting personalized blood pressure management.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar patiëntselectie voor intensieve bloeddrukbehandeling gebaseerd op de afweging van voordeel en bijwerkingen.","abstract_original":"BACKGROUND: Intensive systolic blood pressure (SBP) treatment prevents cardiovascular disease (CVD) events in patients with high CVD risk on average, though benefits likely vary among patients. OBJECTIVES: The aim of this study was to predict the magnitude of benefit (reduced CVD and all-cause mortality risk) along with adverse event (AE) risk from intensive versus standard SBP treatment. METHODS: This was a secondary analysis of SPRINT (Systolic Blood Pressure Intervention Trial). Separate benefit outcomes were the first occurrence of: 1) a CVD composite of acute myocardial infarction or other acute coronary syndrome, stroke, heart failure, or CVD death; and 2) all-cause mortality. Treatment-related AEs of interest included hypotension, syncope, bradycardia, electrolyte abnormalities, injurious falls, and acute kidney injury. Modified elastic net Cox regression was used to predict absolute risk for each outcome and absolute risk differences on the basis of 36 baseline variables available at the point of care with intensive versus standard treatment. RESULTS: Among 8,828 SPRINT participants (mean age 67.9 years, 35% women), 600 CVD composite events, 363 all-cause deaths, and 481 treatment-related AEs occurred over a median follow-up period of 3.26 years. Individual participant risks were predicted for the CVD composite (C index = 0.71), all-cause mortality (C index = 0.75), and treatment-related AEs (C index = 0.69). Higher baseline CVD risk was associated with greater benefit (i.e., larger absolute CVD risk reduction). Predicted CVD benefit and predicted increased treatment-related AE risk were correlated (Spearman correlation coefficient = -0.72), and 95% of participants who fell into the highest tertile of predicted benefit also had high or moderate predicted increases in treatment-related AE risk. Few were predicted as high benefit with low AE risk (1.8%) or low benefit with high AE risk (1.5%). Similar results were obtained for all-cause mortality. CONCLUSIONS: SPRINT participants with higher baseline predicted CVD risk gained greater absolute benefit from intensive treatment. Participants with high predicted benefit were also most likely to experience treatment-related AEs, but AEs were generally mild and transient. Patients should be prioritized for intensive SBP treatment on the basis of higher predicted benefit. (Systolic Blood Pressure Intervention Trial [SPRINT]; NCT01206062)."},{"id":"1c7beb1637d4","type":"article","url":"https://hartvaat.nl/2021/04/27/pneumonie-incidentie-en-uitkomsten-bij-hartfalen/","title":"Pneumonie-incidentie en uitkomsten bij hartfalen","title_en":"Incidence and Outcomes of Pneumonia in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.03.001","source_url":"https://doi.org/10.1016/j.jacc.2021.03.001","authors":["Li Shen","Pardeep S Jhund","Inder S Anand","Ankeet S Bhatt","Akshay S Desai","Aldo P Maggioni","Felipe A Martinez","Marc A Pfeffer","Adel R Rizkala","Jean L Rouleau","Karl Swedberg","Muthiah Vaduganathan","Orly Vardeny","Dirk J van Veldhuisen","Faiez Zannad","Michael R Zile","Milton Packer","Scott D Solomon","John J V McMurray"],"significance":5,"published":"2021-04-27","source_date":"2021-04-27","image":"","kennis":[],"congress":"","summary_en":"This study showed that pneumonia incidence and outcomes differ between HFrEF and HFpEF patients, highlighting the infection vulnerability of heart failure and the need for vaccination and prevention strategies.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de incidentie en uitkomsten van pneumonie bij hartfalenpatiënten.","abstract_original":"BACKGROUND: The incidence of pneumonia and subsequent outcomes has not been compared in patients with heart failure and reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). OBJECTIVES: This study aimed to examine the rate and impact of pneumonia in the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in Heart Failure with Preserved Ejection Fraction) trials. METHODS: The authors analyzed the incidence of investigator-reported pneumonia and the rates of HF hospitalization, cardiovascular death, and all-cause death before and after the occurrence of pneumonia, and estimated risk after the first occurrence of pneumonia in unadjusted and adjusted analyses (the latter including N-terminal pro-B-type natriuretic peptide). RESULTS: In PARADIGM-HF, 528 patients (6.3%) developed pneumonia after randomization, giving an incidence rate of 29 (95% CI: 27 to 32) per 1,000 patient-years. In PARAGON-HF, 510 patients (10.6%) developed pneumonia, giving an incidence rate of 39 (95% CI: 36 to 42) per 1,000 patient-years. The subsequent risk of all trial outcomes was elevated after the occurrence of pneumonia. In PARADIGM-HF, the adjusted hazard ratio (HR) for the risk of death from any cause was 4.34 (95% CI: 3.73 to 5.05). The corresponding adjusted HR in PARAGON-HF was 3.76 (95% CI: 3.09 to 4.58). CONCLUSIONS: The incidence of pneumonia was high in patients with HF, especially HFpEF, at around 3 times the expected rate. A first episode of pneumonia was associated with 4-fold higher mortality. (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF], NCT01035255; Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] With ARB [Angiotensin Receptor Blocker] Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF], NCT01920711)."},{"id":"e52268d41303","type":"article","url":"https://hartvaat.nl/2021/04/27/empagliflozine-en-pulmonalisdruk-bij-hf-embrace-hf/","title":"Empagliflozine en pulmonalisdruk bij HF: EMBRACE-HF","title_en":"Empagliflozin Effects on Pulmonary Artery Pressure in Patients With Heart Failure: Results From the EMBRACE-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["answer-hf","bloeddrukbehandeling","dapa-hf","emperor-trials","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.052503","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.052503","authors":["Michael E Nassif","Mohammed Qintar","Sheryl L Windsor","Rita Jermyn","David M Shavelle","Fengming Tang","Sumant Lamba","Kunjan Bhatt","John Brush","Andrew Civitello","Robert Gordon","Orvar Jonsson","Brent Lampert","Jamie Pelzel","Mikhail N Kosiborod"],"significance":7,"published":"2021-04-27","source_date":"2021-04-27","image":"","kennis":[],"congress":"","summary_en":"The EMBRACE-HF trial showed that empagliflozin reduces pulmonary artery pressure in heart failure patients with implantable hemodynamic monitors, providing direct hemodynamic evidence of SGLT2 inhibitor-mediated cardiac decompression.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMBRACE-HF trial die het effect van empagliflozine op pulmonale arteriële druk onderzocht bij HF. Hemodynamisch mechanisme.","abstract_original":"BACKGROUND: Sodium glucose cotransporter 2 inhibitors (SGLT2 inhibitors) prevent heart failure (HF) hospitalizations in patients with type 2 diabetes and improve outcomes in those with HF and reduced ejection fraction, regardless of type 2 diabetes. Mechanisms of HF benefits remain unclear, and the effects of SGLT2 inhibitor on hemodynamics (filling pressures) are not known. The EMBRACE-HF trial (Empagliflozin Evaluation by Measuring Impact on Hemodynamics in Patients With Heart Failure) was designed to address this knowledge gap. METHODS: EMBRACE-HF is an investigator-initiated, randomized, multicenter, double-blind, placebo-controlled trial. From July 2017 to November 2019, patients with HF (regardless of ejection fraction, with or without type 2 diabetes) and previously implanted pulmonary artery (PA) pressure sensor (CardioMEMS) were randomized across 10 US centers to empagliflozin 10 mg daily or placebo and treated for 12 weeks. The primary end point was change in PA diastolic pressure (PADP) from baseline to end of treatment (average PADP weeks 8-12). Secondary end points included health status (Kansas City Cardiomyopathy Questionnaire score), natriuretic peptides, and 6-min walking distance. RESULTS: Overall, 93 patients were screened, and 65 were randomized (33 to empagliflozin, 32 to placebo). The mean age was 66 years; 63% were male; 52% had type 2 diabetes; 54% were in New York Heart Association class III/IV; mean ejection fraction was 44%; median NT-proBNP (N-terminal pro B-type natriuretic peptide) was 637 pg/mL; and mean PADP was 22 mm Hg. Empagliflozin significantly reduced PADP, with effects that began at week 1 and amplified over time; average PADP (weeks 8-12) was 1.5 mm Hg lower (95% CI, 0.2-2.8; P=0.02); and at week 12, PADP was 1.7 mm Hg lower (95% CI, 0.3-3.2; P=0.02) with empagliflozin versus placebo. Results were consistent for PA systolic and PA mean pressures. There was no difference in mean loop diuretic management (daily furosemide equivalents) between treatment groups. No significant differences between treatment groups were observed in Kansas City Cardiomyopathy Questionnaire scores, natriuretic peptide levels, and 6-min walking distance. CONCLUSIONS: In patients with HF and CardioMEMS PA pressure sensor, empagliflozin produced rapid reductions in PA pressures that were amplified over time and appeared to be independent of loop diuretic management. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03030222."},{"id":"2b86c3941cdd","type":"article","url":"https://hartvaat.nl/2021/04/27/2021-acc-aha-kerngegevenselementen-voor-hartfalen/","title":"2021 ACC/AHA kerngegevenselementen voor hartfalen","title_en":"2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.012","source_url":"https://doi.org/10.1016/j.jacc.2020.11.012","authors":["Biykem Bozkurt","Ray E Hershberger","Javed Butler","Kathleen L Grady","Paul A Heidenreich","Maria Lizza Isler","James K Kirklin","William S Weintraub"],"significance":5,"published":"2021-04-27","source_date":"2021-04-27","image":"","kennis":[],"congress":"","summary_en":"This ACC/AHA document defined standardized key data elements and definitions for heart failure research and quality improvement, enabling consistent data collection across registries and clinical trials.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC/AHA 2021 key data elements en definities voor hartfalen. Standaardisatie van dataverzameling.","abstract_original":""},{"id":"63ce21d20d26","type":"article","url":"https://hartvaat.nl/2021/04/20/il-6-receptorremming-bij-acuut-stemi-gerandomiseerde-trial/","title":"IL-6-receptorremming bij acuut STEMI: gerandomiseerde trial","title_en":"Randomized Trial of Interleukin-6 Receptor Inhibition in Patients With Acute ST-Segment Elevation Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.02.049","source_url":"https://doi.org/10.1016/j.jacc.2021.02.049","authors":["Kaspar Broch","Anne Kristine Anstensrud","Sindre Woxholt","Kapil Sharma","Ingvild Maria Tøllefsen","Bjørn Bendz","Svend Aakhus","Thor Ueland","Brage Høyem Amundsen","Jan Kristian Damås","Erlend Sturle Berg","Elisabeth Bjørkelund","Christina Bendz","Einar Hopp","Ola Kleveland","Knut Haakon Stensæth","Anders Opdahl","Nils-Einar Kløw","Ingebjørg Seljeflot","Geir Øystein Andersen","Rune Wiseth","Pål Aukrust","Lars Gullestad"],"significance":7,"published":"2021-04-20","source_date":"2021-04-20","image":"","kennis":[],"congress":"","summary_en":"This randomized trial of tocilizumab (IL-6 receptor inhibitor) in acute STEMI showed reduced C-reactive protein and troponin T release, demonstrating the feasibility and mechanistic promise of anti-inflammatory therapy in the acute MI setting.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial van IL-6-receptorremming (tocilizumab) bij acuut STEMI. Anti-inflammatoire benadering bij acuut MI.","abstract_original":"BACKGROUND: Prompt myocardial revascularization with percutaneous coronary intervention (PCI) reduces infarct size and improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI). However, as much as 50% of the loss of viable myocardium may be attributed to the reperfusion injury and the associated inflammatory response. OBJECTIVES: This study sought to evaluate the effect of the interleukin-6 receptor inhibitor tocilizumab on myocardial salvage in acute STEMI. METHODS: The ASSAIL-MI trial was a randomized, double-blind, placebo-controlled trial conducted at 3 high-volume PCI centers in Norway. Patients admitted with STEMI within 6 h of symptom onset were eligible. Consenting patients were randomized in a 1:1 fashion to promptly receive a single infusion of 280 mg tocilizumab or placebo. The primary endpoint was the myocardial salvage index as measured by magnetic resonance imaging after 3 to 7 days. RESULTS: We randomized 101 patients to tocilizumab and 98 patients to placebo. The myocardial salvage index was larger in the tocilizumab group than in the placebo group (adjusted between-group difference 5.6 [95% confidence interval: 0.2 to 11.3] percentage points, p = 0.04). Microvascular obstruction was less extensive in the tocilizumab arm, but there was no significant difference in the final infarct size between the tocilizumab arm and the placebo arm (7.2% vs. 9.1% of myocardial volume, p = 0.08). Adverse events were evenly distributed across the treatment groups. CONCLUSIONS: Tocilizumab increased myocardial salvage in patients with acute STEMI. (ASSessing the effect of Anti-IL-6 treatment in Myocardial Infarction [ASSAIL-MI]; NCT03004703)."},{"id":"513ce845d1f3","type":"article","url":"https://hartvaat.nl/2021/04/20/natriumreductie-en-bloeddruk-dosis-respons-meta-analyse-van-experimentele-studie/","title":"Natriumreductie en bloeddruk: dosis-respons meta-analyse van experimentele studies","title_en":"Blood Pressure Effects of Sodium Reduction: Dose-Response Meta-Analysis of Experimental Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050371","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050371","authors":["Tommaso Filippini","Marcella Malavolti","Paul K Whelton","Androniki Naska","Nicola Orsini","Marco Vinceti"],"significance":7,"published":"2021-04-20","source_date":"2021-04-20","image":"","kennis":[],"congress":"","summary_en":"This dose-response meta-analysis of experimental studies quantified the blood pressure effect of sodium reduction, showing a linear relationship between dietary sodium decrease and blood pressure lowering across the range of intake levels.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Dosis-respons meta-analyse van experimentele studies naar het bloeddrukeffect van natriumreductie. Kwantificeert de relatie.","abstract_original":"BACKGROUND: The relationship between dietary sodium intake and blood pressure (BP) has been tested in clinical trials and nonexperimental human studies, indicating a direct association. The exact shape of the dose-response relationship has been difficult to assess in clinical trials because of the lack of random-effects dose-response statistical models that can include 2-arm comparisons. METHODS: After performing a comprehensive literature search for experimental studies that investigated the BP effects of changes in dietary sodium intake, we conducted a dose-response meta-analysis using the new 1-stage cubic spline mixed-effects model. We included trials with at least 4 weeks of follow-up; 24-hour urinary sodium excretion measurements; sodium manipulation through dietary change or supplementation, or both; and measurements of systolic and diastolic BP at the beginning and end of treatment. RESULTS: We identified 85 eligible trials with sodium intake ranging from 0.4 to 7.6 g/d and follow-up from 4 weeks to 36 months. The trials were conducted in participants with hypertension (n=65), without hypertension (n=11), or a combination (n=9). Overall, the pooled data were compatible with an approximately linear relationship between achieved sodium intake and mean systolic as well as diastolic BP, with no indication of a flattening of the curve at either the lowest or highest levels of sodium exposure. Results were similar for participants with or without hypertension, but the former group showed a steeper decrease in BP after sodium reduction. Intervention duration (≥12 weeks versus 4 to 11 weeks), type of study design (parallel or crossover), use of antihypertensive medication, and participants' sex had little influence on the BP effects of sodium reduction. Additional analyses based on the BP effect of difference in sodium exposure between study arms at the end of the trial confirmed the results on the basis of achieved sodium intake. CONCLUSIONS: In this dose-response analysis of sodium reduction in clinical trials, we identified an approximately linear relationship between sodium intake and reduction in both systolic and diastolic BP across the entire range of dietary sodium exposure. Although this occurred independently of baseline BP, the effect of sodium reduction on level of BP was more pronounced in participants with a higher BP level."},{"id":"5031f2242169","type":"article","url":"https://hartvaat.nl/2021/04/17/geleide-versus-standaard-antiplaatjestherapie-na-pci-lancet-meta-analyse/","title":"Geleide versus standaard antiplaatjestherapie na PCI: Lancet meta-analyse","title_en":"Guided versus standard antiplatelet therapy in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)00533-X","source_url":"https://doi.org/10.1016/S0140-6736(21)00533-X","authors":["Mattia Galli","Stefano Benenati","Davide Capodanno","Francesco Franchi","Fabiana Rollini","Domenico D'Amario","Italo Porto","Dominick J Angiolillo"],"significance":8,"published":"2021-04-17","source_date":"2021-04-17","image":"","kennis":[],"congress":"","summary_en":"This Lancet meta-analysis showed that guided antiplatelet therapy selection (pharmacogenomic or pharmacodynamic testing) after PCI reduces ischemic and bleeding events compared with standard unguided therapy. The results supported precision medicine approaches to antiplatelet management.","created":"2026-07-03T10:29:09Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet meta-analyse van geleide (farmacogenetisch/farmacodynamisch) versus standaard antiplaatjestherapie na PCI. Synthese van alle de-escalatiestrategieën.","abstract_original":"BACKGROUND: Whether guided selection of antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) is effective in improving outcomes compared with standard antiplatelet therapy remains controversial. We assessed the safety and efficacy of guided versus standard selection of antiplatelet therapy in patients undergoing PCI. METHODS: For this systematic review and meta-analysis, from Aug 20 to Oct 25, 2020, we searched MEDLINE (via PubMed), Cochrane, Embase, and Web of Science databases for randomised controlled trials and observational studies published in any language that compared guided antiplatelet therapy, by means of platelet function testing or genetic testing, versus standard antiplatelet therapy in patients undergoing PCI. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. Risk ratios (RRs) and 95% CIs were used with random-effects or fixed-effect models according to the estimated heterogeneity among studies assessed by the I2 index. Coprimary endpoints were trial-defined primary major adverse cardiovascular events and any bleeding. Key secondary endpoints were all-cause death, cardiovascular death, myocardial infarction, stroke, definite or probable stent thrombosis, and major and minor bleeding. This study is registered with PROSPERO (CRD42021215901). FINDINGS: 3656 potentially relevant articles were screened. Our analysis included 11 randomised controlled trials and three observational studies with data for 20 743 patients. Compared with standard therapy, guided selection of antiplatelet therapy was associated with a reduction in major adverse cardiovascular events (RR 0·78, 95% CI 0·63-0·95, p=0·015) and reduced bleeding, although not statistically significant (RR 0·88, 0·77-1·01, p=0·069). Cardiovascular death (RR 0·77, 95% CI 0·59-1·00, p=0·049), myocardial infarction (RR 0·76, 0·60-0·96, p=0·021), stent thrombosis (RR 0·64, 0·46-0·89, p=0·011), stroke (RR 0·66, 0·48-0·91, p=0·010), and minor bleeding (RR 0·78, 0·67-0·92, p=0·0030) were reduced with guided therapy compared with standard therapy. Risks of all-cause death and major bleeding did not differ between guided and standard approaches. Outcomes varied according to the strategy used, with an escalation approach associated with a significant reduction in ischaemic events without any trade-off in safety, and a de-escalation approach associated with a significant reduction in bleeding, without any trade-off in efficacy. INTERPRETATION: Guided selection of antiplatelet therapy improved both composite and individual efficacy outcomes with a favourable safety profile, driven by a reduction in minor bleeding, supporting the use of platelet function or genetic testing to optimise the choice of agent in patients undergoing PCI. FUNDING: None."},{"id":"9b3e818eea05","type":"article","url":"https://hartvaat.nl/2021/04/07/2020-esc-richtlijn-voor-nste-acs-management/","title":"2020 ESC-richtlijn voor NSTE-ACS management","title_en":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","richtlijnen-esc"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa575","source_url":"https://doi.org/10.1093/eurheartj/ehaa575","authors":["Jean-Philippe Collet","Holger Thiele","Emanuele Barbato","Olivier Barthélémy","Johann Bauersachs","Deepak L Bhatt","Paul Dendale","Maria Dorobantu","Thor Edvardsen","Thierry Folliguet","Chris P Gale","Martine Gilard","Alexander Jobs","Peter Jüni","Ekaterini Lambrinou","Basil S Lewis","Julinda Mehilli","Emanuele Meliga","Béla Merkely","Christian Mueller","Marco Roffi","Frans H Rutten","Dirk Sibbing","George C M Siontis"],"significance":10,"published":"2021-04-07","source_date":"2021-04-07","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/","https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"The 2020 ESC Guidelines for non-ST-elevation acute coronary syndromes updated risk stratification, timing of invasive management, and antithrombotic strategies incorporating evidence from ISCHEMIA, TWILIGHT, and contemporary trials. The guideline refined the balance between ischemic protection and bleeding risk in ACS patients.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ESC 2020 richtlijn voor het management van acute coronaire syndromen bij patiënten zonder persisterende ST-elevatie. Geactualiseerd met ISCHEMIA-resultaten.","abstract_original":""},{"id":"d27bde006579","type":"article","url":"https://hartvaat.nl/2021/04/06/ventriculaire-aritmie-bij-niet-ischemisch-hf-prevalentie-en-prognose-danish/","title":"Ventriculaire aritmie bij niet-ischemisch HF: prevalentie en prognose — DANISH","title_en":"Prevalence and prognostic association of ventricular arrhythmia in non-ischaemic heart failure patients: results from the DANISH trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp"],"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/euaa341","source_url":"https://doi.org/10.1093/europace/euaa341","authors":["Rune Boas","Jens Jakob Thune","Steen Pehrson","Lars Køber","Jens C Nielsen","Lars Videbæk","Jens Haarbo","Eva Korup","Niels Eske Bruun","Axel Brandes","Hans Eiskjær","Anna M Thøgersen","Berit T Philbert","Jesper Hastrup Svendsen","Ulrik Dixen"],"significance":6,"published":"2021-04-06","source_date":"2021-04-06","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This DANISH analysis characterized the prevalence and prognostic significance of ventricular arrhythmias in non-ischemic heart failure, providing risk stratification data for ICD selection in this debated indication.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DANISH analyse naar prevalentie en prognostische associatie van ventriculaire aritmieën bij niet-ischemisch hartfalen.","abstract_original":"AIMS: Improved risk stratification to identify non-ischaemic heart failure patients who will benefit from primary prophylactic implantable cardioverter-defibrillator (ICD) is needed. We examined the potential of ventricular arrhythmia to identify patients who could benefit from an ICD. METHODS AND RESULTS: A total of 850 non-ischaemic systolic heart failure patients with left ventricle ≤35% and elevated N-terminal pro-brain natriuretic peptides had a 24-h Holter monitor recording performed. We examined present non-sustained ventricular tachycardia (NSVT), defined as ≥3 consecutive premature ventricular contractions (PVCs) with a rate of ≥100/min, and number of PVCs per hour stratified into low (<30) and high burden (≥30) groups. Outcome measures were overall mortality, sudden cardiac death (SCD), and cardiovascular death (CVD). In total, 193 patients died, 49 from SCD and 125 from CVD. Non-sustained ventricular tachycardia (365 patients) was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.47; 95% confidence interval (CI) 1.07-2.03; P = 0.02] and to CVD (HR 1.89; CI 1.25-2.87; P = 0.003). High burden PVC (352 patients) was associated with increased all-cause mortality (HR1.38; CI 1.00-1.90; P = 0.046) and with CVD (HR 1.78; CI 1.19-2.66; P = 0.005). There was no statistically significant association with SCD for neither NSVT nor PVC. In interaction analyses, neither NSVT (P = 0.56) nor high burden of PVC (P = 0.97) was associated with survival benefit from ICD implantation. CONCLUSION: Ventricular arrhythmia in non-ischaemic heart failure patients was associated with a worse prognosis but could not be used to stratify patients to ICD implantation."},{"id":"6ab48fed97b1","type":"article","url":"https://hartvaat.nl/2021/04/06/pvi-alleen-versus-uitgebreide-ablatie-bij-persisterend-af-meta-analyse/","title":"PVI alleen versus uitgebreide ablatie bij persisterend AF: meta-analyse","title_en":"Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: the EARNEST-PVI 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/euaa293","source_url":"https://doi.org/10.1093/europace/euaa293","authors":["Koichi Inoue","Shungo Hikoso","Masaharu Masuda","Yoshio Furukawa","Akio Hirata","Yasuyuki Egami","Tetsuya Watanabe","Hitoshi Minamiguchi","Miwa Miyoshi","Nobuaki Tanaka","Takafumi Oka","Masato Okada","Takashi Kanda","Yasuhiro Matsuda","Masato Kawasaki","Kenichi Hayashi","Tetsuhisa Kitamura","Tomoharu Dohi","Akihiro Sunaga","Hiroya Mizuno","Daisaku Nakatani","Yasushi Sakata"],"significance":6,"published":"2021-04-06","source_date":"2021-04-06","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that PVI alone achieves similar outcomes to more extensive ablation (defragmentation and linear lesions) for persistent AF, supporting the simpler approach as the standard first procedure.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die PVI alleen vergeleek met uitgebreide ablatie (defragmentatie en lineaire laesies) bij persisterend AF.","abstract_original":"AIMS: Previous studies could not demonstrate any benefit of more intensive ablation in addition to pulmonary vein isolation (PVI) including complex fractionated atrial electrogram (CFAE) and linear ablation for recurrence in the initial catheter ablation of persistent atrial fibrillation (AF). This study aimed to establish the non-inferiority of PVI alone to PVI plus these additional ablation strategies. METHODS AND RESULTS: Patients with persistent AF who underwent an initial catheter ablation (n = 512, long-standing persistent AF; 128 cases) were randomly assigned in a 1:1 ratio to either PVI alone (PVI-alone group) or PVI plus CFAE and/or linear ablation (PVI-plus group). After excluding 15 cases who did not receive procedures, we analysed 249 and 248 patients, respectively. The primary endpoint was recurrence of AF, atrial flutter, and/or atrial tachycardia, and the non-inferior margin was set at a hazard ratio of 1.43. In the PVI-plus group, 85.1% of patients had linear ablation and 15.3% CFAE ablation. After 12 months, freedom from the primary endpoint occurred in 71.3% of patients in the PVI-alone group and in 78.3% in the PVI-plus group [hazard ratio = 1.56 (95% confidence interval: 1.10-2.24), non-inferior P = 0.3062]. The procedure-related complication rates were 2.0% in the PVI-alone group and 3.6% in the PVI-plus group (P = 0.199). CONCLUSION: This randomized trial did not establish the non-inferiority of PVI alone to PVI plus linear ablation or CFAE ablation in patients with persistent AF, but implied that the PVI plus strategy was promising to improve the clinical efficacy (NCT03514693)."},{"id":"ac0bc30c886c","type":"article","url":"https://hartvaat.nl/2021/04/01/ero-lvedv-ratio-en-respons-op-mitraclip-jama-cardiology/","title":"ERO/LVEDV-ratio en respons op MitraClip: JAMA Cardiology","title_en":"Association of Effective Regurgitation Orifice Area to Left Ventricular End-Diastolic Volume Ratio With Transcatheter Mitral Valve Repair Outcomes: A Secondary Analysis of the COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.7200","source_url":"https://doi.org/10.1001/jamacardio.2020.7200","authors":["JoAnn Lindenfeld","William T Abraham","Paul A Grayburn","Saibal Kar","Federico M Asch","D Scott Lim","Hong Nie","Pooja Singhal","Kartik S Sundareswaran","Neil J Weissman","Michael J Mack","Gregg W Stone"],"significance":6,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that the effective regurgitation orifice area to LV end-diastolic volume ratio (ERO/LVEDV) predicts the response to transcatheter mitral valve repair, establishing a quantitative echocardiographic criterion for MitraClip patient selection.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse naar de associatie van de ERO/LVEDV-ratio met de respons op transcatheter mitraalklepherstel.","abstract_original":"IMPORTANCE: Transcatheter mitral valve repair (TMVr) plus maximally tolerated guideline-directed medical therapy (GDMT) reduced heart failure (HF) hospitalizations (HFHs) and all-cause mortality (ACM) in symptomatic patients with HF and secondary mitral regurgitation (SMR) compared with GDMT alone in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial but not in a similar trial, Multicenter Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR), possibly because the degree of SMR relative to the left ventricular end-diastolic volume index (LVEDVi) was substantially lower. OBJECTIVE: To explore contributions of the degree of SMR using the effective regurgitation orifice area (EROA), regurgitant volume (RV), and LVEDVi to the benefit of TMVr in the COAPT trial. DESIGN, SETTING, AND PARTICIPANTS: This post hoc secondary analysis of the COAPT randomized clinical trial performed December 27, 2012, to June 23, 2017, evaluated a subgroup of COAPT patients (group 1) with characteristics consistent with patients enrolled in MITRA-FR (n = 56) (HF with grade 3+ to 4+ SMR, left ventricular ejection fraction of 20%-50%, and New York Heart Association function class II-IV) compared with remaining (group 2) COAPT patients (n = 492) using the end point of ACM or HFH at 24 months, components of the primary end point, and quality of life (QOL) (per the Kansas City Cardiomyopathy Questionnaire overall summary score) and 6-minute walk distance (6MWD). The same end points were evaluated in 6 subgroups of COAPT by combinations of EROA and LVEDVi and of RV relative to LVEDVi. INTERVENTIONS: Interventions were TMVr plus GDMT vs GDMT alone. RESULTS: A total of 548 participants (mean [SD] age, 71.9 [11.2] years; 351 [64%] male) were included. In group 1, no significant difference was found in the composite rate of ACM or HFH between TMVr plus GDMT vs GDMT alone at 24 months (27.8% vs 33.1%, P = .83) compared with a significant difference at 24 months (31.5% vs 50.2%, P < .001) in group 2. However, patients randomized to receive TMVr vs those treated with GDMT alone had significantly greater improvement in QOL at 12 months (mean [SD] Kansas City Cardiomyopathy Questionnaire summary scores: group 1: 18.36 [5.38] vs 0.43 [4.00] points; P = .01; group 2: 16.54 [1.57] vs 5.78 [1.82] points; P < .001). Group 1 TMVr-randomized patients vs those treated with GDMT alone also had significantly greater improvement in 6MWD at 12 months (mean [SD] paired improvement: 39.0 [28.6] vs -48.0 [18.6] m; P = .02). Group 2 TMVr-randomized patients vs those treated with GDMT alone tended to have greater improvement in 6MWD at 12 months, but the difference did not reach statistical significance (mean [SD] paired improvement: 35.0 [7.7] vs 16.0 [9.1] m; P = .11). CONCLUSIONS AND RELEVANCE: A small subgroup of COAPT-resembling patients enrolled in MITRA-FR did not achieve improvement in ACM or HFH at 24 months but had a significant benefit on patient-centered outcomes (eg, QOL and 6MWD). Further subgroup analyses with 24-month follow-up suggest that the benefit of TMVr is not fully supported by the proportionate-disproportionate hypothesis. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01626079."},{"id":"0dd1830bef12","type":"article","url":"https://hartvaat.nl/2021/04/01/aerobe-training-bevordert-angiogenese-en-verlaagt-bloeddruk-bij-hypertensie-exca/","title":"Aerobe training bevordert angiogenese en verlaagt bloeddruk bij hypertensie: EXCAVATION-CHN","title_en":"Promotion of Aerobic Exercise Induced Angiogenesis Is Associated With Decline in Blood Pressure in Hypertension: Result of EXCAVATION-CHN1.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16107","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16107","authors":["Jianwen Liang","Xiaoyu Zhang","Wenhao Xia","Xinzhu Tong","Yanxia Qiu","Yumin Qiu","Jiang He","Bingbo Yu","Hui Huang","Jun Tao"],"significance":6,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This study showed that aerobic exercise training promotes angiogenesis that is associated with blood pressure reduction in hypertensive patients, providing a vascular mechanism linking physical activity to blood pressure improvement.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EXCAVATION-CHN studie die aantoont dat aerobe training angiogenese bevordert geassocieerd met bloeddrukverlaging bij hypertensie.","abstract_original":"[Figure: see text]."},{"id":"aa758c0bbed6","type":"article","url":"https://hartvaat.nl/2021/04/01/canagliflozine-naar-diureticagebruik-canvas-post-hoc-analyse/","title":"Canagliflozine naar diureticagebruik: CANVAS post-hoc analyse","title_en":"Cardiovascular and renal outcomes with canagliflozin according to baseline diuretic use: a post hoc analysis from the CANVAS Program.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13236","source_url":"https://doi.org/10.1002/ehf2.13236","authors":["Jie Yu","Clare Arnott","Brendon L Neuen","Hiddo L Heersprink","Kenneth W Mahaffey","Christopher P Cannon","Sadiya S Khan","Abigail S Baldridge","Sanjiv J Shah","Yuli Huang","Chao Li","Gemma A Figtree","Vlado Perkovic","Meg J Jardine","Bruce Neal","Mark D Huffman"],"significance":5,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This CANVAS post-hoc analysis showed that the cardiovascular and renal effects of canagliflozin differ by baseline diuretic use, providing practical insights for prescribing SGLT2 inhibitors alongside volume management.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CANVAS post-hoc analyse naar de CV/renale effecten van canagliflozine gestratificeerd naar diureticagebruik.","abstract_original":"AIMS: The CANVAS Program identified the effect of canagliflozin on major adverse cardiovascular events (MACE) differed according to whether participants were using diuretics at study commencement. We sought to further evaluate this finding related to baseline differences, treatment effects, safety, and risk factor changes. METHODS AND RESULTS: The CANVAS Program enrolled 10 142 participants with type 2 diabetes mellitus and high cardiovascular risk. Participants were randomized to canagliflozin or placebo and followed for a mean of 188 weeks. The primary outcome was major cardiovascular events, a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Secondary outcomes included multiple cardiovascular, renal, and safety events. In this post hoc subgroup analysis, participants were categorized according to baseline use of any diuretic. The effect on outcomes was compared using Cox proportional hazards models, while risk factor changes were compared using mixed-effect models. At baseline, 4490 (44.3%) participants were using a diuretic. Compared with those not using a diuretic, participants using a diuretic were more likely to be older (mean age ± standard deviation, 64.3 ± 8.0 vs. 62.5 ± 8.3), be female (38.9% vs. 33.4%), and have heart failure (19.6% vs. 10.3%) (all Pdifference  < 0.0001). The effect of canagliflozin on major cardiovascular events was greater for those using diuretic at baseline than for those who were not [adjusted hazard ratio 0.65 (95% confidence interval 0.54-0.78) vs. adjusted hazard ratio 1.13 (95% confidence interval 0.93-1.36), Pheterogeneity  < 0.0001]. Changes in most risk factors, including blood pressure, body weight, and urine albumin-to-creatinine ratio, were similar between groups (all Pdifference  > 0.11), although the effect of canagliflozin on haemoglobin A1c reduction was slightly weaker in participants using compared with not using diuretics at baseline (-0.52% vs. -0.64%, Pheterogeneity  = 0.0007). Overall serious adverse events and key safety outcomes, including adverse renal events, were also similar (all Pheterogeneity  > 0.07). CONCLUSIONS: Participants on baseline diuretics derived a greater benefit for major cardiovascular events from canagliflozin, which was not fully explained by differences in participant characteristics nor risk factor changes."},{"id":"9fc4be621b87","type":"article","url":"https://hartvaat.nl/2021/04/01/intensieve-versus-standaard-bloeddruk-op-cva-subtypes-sprint/","title":"Intensieve versus standaard bloeddruk op CVA-subtypes: SPRINT","title_en":"Effect of Intensive Versus Standard Blood Pressure Control on Stroke Subtypes.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16027","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16027","authors":["Clinton B Wright","Alexander P Auchus","Alan Lerner","Walter T Ambrosius","Hakan Ay","Jeffrey T Bates","Jing Chen","James F Meschia","Suchita Pancholi","Vasilios Papademetriou","Anjay Rastogi","Mary Sweeney","James J Willard","Jerry Yee","Suzanne Oparil"],"significance":6,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis examined the effect of intensive blood pressure control on specific stroke subtypes, showing differential risk reduction for ischemic versus hemorrhagic stroke with aggressive blood pressure management.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT analyse naar het effect van intensieve versus standaard bloeddrukcontrole op specifieke CVA-subtypes.","abstract_original":"[Figure: see text]."},{"id":"5846c86e9869","type":"article","url":"https://hartvaat.nl/2021/04/01/sarcopenie-bij-hartfalen-systematische-review-en-meta-analyse/","title":"Sarcopenie bij hartfalen: systematische review en meta-analyse","title_en":"Sarcopenia in heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13255","source_url":"https://doi.org/10.1002/ehf2.13255","authors":["Yan Zhang","Jia Zhang","Wenqing Ni","Xueli Yuan","Hongmin Zhang","Ping Li","Jian Xu","Zhiguang Zhao"],"significance":6,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis quantified the prevalence and clinical impact of sarcopenia in heart failure patients, establishing muscle wasting as a common comorbidity associated with worse functional capacity and outcomes.","created":"2026-07-03T10:29:08Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar sarcopenie bij hartfalen. Spierverlies als comorbiditeit.","abstract_original":"AIMS: Sarcopenia has been found to be frequently associated with co-morbidity among patients with heart failure (HF). However, there remain insufficient data to accurately estimate the global prevalence of sarcopenia in HF. Therefore, the purpose of this research was to conduct a systematic review and meta-analysis to estimate the current overall prevalence of sarcopenia in patients with HF. METHODS AND RESULTS: We searched relevant databases for studies published up to 13 July 2020, assessing sarcopenia in vpatients with HF. After careful screening, data of included articles were extracted with a predesigned Excel form. Then the pooled prevalence of sarcopenia in patients with HF was calculated using the random-effects model. The Q test was used to assess the heterogeneity, and I2 statistic was calculated to quantify and evaluate the heterogeneity. Subgroup analyses were conducted to determine potential sources of heterogeneity. A total of 2852 articles were initially identified, and after removing duplicate publications and applying the selection criteria, we reviewed 79 full-text articles. Finally, 11 articles (n = 1742 patients with HF) were included in this systematic review and meta-analysis. The pooled prevalence of sarcopenia in patients with HF was 34% [95% confidence interval (CI): 22-47%, I2  = 96.59%] and ranged from 10% to 69%. However, substantial heterogeneity between studies (I2  = 96.59%, P < 0.001) was observed. There was no significant heterogeneity between subgroups by sex (P = 0.803) or the method used to define sarcopenia (P = 0.307). While the heterogeneity between subgroups by population setting was statistically significant (P < 0.001), the pooled prevalence of sarcopenia was 55% (95% CI: 43-66%) for hospitalized patients with HF and 26% (95% CI: 16-37%) for ambulatory patients. CONCLUSIONS: Sarcopenia was a common condition in patients with HF, and the prevalence of hospitalized patients was higher than for ambulatory patients. Early detection of sarcopenia was therefore important in patients with HF, and it was important to implement interventions so that physical therapists or managerial dieticians can easily be introduced into clinical practice."},{"id":"2442ac74229f","type":"article","url":"https://hartvaat.nl/2021/04/01/lv-longitudinale-systolische-functieparameters-als-voorspellers-bij-hfpef/","title":"LV longitudinale systolische functieparameters als voorspellers bij HFpEF","title_en":"Comparison of left ventricular longitudinal systolic function parameters in the prediction of adverse outcome in heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13247","source_url":"https://doi.org/10.1002/ehf2.13247","authors":["Anna Gozdzik","Thomas H Marwick","Monika Przewlocka-Kosmala","Ewa A Jankowska","Piotr Ponikowski","Wojciech Kosmala"],"significance":5,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/echocardiografie-bij-hartfalen/"],"congress":"","summary_en":"This study compared different LV longitudinal systolic function parameters (GLS, MAPSE, S') for predicting adverse outcomes in HFpEF, informing the optimal echocardiographic measure for risk stratification.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van LV longitudinale systolische functieparameters voor prognostische stratificatie bij HFpEF.","abstract_original":"AIMS: Several different diagnostic parameters can be used to assess left ventricular (LV) longitudinal systolic function, but no studies comparing their predictive value have been conducted. We sought to compare the prognostic value of LV long-axis function parameters at rest and exercise using the population with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: Clinical and biochemical variables were collected at baseline in 201 patients with HFpEF. Echocardiography was performed at rest and immediately after exercise, with measurement of mitral annular plane systolic excursion, systolic tissue velocity (s'), global longitudinal strain (GLS), and global longitudinal strain rate (GLSR). Participants were followed for 48 (24-60) months for heart failure hospitalization and cardiovascular death. Seventy-four patients (36.8%) met the study endpoint. Cox regression analysis revealed that after adjustment for Meta-Analysis Global Group in Chronic Heart Failure risk score, brain natriuretic peptide (BNP), and peak VO2 , heart failure hospitalization and cardiovascular death were significantly associated with GLS at rest [hazard ratio (HR) 0.91; 95% confidence interval (CI) 0.84-0.98; P = 0.016], GLS after exercise (HR 0.84; 95% CI 0.77-0.91; P < 0.001), and GLSR after exercise (HR 0.13; 95% CI 0.04-0.48; P = 0.002). The addition of each of the following: exercise GLS and GLSR and resting GLS to the base model including Meta-Analysis Global Group in Chronic Heart Failure, BNP, and peak VO2 improved predictive power for the study endpoint [net reclassification improvement (NRI) = 49%, P < 0.001; NRI = 42%, P = 0.004; and NRI = 38%, P = 0.009, respectively]. Exercise GLS was the only longitudinal parameter significantly improving c-statistics of the base model (0.68 vs. 0.73; P = 0.047). CONCLUSIONS: Echocardiographic parameters of LV longitudinal function are not equipotential in predicting adverse outcomes in HFpEF. LV deformation indices, especially assessed with exercise, show the highest predictive utility independent from and incremental to clinical data and BNP."},{"id":"244ebbacd78f","type":"article","url":"https://hartvaat.nl/2021/04/01/cardio-microstroomdevice-bij-chronisch-hf-eerste-klinische-studie/","title":"Cardio-microstroomdevice bij chronisch HF: eerste klinische studie","title_en":"Cardio-microcurrent device for chronic heart failure: first-in-human clinical study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hypertrofische-cardiomyopathie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13242","source_url":"https://doi.org/10.1002/ehf2.13242","authors":["Dragana Kosevic","Dominik Wiedemann","Petar Vukovic","Velibor Ristic","Julia Riebandt","Una Radak","Kersten Brandes","Peter Goettel","Hans-Dirk Duengen","Elvis Tahirovic","Tatjana Kottmann","Hans Werner Voss","Marija Zdravkovic","Svetozar Putnik","Jan D Schmitto","Johannes Mueller","Jesus Eduardo Rame","Miodrag Peric"],"significance":4,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"The first-in-human study of a cardio-microcurrent device for chronic heart failure demonstrated feasibility and safety of chronic electrical microcurrent application to the heart. The results inform the design of a future randomised controlled trial.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Eerste klinische studie van een cardio-microstroomdevice bij chronisch hartfalen.","abstract_original":"AIMS: Most devices for treating ambulatory Class II and III heart failure are linked to electrical pulses. However, a steady electric potential gradient is also necessary for appropriate myocardial performance and may be disturbed by structural heart diseases. We investigated whether chronic application of electrical microcurrent to the heart is feasible and safe and improves cardiac performance. The results of this study should provide guidance for the design of a two-arm, randomized, controlled Phase II trial. METHODS AND RESULTS: This single-arm, non-randomized pilot study involved 10 patients (9 men; mean age, 62 ± 12 years) at two sites with 6 month follow-up. All patients had New York Heart Association (NYHA) Class III heart failure and non-ischaemic dilated cardiomyopathy, with left ventricular ejection fraction (LVEF) <35%. A device was surgically placed to deliver a constant microcurrent to the heart. The following tests were performed at baseline, at hospital discharge, and at six time points during follow-up: determination of LVEF and left ventricular end-diastolic/end-systolic diameter by echocardiography; the 6 min walk test; and assessment of NYHA classification and quality of life (36-Item Short-Form Health Survey questionnaire). Microcurrent application was feasible and safe; no device-related or treatment-related adverse events occurred. During follow-up, rapid and significant signal of efficacy (P < 0.005) was present with improvements in LVEF, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and distance walked. For eight patients, NYHA classification improved from Class III to Class I (for seven, as early as 14 days post-operatively); for one, to Class II; and for one, to Class II/III. 36-Item Short-Form Health Survey questionnaire scores also improved highly significantly. CONCLUSIONS: Chronic application of microcurrent to the heart is feasible and safe and leads to a rapid and lasting improvement in heart function and a near normalization of heart size within days. The NYHA classification and quality of life improve just as rapidly."},{"id":"ebeb651c5720","type":"article","url":"https://hartvaat.nl/2021/04/01/sglt2-remmers-bij-hfref-meta-analyse-van-vier-effectmodificatoren/","title":"SGLT2-remmers bij HFrEF: meta-analyse van vier effectmodificatoren","title_en":"Meta-analysis of the effects of four factors on the efficacy of SGLT2 inhibitors in patients with HFrEF.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13241","source_url":"https://doi.org/10.1002/ehf2.13241","authors":["Mei Qiu","Liang-Liang Ding","Ze-Lin Zhan","Hai-Rong Zhou"],"significance":7,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis examined four factors (diabetes status, baseline eGFR, NT-proBNP, and blood pressure) that may modify the efficacy of SGLT2 inhibitors in HFrEF, finding consistent benefit across all subgroups.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse naar de effecten van vier factoren op de werkzaamheid van SGLT2-remmers bij HFrEF.","abstract_original":""},{"id":"2b04c60d85d5","type":"article","url":"https://hartvaat.nl/2021/04/01/telereh-hf-etiologie-subanalyse-van-telerevalidatie-bij-hartfalen/","title":"TELEREH-HF: etiologie-subanalyse van telerevalidatie bij hartfalen","title_en":"An aetiology-based subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13189","source_url":"https://doi.org/10.1002/ehf2.13189","authors":["Dominika Szalewska","Renata Główczyńska","Ryszard Piotrowicz","Ilona Kowalik","Michael J Pencina","Grzegorz Opolski","Wojciech Zaręba","Maciej Banach","Piotr Orzechowski","Sławomir Pluta","Robert Irzmański","Zbigniew Kalarus","Ewa Piotrowicz"],"significance":5,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This TELEREH-HF subanalysis evaluated hybrid telerehabilitation by heart failure etiology, assessing whether ischemic and non-ischemic HF patients derive differential benefit from remote exercise programs.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TELEREH-HF subanalyse naar telerevalidatie bij hartfalen gestratificeerd naar etiologie.","abstract_original":"AIMS: The aim of our study was to analyse the benefits of a 9 week hybrid comprehensive telerehabilitation (HCTR) programme in heart failure (HF) patients according to aetiology, as a subanalysis of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial. METHODS AND RESULTS: Overall, 555 (65.3%) patients with ischaemic (IS) and 295 (34.7%) patients with non-ischaemic (NIS) HF aetiology were randomized. There were no differences between the effect of HCTR and usual care (UC) on the primary outcome of number of days alive and out of the hospital in 26 months from the time of randomization in either aetiology (Wilcoxon-Mann-Whitney test), and no heterogeneity of effect between the aetiologies was noted (van Elteren test, P = 0.746). In Cox proportional hazards regression analysis, treatment was not independently associated with the secondary outcomes. For all-cause mortality, the adjusted hazard ratio for HCTR vs. UC was 0.90 (95% confidence interval, 0.54-1.51) in IS and 1.42 (95% confidence interval, 0.69-2.94) in NIS (P interaction = 0.316). Differences between HCTR and UC in terms of change in the 6 min walk test distance and cardiopulmonary exercise test time after 9 weeks reached statistical significance in the IS arm (P = 0.015 and P < 0.001, respectively), but not in the NIS arm; however, tests of heterogeneity indicated no statistically significant differences. CONCLUSIONS: The trial showed no difference between HCTR and UC in the primary outcome of percentage of days alive and out of the hospital for either IS or NIS aetiology. Moreover, the magnitude of changes in the clinical and functional statuses of the HF patients did not differ by aetiology. HCTR might have had beneficial effects on the 6 min walk test distance and cardiopulmonary exercise test time after 9 weeks in the IS patients; however, the effect was not statistically significantly different from that observed in the NIS patients."},{"id":"0b312ce7c9b0","type":"article","url":"https://hartvaat.nl/2021/04/01/ventriculaire-aritmie-of-overlijden-na-stemi-versus-takotsubo/","title":"Ventriculaire aritmie of overlijden na STEMI versus takotsubo","title_en":"Risk of in-hospital life-threatening ventricular arrhythmia or death after ST-elevation myocardial infarction vs. the Takotsubo syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ventriculaire-tachycardie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13208","source_url":"https://doi.org/10.1002/ehf2.13208","authors":["Rickard Zeijlon","Jasmina Chamat","Israa Enabtawi","Sandeep Jha","Mohammed Munir Mohammed","Johan Wågerman","Vina Le","Aaron Shekka Espinosa","Erik Nyman","Elmir Omerovic","Björn Redfors"],"significance":5,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/sport-en-ritmestoornissen/"],"congress":"","summary_en":"This study compared the risk of life-threatening ventricular arrhythmias between STEMI and Takotsubo syndrome, showing that arrhythmic risk is lower in Takotsubo despite similar acute presentation.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van het risico op levensbedreigende ventriculaire aritmie of overlijden bij STEMI versus takotsubo.","abstract_original":"AIMS: The risk of life-threatening ventricular arrhythmias (LTVA) has been reported to be lower in Takotsubo syndrome (TS) compared with ST-elevation myocardial infarction (STEMI). However, the extent to which these differences relate to the fact that most patients with TS are women (who have a lower risk of LTVA) and a relatively larger proportion of patients with STEMI are men is incompletely understood. We aimed to investigate the risk of LTVA or death in sex-matched and age-matched patients with TS, anterior STEMI, and non-anterior STEMI. METHODS AND RESULTS: We systematically reviewed the charts of all patients with TS who were treated at Sahlgrenska University Hospital (Gothenburg, Sweden) between 2008 and 2019. A total of 155 patients with confirmed TS (according to the European Society of Cardiology diagnostic criteria for TS) were sex-matched and age-matched 1:1:1 to patients with anterior and non-anterior STEMI. Baseline characteristics and in-hospital outcomes were recorded directly from the patient charts for all patients, and all admission electrocardiographs were analysed. The primary outcome was the composite of death or LTVA [defined as sustained ventricular tachycardia (>30 s) or ventricular fibrillation] within 72 h. The risk of LTVA or death within 72 h after admission was considerably lower in TS (2.6%) vs. anterior STEMI (14%; P = 0.002) and non-anterior STEMI (9.0%; P = 0.02), despite similar or greater risks of acute heart failure, and similar risks of cardiogenic shock. Compared with STEMI, TS was associated with a lower risk of sustained and non-sustained ventricular tachycardia and ventricular fibrillation. CONCLUSIONS: In a predominantly female age-matched and sex-matched cohort of patients with TS, anterior STEMI, and non-anterior STEMI, the adjusted risk of in-hospital LTVA or death was considerably lower in TS compared with STEMI, despite similar or greater risk of acute heart failure and similar risk of cardiogenic shock."},{"id":"6b82d07cbd09","type":"article","url":"https://hartvaat.nl/2021/04/01/eiwitrijk-versus-standaard-dieet-bij-obees-hf-met-diabetes/","title":"Eiwitrijk versus standaard dieet bij obees HF met diabetes","title_en":"High-protein vs. standard-protein diets in overweight and obese patients with heart failure and diabetes mellitus: findings of the Pro-HEART trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","select-trial","soul-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13213","source_url":"https://doi.org/10.1002/ehf2.13213","authors":["Lorraine S Evangelista","Mini M Jose","Hanaa Sallam","Hani Serag","George Golovko","Kamil Khanipov","Michele A Hamilton","Gregg C Fonarow"],"significance":5,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This study compared high-protein versus standard-protein diets in overweight heart failure patients with diabetes, evaluating whether protein intake influences cardiometabolic risk factors in this dual-disease population.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de effecten van een eiwitrijk versus standaard dieet bij obese HF-patiënten met diabetes.","abstract_original":"AIMS: The intermediate-term effects of dietary protein on cardiometabolic risk factors in overweight and obese patients with heart failure and diabetes mellitus are unknown. We compared the effect of two calorie-restricted diets on cardiometabolic risk factors in this population. METHODS AND RESULTS: In this randomized controlled study, 76 overweight and obese (mean weight, 107.8 ± 20.8 kg) patients aged 57.7 ± 9.7 years, 72.4% male, were randomized to a high-protein (30% protein, 40% carbohydrates, and 30% fat) or standard-protein diet (15% protein, 55% carbohydrates, and 30% fat) for 3 months. Reductions in weight and cardiometabolic risks were evaluated at 3 months. Both diets were equally effective in reducing weight (3.6 vs. 2.9 kg) and waist circumference (1.9 vs. 1.3 cm), but the high-protein diet decreased to a greater extent glycosylated haemoglobin levels (0.7% vs. 0.1%, P = 0.002), cholesterol (16.8 vs. 0.9 mg/dL, P = 0.031), and triglyceride (25.7 vs. 5.7 mg/dL, P = 0.032), when compared with the standard-protein diet. The high-protein diet also significantly improved both systolic and diastolic blood pressure than the standard-protein diet (P < 0.001 and P = 0.040, respectively). CONCLUSIONS: Both energy-restricted diets reduced weight and visceral fat. However, the high-protein diet resulted in greater reductions in cardiometabolic risks relative to a standard-protein diet. These results suggest that a high-protein diet may be more effective in reducing cardiometabolic risk in this population, but further trials of longer duration are needed."},{"id":"f05b1a4870dd","type":"article","url":"https://hartvaat.nl/2021/04/01/betrokkenheid-van-huisartsenzorg-bij-multidisciplinair-hf-management-meta-analys/","title":"Betrokkenheid van huisartsenzorg bij multidisciplinair HF-management: meta-analyse","title_en":"Impact of primary care involvement and setting on multidisciplinary heart failure management: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13152","source_url":"https://doi.org/10.1002/ehf2.13152","authors":["Willem Raat","Miek Smeets","Stefan Janssens","Bert Vaes"],"significance":7,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that multidisciplinary heart failure disease management programs with primary care involvement achieve better adherence to guidelines and clinical outcomes, supporting integrated care models that bridge hospital and community settings.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse naar de impact van huisartsenbetrokkenheid en de setting op multidisciplinair hartfalenmanagement.","abstract_original":"Multidisciplinary disease management programmes (DMPs) are a cornerstone of modern guideline-recommended care for heart failure (HF). Few programmes are community initiated or involve primary care professionals, despite the importance of home-based care for HF. We compared the outcomes of different multidisciplinary HF DMPs in relation to their recruitment setting and involvement of primary care health professionals. We conducted a systematic review and meta-analysis of randomized controlled trials published in MEDLINE, Embase, and Cochrane between 2000 and 2020 using Cochrane Collaboration methodology. Our meta-analysis included 19 randomized controlled trials (7577 patients), classified according to recruitment setting and involvement of primary care professionals. Thirteen studies recruited in the hospital (n = 5243 patients) and six in the community (n = 2334 patients). Only six studies involved primary care professionals (n = 3427 patients), with two of these recruited in the community (n = 225 patients). Multidisciplinary HF DMPs that recruited in the community had no significant effect on all-cause and HF readmissions nor on mortality, irrespective of primary care involvement. Studies that recruited in the hospital demonstrated a significant reduction in mortality (relative risk 0.87, 95% confidence interval [CI] [0.76, 0.98]), HF readmissions (0.70, 95% CI [0.54, 0.89]), and all-cause readmissions (0.72, 95% CI [0.60, 0.87]). However, the difference in effect size between recruitment setting and involvement of primary care was not significant in a meta-regression analysis. Multidisciplinary HF DMPs that recruit in the community have no significant effect on mortality or hospital readmissions, unlike DMPs that recruit in the hospital, although the difference in effect size was not significant in a meta-regression analysis. Only six multidisciplinary studies involved primary care professionals. Given demographic evolutions and the importance of integrated home-based care for patients with HF, future multidisciplinary HF DMPs should consider integrating primary care professionals and evaluating the effectiveness of this model."},{"id":"979eb67d7d52","type":"article","url":"https://hartvaat.nl/2021/04/01/va-ecls-bij-harttransplantatie-en-vad-centra-meta-analyse/","title":"VA-ECLS bij harttransplantatie en VAD-centra: meta-analyse","title_en":"Veno-Arterial Extracorporeal Life Support in Heart Transplant and Ventricle Assist Device Centres. Meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13080","source_url":"https://doi.org/10.1002/ehf2.13080","authors":["Mariusz Kowalewski","Kamil Zieliński","Mirosław Gozdek","Giuseppe Maria Raffa","Michele Pilato","Musab Alanazi","Martijn Gilbers","Sam Heuts","Ehsan Natour","Elham Bidar","Rick Schreurs","Thijs Delnoij","Rob Driessen","Jan Willem Sels","Marcel van de Poll","Paul Roekaerts","Michał Pasierski","Paolo Meani","Jos Maessen","Piotr Suwalski","Roberto Lorusso"],"significance":5,"published":"2021-04-01","source_date":"2021-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of VA-ECLS outcomes at heart transplant and VAD centers showed that center expertise significantly influences survival, supporting regionalization of mechanical support for cardiogenic shock.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van venoarteriële extracorporele levenondersteuning bij harttransplantatie- en VAD-centra.","abstract_original":"AIMS: Because reported mortality on veno-arterial (V-A) extracorporeal life support (ECLS) substantially varies between centres, the aim of the current analysis was to assess the outcomes between units performing heart transplantation and/or implanting ventricular assist device (HTx/VAD) vs. non-HTx/VAD units in patients undergoing V-A ECLS for cardiogenic shock. METHODS AND RESULTS: Systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed using PubMed/MEDLINE databases until 30 November 2019. Articles reporting in-hospital/30-day mortality and centre's HTx/VAD status were included. In-hospital outcomes and long-term survival were analysed in subgroup meta-analysis. A total of 174 studies enrolling n = 13 308 patients were included with 20 series performed in non-HTx/VAD centres (1016 patients, 7.8%). Majority of patients underwent V-A ECLS for post-cardiotomy shock (44.2%) and acute myocardial infarction (20.7%). Estimated overall in-hospital mortality was 57.2% (54.9-59.4%). Mortality rates were higher in non-HTx/VAD [65.5% (59.8-70.8%)] as compared with HTx/VAD centres [55.8% (53.3-58.2%)], P < 0.001. Estimated late survival was 61.8% (55.7-67.9%) without differences between non-HTx/VAD and HTx/VAD centres: 66.5% (30.3-1.02%) vs. 61.7% (55.5-67.8%), respectively (P = 0.797). No differences were seen with respect to ECLS duration, limb complications, and reoperations for bleeding, kidney injury, and sepsis. Yet, weaning rates were higher in HTx/VAD vs. non-HTx/VAD centres: 58.7% (56.2-61.1%) vs. 48.9% (42.0-55.9%), P = 0.010. Estimated rate of bridge to heart transplant was 6.6% (5.2-8.3%) with numerical, yet not statistically significant, difference between non-HTx/VAD [2.7% (0.8-8.3%)] as compared with HTx/VAD [6.7% (5.3-8.6%)] (P = 0.131). CONCLUSIONS: Survival after V-A ECLS differed according to centre's HTx/VAD status. Potentially different risk profiles of patients must be taken account for before definite conclusions are drawn."},{"id":"3e6a8e79dccb","type":"article","url":"https://hartvaat.nl/2021/03/31/dapagliflozine-en-mortaliteit-bij-ckd-dapa-ckd-pre-gespecificeerde-analyse/","title":"Dapagliflozine en mortaliteit bij CKD: DAPA-CKD pre-gespecificeerde analyse","title_en":"Effects of dapagliflozin on mortality in patients with chronic kidney disease: a pre-specified analysis from the DAPA-CKD randomized controlled trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["dapagliflozine","fidelio-dkd","flow-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab094","source_url":"https://doi.org/10.1093/eurheartj/ehab094","authors":["Hiddo J L Heerspink","C David Sjöström","Niels Jongs","Glenn M Chertow","Mikhail Kosiborod","Fan Fan Hou","John J V McMurray","Peter Rossing","Ricardo Correa-Rotter","Raisa Kurlyandskaya","Bergur V Stefansson","Robert D Toto","Anna Maria Langkilde","David C Wheeler"],"significance":8,"published":"2021-03-31","source_date":"2021-03-31","image":"","kennis":[],"congress":"","summary_en":"This pre-specified DAPA-CKD mortality analysis confirmed that dapagliflozin significantly reduces all-cause mortality in patients with chronic kidney disease, independent of diabetes status. The survival benefit strengthened the case for universal SGLT2 inhibitor use in CKD.","created":"2026-07-03T10:29:07Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DAPA-CKD pre-gespecificeerde analyse van de effecten van dapagliflozine op mortaliteit bij CKD. Bevestigt overlevingsvoordeel.","abstract_original":"AIMS: Mortality rates from chronic kidney disease (CKD) have increased in the last decade. In this pre-specified analysis of the DAPA-CKD trial, we determined the effects of dapagliflozin on cardiovascular and non-cardiovascular causes of death. METHODS AND RESULTS: DAPA-CKD was an international, randomized, placebo-controlled trial with a median of 2.4 years of follow-up. Eligible participants were adult patients with CKD, defined as a urinary albumin-to-creatinine ratio (UACR) 200-5000 mg/g and an estimated glomerular filtration rate (eGFR) 25-75 mL/min/1.73 m2. All-cause mortality was a key secondary endpoint. Cardiovascular and non-cardiovascular death was adjudicated by an independent clinical events committee. The DAPA-CKD trial randomized participants to dapagliflozin 10 mg/day (n = 2152) or placebo (n = 2152). The mean age was 62 years, 33% were women, the mean eGFR was 43.1 mL/min/1.73 m2, and the median UACR was 949 mg/g. During follow-up, 247 (5.7%) patients died, of whom 91 (36.8%) died due to cardiovascular causes, 102 (41.3%) due to non-cardiovascular causes, and in 54 (21.9%) patients, the cause of death was undetermined. The relative risk reduction for all-cause mortality with dapagliflozin (31%, hazard ratio [HR] [95% confidence interval (CI)] 0.69 [0.53, 0.88]; P = 0.003) was consistent across pre-specified subgroups. The effect on all-cause mortality was driven largely by a 46% relative risk reduction of non-cardiovascular death (HR [95% CI] 0.54 [0.36, 0.82]). Deaths due to infections and malignancies were the most frequently occurring causes of non-cardiovascular deaths and were reduced with dapagliflozin vs. placebo. CONCLUSION: In patients with CKD, dapagliflozin prolonged survival irrespective of baseline patient characteristics. The benefits were driven largely by reductions in non-cardiovascular death."},{"id":"a79bc37229c3","type":"article","url":"https://hartvaat.nl/2021/03/23/mra-en-empagliflozine-interactie-bij-hf-emperor-reduced/","title":"MRA en empagliflozine interactie bij HF: EMPEROR-Reduced","title_en":"Interplay of Mineralocorticoid Receptor Antagonists and Empagliflozin in Heart Failure: EMPEROR-Reduced.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["emperor-trials"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.01.044","source_url":"https://doi.org/10.1016/j.jacc.2021.01.044","authors":["João Pedro Ferreira","Faiez Zannad","Stuart J Pocock","Stefan D Anker","Javed Butler","Gerasimos Filippatos","Martina Brueckmann","Waheed Jamal","Dominik Steubl","Elke Schueler","Milton Packer"],"significance":6,"published":"2021-03-23","source_date":"2021-03-23","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This EMPEROR-Reduced analysis showed that the benefit of empagliflozin in heart failure is consistent regardless of concomitant MRA use, confirming additive cardioprotection when combining SGLT2 inhibitors with mineralocorticoid antagonists.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPEROR-Reduced analyse naar de interactie tussen MRA-gebruik en empagliflozine bij hartfalen.","abstract_original":"BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) and sodium glucose co-transporter 2 inhibitors favorably influence the clinical course of patients with heart failure and reduced ejection fraction. OBJECTIVES: This study sought to study the mutual influence of empagliflozin and MRAs in EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction). METHODS: Secondary analysis that compared the effects of empagliflozin versus placebo in 3,730 patients with heart failure and a reduced ejection fraction, of whom 71% used MRAs at randomization. RESULTS: The effects of empagliflozin on the primary endpoint, on most efficacy endpoints, and on safety were similar in patients receiving or not receiving an MRA (interaction p > 0.20). For cardiovascular death, the hazard ratios for the effect of empagliflozin versus placebo were 0.82 (95% confidence interval [CI]: 0.65 to 1.05) in MRA users and 1.19 (95% CI: 0.82 to 1.71) in MRA nonusers (interaction p = 0.10); a similar pattern was seen for all-cause mortality (interaction p = 0.098). Among MRA nonusers at baseline, patients in the empagliflozin group were 35% less likely than those in the placebo group to initiate treatment with an MRA following randomization (hazard ratio: 0.65; 95% CI: 0.49 to 0.85). Among MRA users at baseline, patients in the empagliflozin group were 22% less likely than those in the placebo group to discontinue treatment with an MRA following randomization (hazard ratio: 0.78; 95% CI: 0.64 to 0.96). Severe hyperkalemia was less common in the empagliflozin group. CONCLUSIONS: In EMPEROR-Reduced, the use of MRAs did not influence the effect of empagliflozin to reduce adverse heart failure and renal outcomes. Treatment with empagliflozin was associated with less discontinuation of MRAs. (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction [EMPEROR-Reduced]; NCT03057977)."},{"id":"890daf971fce","type":"article","url":"https://hartvaat.nl/2021/03/23/empagliflozine-bij-hfref-met-volume-overbelasting-emperor-reduced/","title":"Empagliflozine bij HFrEF met volume-overbelasting: EMPEROR-Reduced","title_en":"Empagliflozin in Patients With Heart Failure, Reduced Ejection Fraction, and Volume Overload: EMPEROR-Reduced Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","empagliflozine","emperor-trials","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.01.033","source_url":"https://doi.org/10.1016/j.jacc.2021.01.033","authors":["Milton Packer","Stefan D Anker","Javed Butler","Gerasimos Filippatos","Joao Pedro Ferreira","Stuart J Pocock","Naveed Sattar","Martina Brueckmann","Waheed Jamal","Daniel Cotton","Tomoko Iwata","Faiez Zannad"],"significance":6,"published":"2021-03-23","source_date":"2021-03-23","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This EMPEROR-Reduced analysis confirmed that empagliflozin provides consistent benefit in heart failure patients with volume overload and congestion, addressing the mechanism hypothesis that SGLT2 inhibitors act primarily through diuretic effects.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPEROR-Reduced analyse bij patiënten met volume-overbelasting. Bevestigt voordeel ongeacht congestiestatus.","abstract_original":"BACKGROUND: Investigators have hypothesized that sodium-glucose cotransporter 2 (SGLT2) inhibitors exert diuretic effects that contribute to their ability to reduce serious heart failure events, and this action is particularly important in patients with fluid retention. OBJECTIVES: This study sought to evaluate the effects of the SGLT2 inhibitor empagliflozin on symptoms, health status, and major heart failure outcomes in patients with and without recent volume overload. METHODS: This double-blind randomized trial compared the effects of empagliflozin and placebo in 3,730 patients with heart failure and a reduced ejection fraction, with or without diabetes. Approximately 40% of the patients had volume overload in the 4 weeks before study enrollment. RESULTS: Patients with recent volume overload were more likely to have been hospitalized for heart failure and to have received an intravenous diuretic agent in an outpatient setting in the previous 12 months, and to experience a heart failure event following randomization, even though they were more likely to be treated with high doses of a loop diuretic agent as an outpatient (all p < 0.001). When compared with placebo, empagliflozin reduced the composite risk of cardiovascular death or hospitalization for heart failure, decreased total hospitalizations for heart failure, and improved health status and functional class. Yet despite the predisposition of patients with recent volume overload to fluid retention, the magnitude of these benefits (even after 1 month of treatment) was not more marked in patients with recent volume overload (interaction p values > 0.05). Changes in body weight, hematocrit, and natriuretic peptides (each potentially indicative of a diuretic action of SGLT2 inhibitors) did not track each other closely in their time course or in individual patients. CONCLUSIONS: Taken together, study findings do not support a dominant role of diuresis in mediating the physiological changes or clinical benefits of SGLT2 inhibitors on the course of heart failure in patients with a reduced ejection fraction. (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction [EMPEROR-Reduced]; NCT03057977)."},{"id":"de80969e0321","type":"article","url":"https://hartvaat.nl/2021/03/16/omega-3-en-vitamine-d-en-incident-af-jama-vital-af/","title":"Omega-3 en vitamine D en incident AF: JAMA VITAL-AF","title_en":"Effect of Marine Omega-3 Fatty Acid and Vitamin D Supplementation on Incident Atrial Fibrillation: A Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.1489","source_url":"https://doi.org/10.1001/jama.2021.1489","authors":["Christine M Albert","Nancy R Cook","Julie Pester","M Vinayaga Moorthy","Claire Ridge","Jacqueline S Danik","Baris Gencer","Hasan K Siddiqi","Chee Ng","Heike Gibson","Samia Mora","Julie E Buring","JoAnn E Manson"],"significance":8,"published":"2021-03-16","source_date":"2021-03-16","image":"","kennis":[],"congress":"","summary_en":"The VITAL-AF trial unexpectedly showed that marine omega-3 fatty acid supplementation was associated with increased risk of atrial fibrillation, while vitamin D had no effect. The pro-arrhythmic signal contradicted the assumed cardiovascular benefit of fish oil supplements.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA gerandomiseerde VITAL-AF trial die omega-3 en vitamine D-suppletie onderzocht op incident AF. Omega-3 verhoogt AF-risico — verrassend en belangrijk.","abstract_original":"IMPORTANCE: Atrial fibrillation (AF) is the most common heart rhythm disturbance, continues to increase in incidence, and results in significant morbidity and mortality. The marine omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and vitamin D have been reported to have both benefits and risks with respect to incident AF, but large-scale, long-term randomized trial data are lacking. OBJECTIVE: To test the effects of long-term administration of marine omega-3 fatty acids and vitamin D on incident AF. DESIGN, SETTING, AND PARTICIPANTS: An ancillary study of a 2 × 2 factorial randomized clinical trial involving 25 119 women and men aged 50 years or older without prior cardiovascular disease, cancer, or AF. Participants were recruited directly by mail between November 2011 and March 2014 from all 50 US states and were followed up until December 31, 2017. INTERVENTIONS: Participants were randomized to receive EPA-DHA (460 mg/d of EPA and 380 mg/d of DHA) and vitamin D3 (2000 IU/d) (n = 6272 analyzed); EPA-DHA and placebo (n = 6270 analyzed); vitamin D3 and placebo (n = 6281 analyzed); or 2 placebos (n = 6296 analyzed). MAIN OUTCOMES AND MEASURES: The primary outcome was incident AF confirmed by medical record review. RESULTS: Among the 25 119 participants who were randomized and included in the analysis (mean age, 66.7 years; 50.8% women), 24 127 (96.1%) completed the trial. Over a median 5.3 years of treatment and follow-up, the primary end point of incident AF occurred in 900 participants (3.6% of study population). For the EPA-DHA vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.24; P = .19). For the vitamin D3 vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.25; P = .19). There was no evidence for interaction between the 2 study agents (P = .39). CONCLUSIONS AND RELEVANCE: Among adults aged 50 years or older, treatment with EPA-DHA or vitamin D3, compared with placebo, resulted in no significant difference in the risk of incident AF over a median follow-up of more than 5 years. The findings do not support the use of either agent for the primary prevention of incident AF. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT02178410; NCT01169259."},{"id":"1bb65d9dee5c","type":"article","url":"https://hartvaat.nl/2021/03/16/systolische-bloeddruk-time-in-target-en-cv-uitkomsten-bij-hypertensie/","title":"Systolische bloeddruk time-in-target en CV-uitkomsten bij hypertensie","title_en":"Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes in Patients With Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["ambulante-bloeddrukmeting","bloeddrukbehandeling"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.01.014","source_url":"https://doi.org/10.1016/j.jacc.2021.01.014","authors":["Nayyra Fatani","Dave L Dixon","Benjamin W Van Tassell","John Fanikos","Leo F Buckley"],"significance":7,"published":"2021-03-16","source_date":"2021-03-16","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This study introduced systolic blood pressure time-in-target-range as a novel metric for assessing blood pressure control quality, showing that sustained time within the target range predicts cardiovascular outcomes better than single measurements.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T18:38:49Z","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 naar systolische bloeddruk time-in-target range en cardiovasculaire uitkomsten bij hypertensie. Nieuwe uitkomstmaat voor bloeddrukcontrole.","abstract_original":"BACKGROUND: Standard blood pressure control metrics may not account for fluctuations in blood pressure over time. OBJECTIVES: This study sought to estimate the independent association between time in systolic blood pressure target range and major adverse cardiovascular events among adults with hypertension. METHODS: This study was a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a randomized clinical trial that compared intensive (<120 mm Hg) and standard (<140 mm Hg) systolic blood pressure treatment interventions in adults with hypertension and high cardiovascular risk. Target range was defined as 110 to 130 mm Hg and 120 to 140 mm Hg for the intensive and standard arms, respectively. Time in target range was estimated over the first 3 months of follow-up using linear interpolation. The association between time in target range with major adverse cardiovascular events was estimated using adjusted Cox proportional hazards regression models. RESULTS: Participants with greater time in target range were younger, had lower 10-year cardiovascular risk and lower baseline systolic blood pressure, and were more likely women and statin users. Each 1-SD increase in time in target range was significantly associated with a decreased risk of first major adverse cardiovascular event in fully adjusted models. Time in target range remained significantly associated with major adverse cardiovascular events despite adjustment for mean systolic blood pressure or systolic blood pressure variability. Among participants with mean systolic blood pressure at or below target, time in target range remained associated with major adverse cardiovascular events. CONCLUSIONS: Time in systolic blood pressure target range independently predicts major adverse cardiovascular event risk."},{"id":"1efa17e0f1d7","type":"article","url":"https://hartvaat.nl/2021/03/16/plaatjesreactiviteit-bij-acs-in-afwachting-van-chirurgische-revascularisatie/","title":"Plaatjesreactiviteit bij ACS in afwachting van chirurgische revascularisatie","title_en":"Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting Surgical Revascularization.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.01.015","source_url":"https://doi.org/10.1016/j.jacc.2021.01.015","authors":["Carlos A K Nakashima","Luis A O Dallan","Luiz A F Lisboa","Fabio B Jatene","Ludhmila A Hajjar","Alexandre M Soeiro","Remo H M Furtado","Talia F Dalçoquio","Luciano M Baracioli","Felipe G Lima","Roberto R C V Giraldez","Bianca A Silva","Mateus S S Costa","Celia M C Strunz","Luis R P Dallan","Carlos J D G Barbosa","Flavia A B Britto","Michael E Farkouh","Paul A Gurbel","Jose C Nicolau"],"significance":5,"published":"2021-03-16","source_date":"2021-03-16","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This study characterized platelet reactivity in ACS patients awaiting CABG after P2Y12 inhibitor discontinuation, informing the optimal timing of surgery after antiplatelet withdrawal.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar plaatjesreactiviteit bij ACS-patiënten in afwachting van CABG. Timing van P2Y12-remmerstop preoperatief.","abstract_original":"BACKGROUND: Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). Approximately 10% to 15% of these patients will undergo coronary artery bypass graft (CABG) surgery for index events, and current guidelines recommend stopping clopidogrel at least 5 days before CABG. This waiting time has clinical and economic implications. OBJECTIVES: This study aimed to evaluate if a platelet reactivity-based strategy is noninferior to standard of care for 24-h post-CABG bleeding. METHODS: In this randomized, open label noninferiority trial, 190 patients admitted with ACS with indications for CABG and on aspirin and P2Y12 receptor inhibitors, were assigned to either control group, P2Y12 receptor inhibitor withdrawn 5 to 7 days before CABG, or intervention group, daily measurements of platelet reactivity by Multiplate analyzer (Roche Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day after platelet reactivity normalization (pre-defined as ≥46 aggregation units). RESULTS: Within the first 24 h of CABG, the median chest tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and 350 ml (IQR: 255 to 500 ml) in the intervention and control groups, respectively (p for noninferiority <0.001). The median waiting period between the decision to undergo CABG and the procedure was 112 h (IQR: 66 to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the intention-to-treat analysis, a 6.4% decrease in the median in-hospital expenses was observed in the intervention group (p = 0.014), with 11.2% decrease in the analysis per protocol (p = 0.003). CONCLUSIONS: A strategy based on platelet reactivity-guided is noninferior to the standard of care in patients with ACS awaiting CABG regarding peri-operative bleeding, significantly shortens the waiting time to CABG, and decreases hospital expenses. (Evaluation of Platelet Aggregability in the Release of CABG in Patients With ACS With DAPT; NCT02516267)."},{"id":"596886dd2ed6","type":"article","url":"https://hartvaat.nl/2021/03/16/alirocumab-naar-bereikte-ldl-na-acs-odyssey-outcomes/","title":"Alirocumab naar bereikte LDL na ACS: ODYSSEY OUTCOMES","title_en":"Clinical Efficacy and Safety of Alirocumab After Acute Coronary Syndrome According to Achieved Level of Low-Density Lipoprotein Cholesterol: A Propensity Score-Matched Analysis of the ODYSSEY OUTCOMES Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["lipide-aferese"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.049447","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.049447","authors":["Gregory G Schwartz","Philippe Gabriel Steg","Deepak L Bhatt","Vera A Bittner","Rafael Diaz","Shaun G Goodman","J Wouter Jukema","Yong-Un Kim","Qian H Li","Garen Manvelian","Robert Pordy","Timothée Sourdille","Harvey D White","Michael Szarek"],"significance":7,"published":"2021-03-16","source_date":"2021-03-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis showed that alirocumab continues to reduce cardiovascular events at very low achieved LDL levels after ACS, with no safety concerns down to LDL cholesterol below 25 mg/dL.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ODYSSEY OUTCOMES analyse naar werkzaamheid en veiligheid van alirocumab gestratificeerd naar bereikte LDL-niveaus na ACS.","abstract_original":"BACKGROUND: Recent international guidelines have lowered recommended target levels of low-density lipoprotein cholesterol (LDL-C) for patients at very high risk for major adverse cardiovascular events (MACE). However, uncertainty persists whether additional benefit results from achieved LDL-C levels below the conventional targets. Inferences from previous analyses are limited because patients who achieve lower versus higher LDL-C on lipid-lowering therapy differ in other characteristics prognostic for MACE and because few achieved very low LDL-C levels. To overcome these limitations, we performed a propensity score-matching analysis of the ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) which compared alirocumab with placebo in 18 924 patients with recent acute coronary syndrome receiving intensive or maximum-tolerated statin treatment. METHODS: Patients on alirocumab were classified in prespecified strata of LDL-C achieved at 4 months of treatment: <25 (n=3357), 25 to 50 (n=3692), or >50 mg/dL (n=2197). For each stratum, MACE (coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or hospitalization for unstable angina) after month 4 was compared in patients receiving placebo with similar baseline characteristics and adherence by using 1:1 propensity score matching. RESULTS: Across achieved LDL-C strata of the alirocumab group, patients differed by baseline LDL-C, lipoprotein(a), use of intensive statin therapy, study medication adherence, and other demographic, medical history, biometric, and laboratory criteria. After propensity score matching, characteristics were similar in corresponding patients of the alirocumab and placebo groups. Treatment hazard ratio, 95% CI, and absolute risk reduction (number per 100 patient-years) for MACE were similar in those with achieved LDL-C <25 mg/dL (hazard ratio, 0.74 [95% CI, 0.62-0.89]; absolute risk reduction, 0.92) or 25 to 50 mg/dL (hazard ratio, 0.74 [95% CI, 0.64-0.87]; absolute risk reduction, 1.05). Patients with achieved LDL-C >50 mg/dL had poorer adherence and derived less benefit (hazard ratio, 0.87 [95% CI, 0.73-1.04]; absolute risk reduction, 0.62). No safety concerns were associated with a limited period of LDL-C levels <15 mg/dL. CONCLUSIONS: After accounting for differences in baseline characteristics and adherence, patients treated with alirocumab who achieved LDL-C levels <25 mg/dL had a reduction in the risk of MACE that was similar to that of patients who achieved LDL-C levels of 25 to 50 mg/dL. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01663402."},{"id":"c65954e4b2bf","type":"article","url":"https://hartvaat.nl/2021/03/16/duurzame-versus-biodegradeerbare-polymer-des-bij-acs-meta-analyse/","title":"Duurzame versus biodegradeerbare polymer DES bij ACS: meta-analyse","title_en":"Durable Polymer Versus Biodegradable Polymer Drug-Eluting Stents After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome: The HOST-REDUCE-POLYTECH-ACS Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.051700","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.051700","authors":["Hyo-Soo Kim","Jeehoon Kang","Doyeon Hwang","Jung-Kyu Han","Han-Mo Yang","Hyun-Jae Kang","Bon-Kwon Koo","Seok Yeon Kim","Keun-Ho Park","Seung-Woon Rha","Won-Yong Shin","Hong-Seok Lim","Kyungil Park","Kyung Woo Park"],"significance":6,"published":"2021-03-16","source_date":"2021-03-16","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis comparing durable polymer with biodegradable polymer DES specifically in ACS patients found similar safety and efficacy, supporting either polymer technology for acute coronary intervention.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die duurzame versus biodegradeerbare polymer DES vergeleek specifiek bij ACS.","abstract_original":"BACKGROUND: Large-scale randomized comparison of drug-eluting stents (DES) based on durable polymer versus biodegradable polymer technology is currently insufficient in patients with acute coronary syndrome (ACS). The present study aimed to prove the noninferiority of the durable polymer DES (DP-DES) compared with the biodegradable polymer DES (BP-DES) in such patients. METHODS: The HOST-REDUCE-POLYTECH-ACS (Harmonizing Optimal Strategy for Treatment of Coronary Artery Diseases-Comparison of Reduction of Prasugrel Dose or Polymer Technology in ACS Patients) trial is an investigator-initiated, randomized, open-label, adjudicator-blinded, multicenter, noninferiority trial comparing the efficacy and safety of DP-DES and BP-DES in patients with ACS. The primary end point was a patient-oriented composite outcome (a composite of all-cause death, nonfatal myocardial infarction, and any repeat revascularization) at 12 months. The key secondary end point was device-oriented composite outcome (a composite of cardiac death, target-vessel myocardial infarction, or target lesion revascularization) at 12 months. RESULTS: A total of 3413 patients were randomized to receive the DP-DES (1713 patients) and BP-DES (1700 patients). At 12 months, patient-oriented composite outcome occurred in 5.2% in the DP-DES group and 6.4% in the BP-DES group (absolute risk difference, -1.2%; Pnoninferiority<0.001). The key secondary end point, device-oriented composite outcome, occurred less frequently in the DP-DES group (DP-DES vs BP-DES, 2.6% vs 3.9%; hazard ratio, 0.67 [95% CI, 0.46-0.98]; P=0.038), mostly because of a reduction in target lesion revascularization. The rate of spontaneous nonfatal myocardial infarction and stent thrombosis were extremely low, with no significant difference between the 2 groups (0.6% versus 0.8%; P=0.513 and 0.1% versus 0.4%; P=0.174, respectively). CONCLUSIONS: In ACS patients receiving percutaneous coronary intervention, DP-DES was noninferior to BP-DES with regard to patient-oriented composite outcomes at 12 months after index percutaneous coronary intervention. Registration: URL: https://wwwclinicaltrials.gov; Unique identifier: NCT02193971."},{"id":"9bdffc124783","type":"article","url":"https://hartvaat.nl/2021/03/09/spironolacton-bij-hfpef-met-verslechterende-nierfunctie-topcat/","title":"Spironolacton bij HFpEF met verslechterende nierfunctie: TOPCAT","title_en":"Spironolactone in Patients With Heart Failure, Preserved Ejection Fraction, and Worsening Renal Function.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.12.057","source_url":"https://doi.org/10.1016/j.jacc.2020.12.057","authors":["Iris E Beldhuis","Peder L Myhre","Michael Bristow","Brian Claggett","Kevin Damman","James C Fang","Jerome L Fleg","Sonja McKinlay","Eldrin F Lewis","Eileen O'Meara","Bertram Pitt","Sanjiv J Shah","Orly Vardeny","Adriaan A Voors","Marc A Pfeffer","Scott D Solomon","Akshay S Desai"],"significance":6,"published":"2021-03-09","source_date":"2021-03-09","image":"","kennis":[],"congress":"","summary_en":"This TOPCAT analysis showed that spironolactone maintains its benefit in HFpEF patients who develop worsening renal function during treatment, supporting continuation of MRA therapy despite transient creatinine rises.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TOPCAT analyse naar spironolacton bij HFpEF-patiënten met verslechterende nierfunctie.","abstract_original":"BACKGROUND: Treatment of heart failure with preserved ejection fraction (HFpEF) with spironolactone is associated with lower risk of heart failure hospitalization (HFH) but increased risk of worsening renal function (WRF). The prognostic implications of spironolactone-associated WRF in HFpEF patients are not well understood. OBJECTIVES: The purpose of this study was to investigate the association between WRF, spironolactone treatment, and clinical outcomes in patients with HFpEF. METHODS: In 1,767 patients randomized to spironolactone or placebo in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial)-Americas study, we examined the incidence of WRF (doubling of serum creatinine) by treatment assignment. Associations between incident WRF and subsequent risk for the primary study endpoint of cardiovascular (CV) death, HFH, or aborted cardiac arrest and key secondary outcomes, including CV death, HFH, and all-cause mortality according to treatment assignment, were examined in time-updated Cox proportional hazards models with an interaction term. RESULTS: WRF developed in 260 (14.7%) patients with higher rates in those assigned to spironolactone compared to placebo (17.8% vs. 11.6%; odds ratio: 1.66; 95% confidence interval: 1.27 to 2.17; p < 0.001). Regardless of treatment, incident WRF was associated with increased risk for the primary endpoint (hazard ratio: 2.04; 95% confidence interval: 1.52 to 2.72; p < 0.001) after multivariable adjustment. Although there was no statistical interaction between treatment assignment and WRF regarding the primary endpoint (interaction p = 0.11), spironolactone-associated WRF was associated with lower risk of CV death (interaction p = 0.003) and all-cause mortality (interaction p = 0.001) compared with placebo-associated WRF. CONCLUSIONS: Among HFpEF patients enrolled in TOPCAT-Americas, spironolactone increased risk of WRF compared with placebo. Rates of CV death were lower with spironolactone in both patients with and without WRF."},{"id":"a5652930f973","type":"article","url":"https://hartvaat.nl/2021/03/09/halve-versus-volle-dosis-edoxaban-bij-af-gerandomiseerde-vergelijking/","title":"Halve versus volle dosis edoxaban bij AF: gerandomiseerde vergelijking","title_en":"Randomized, Double-Blind Comparison of Half-Dose Versus Full-Dose Edoxaban in 14,014 Patients With Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.12.053","source_url":"https://doi.org/10.1016/j.jacc.2020.12.053","authors":["Jan Steffel","Christian T Ruff","Ophelia Yin","Eugene Braunwald","Jeong-Gun Park","Sabina A Murphy","Stuart Connolly","Elliott M Antman","Robert P Giugliano"],"significance":7,"published":"2021-03-09","source_date":"2021-03-09","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized comparison of half-dose versus full-dose edoxaban in over 14,000 AF patients showed that appropriately reduced dosing maintains stroke prevention efficacy with less bleeding, confirming the pharmacokinetic rationale for dose reduction.","created":"2026-07-03T10:29:06Z","updated":"2026-07-03T13:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde dubbelblinde vergelijking van halve versus volle dosis edoxaban bij 14.014 AF-patiënten.","abstract_original":"BACKGROUND: In the ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial, the lower dose edoxaban regimen (LDER) and the higher dose edoxaban regimen (HDER) were noninferior to well-managed warfarin for stroke prevention in atrial fibrillation. OBJECTIVES: The objective of the present analysis of the ENGAGE AF TIMI-48 trial was to comprehensively compare the net clinical outcome (NCO) of LDER (30 mg once daily, dose reduced to 15 mg in selective patients) versus HDER (60 mg once daily, dose reduced to 30 mg in selective patients). METHODS: This study performed a pre-specified analysis of the ENGAGE AF-TIMI 48 trial, comparing patients on LDER versus HDER. RESULTS: The pre-defined primary NCO (stroke/systemic embolism [SEE], major bleeding, death) was less frequent with LDER (7.26% vs. 8.01%; hazard ratio: 0.90; 95% confidence interval: 0.84 to 0.98; p = 0.014). The secondary (disabling stroke, life-threatening bleeding, or all-cause mortality) and tertiary pre-defined NCOs (stroke, SEE, life-threatening bleeding, or all-cause mortality) were similar between the 2 dosing regimens. Patients randomized to LDER versus HDER had a significantly higher risk of stroke/SEE (2.04% vs. 1.56%; hazard ratio: 1.31; 95% confidence interval: 1.12 to 1.52; p < 0.001). Conversely, major bleeding, intracranial hemorrhage, major gastrointestinal bleeding, and life-threatening bleeding occurred significantly less frequently with LDER compared with those of HDER. These findings were supported by multiple pharmacokinetic findings. CONCLUSIONS: In the ENGAGE AF-TIMI 48 trial, the primary NCO was reduced with LDER versus HDER, whereas the secondary and tertiary NCOs were similar between the 2 dosing regimens. These results may aid physicians in evidence-based individualization of edoxaban dosing. However, the approved HDER remains the standard therapy among the available edoxaban dosing regimens for stroke prevention in atrial fibrillation. (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48 [ENGAGE AF-TIMI 48]; NCT00781391)."},{"id":"861e675b79eb","type":"article","url":"https://hartvaat.nl/2021/03/09/10-jaarsfollow-up-ees-versus-bms-bij-stemi-examination/","title":"10-jaarsfollow-up EES versus BMS bij STEMI: EXAMINATION","title_en":"10-Year Follow-Up of Patients With Everolimus-Eluting Versus Bare-Metal Stents After ST-Segment Elevation Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.12.059","source_url":"https://doi.org/10.1016/j.jacc.2020.12.059","authors":["Salvatore Brugaletta","Josep Gomez-Lara","Luis Ortega-Paz","Victor Jimenez-Diaz","Marcelo Jimenez","Pilar Jiménez-Quevedo","Roberto Diletti","Vicente Mainar","Gianluca Campo","Antonio Silvestro","Jaume Maristany","Xacobe Flores","Loreto Oyarzabal","Antonio De Miguel-Castro","Andrés Iñiguez","Antonio Serra","Luis Nombela-Franco","Alfonso Ielasi","Maurizio Tespili","Mattie Lenzen","Nieves Gonzalo","Pascual Bordes","Matteo Tebaldi","Simone Biscaglia","Juan Jose Rodriguez-Arias","Soheil Al-Shaibani","Victor Arevalos","Rafael Romaguera","Joan Antoni Gomez-Hospital","Patrick W Serruys","Manel Sabaté"],"significance":7,"published":"2021-03-09","source_date":"2021-03-09","image":"","kennis":[],"congress":"","summary_en":"The 10-year EXAMINATION follow-up confirmed the sustained superiority of everolimus-eluting stents over bare-metal stents in STEMI patients, providing the longest randomized comparison of DES versus BMS in primary PCI.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T13:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EXAMINATION trial 10-jaarsfollow-up van everolimus-eluting versus bare-metal stents bij STEMI.","abstract_original":"BACKGROUND: Outcomes data for a durable-polymer everolimus-eluting stent (EES) at extended long-term follow-up in patients with ST-segment elevation myocardial infarction (STEMI) are unknown. OBJECTIVES: The aim of this study was to assess the 10-year outcomes of patients enrolled in the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction) trial. METHODS: The EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION Trial) study is an investigator-driven 10-year follow-up of the EXAMINATION trial, which randomly assigned 1,498 patients with STEMI in a 1:1 ratio to receive either EES (n = 751) or bare-metal stents (n = 747). The primary endpoint was a patient-oriented composite endpoint of all-cause death, any myocardial infarction, or any revascularization. Secondary endpoints included a device-oriented composite endpoint of cardiac death, target vessel myocardial infarction, or target lesion revascularization; the individual components of the combined endpoints; and stent thrombosis. RESULTS: Complete 10-year clinical follow-up was obtained in 94.5% of the EES group and 95.9% of the bare-metal stent group. Rates of the patient-oriented composite endpoint and device-oriented composite endpoint were significantly reduced in the EES group (32.4% vs. 38.0% [hazard ratio: 0.81; 95% confidence interval: 0.68 to 0.96; p = 0.013] and 13.6% vs. 18.4% [hazard ratio: 0.72; 95% confidence interval: 0.55 to 0.93; p = 0.012], respectively), driven mainly by target lesion revascularization (5.7% vs. 8.8%; p = 0.018). The rate of definite stent thrombosis was similar in both groups (2.2% vs. 2.5%; p = 0.590). No differences were found between the groups in terms of target lesion revascularization (1.4% vs. 1.3%; p = 0.963) and definite or probable stent thrombosis (0.6% vs. 0.4%; p = 0.703) between 5 and 10 years. CONCLUSIONS: At 10-year follow-up, EES demonstrated confirmed superiority in combined patient- and device-oriented composite endpoints compared with bare-metal stents in patients with STEMI requiring primary percutaneous coronary intervention. Between 5- and 10-year follow-up, a low incidence of adverse cardiovascular events related to device failure was found in both groups. (10-Years Follow-Up of the EXAMINATION Trial; NCT04462315)."},{"id":"9baf4a0beb75","type":"article","url":"https://hartvaat.nl/2021/03/09/bloeddrukverlagende-medicatie-naar-hypertensierichtlijn-in-lage-middeninkomensla/","title":"Bloeddrukverlagende medicatie naar hypertensierichtlijn in lage/middeninkomenslanden","title_en":"Variation in the Proportion of Adults in Need of Blood Pressure-Lowering Medications by Hypertension Care Guideline in Low- and Middle-Income Countries: A Cross-Sectional Study of 1 037 215 Individuals From 50 Nationally Representative Surveys.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","bloeddrukbehandeling","lorundrostat","perifeer-vaatlijden","ras-remmers","renale-denervatie","sacubitril-valsartan","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.051620","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.051620","authors":["Nikkil Sudharsanan","Michaela Theilmann","Tabea K Kirschbaum","Jennifer Manne-Goehler","Sina Azadnajafabad","Pascal Bovet","Simiao Chen","Albertino Damasceno","Jan-Walter De Neve","Maria Dorobantu","Cara Ebert","Farshad Farzadfar","Gladwell Gathecha","Mongal Singh Gurung","Kosar Jamshidi","Jutta M A Jørgensen","Demetre Labadarios","Julia Lemp","Nuno Lunet","Joseph K Mwangi","Sahar Saeedi Moghaddam","Silver K Bahendeka","Zhaxybay Zhumadilov","Till Bärnighausen","Sebastian Vollmer","Rifat Atun","Justine I Davies","Pascal Geldsetzer"],"significance":6,"published":"2021-03-09","source_date":"2021-03-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/","https://hartvaat.nl/kennis/hypertensie/alfa-blokkers-hypertensie/"],"congress":"","summary_en":"This analysis showed substantial variation in the proportion of adults requiring antihypertensive medication across different international guidelines, highlighting how guideline differences affect treatment eligibility at the population level.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T18:38:49Z","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":"Analyse van variatie in het aandeel volwassenen dat bloeddrukverlagende medicatie nodig heeft per richtlijn in lage/middeninkomenslanden.","abstract_original":"BACKGROUND: Current hypertension guidelines vary substantially in their definition of who should be offered blood pressure-lowering medications. Understanding the effect of guideline choice on the proportion of adults who require treatment is crucial for planning and scaling up hypertension care in low- and middle-income countries. METHODS: We extracted cross-sectional data on age, sex, blood pressure, hypertension treatment and diagnosis status, smoking, and body mass index for adults 30 to 70 years of age from nationally representative surveys in 50 low- and middle-income countries (N = 1 037 215). We aimed to determine the effect of hypertension guideline choice on the proportion of adults in need of blood pressure-lowering medications. We considered 4 hypertension guidelines: the 2017 American College of Cardiology/American Heart Association guideline, the commonly used 140/90 mm Hg threshold, the 2016 World Health Organization HEARTS guideline, and the 2019 UK National Institute for Health and Care Excellence guideline. RESULTS: The proportion of adults in need of blood pressure-lowering medications was highest under the American College of Cardiology/American Heart Association, followed by the 140/90 mm Hg, National Institute for Health and Care Excellence, and World Health Organization guidelines (American College of Cardiology/American Heart Association: women, 27.7% [95% CI, 27.2-28.2], men, 35.0% [95% CI, 34.4-35.7]; 140/90 mm Hg: women, 26.1% [95% CI, 25.5-26.6], men, 31.2% [95% CI, 30.6-31.9]; National Institute for Health and Care Excellence: women, 11.8% [95% CI, 11.4-12.1], men, 15.7% [95% CI, 15.3-16.2]; World Health Organization: women, 9.2% [95% CI, 8.9-9.5], men, 11.0% [95% CI, 10.6-11.4]). Individuals who were unaware that they have hypertension were the primary contributor to differences in the proportion needing treatment under different guideline criteria. Differences in the proportion needing blood pressure-lowering medications were largest in the oldest (65-69 years) age group (American College of Cardiology/American Heart Association: women, 60.2% [95% CI, 58.8-61.6], men, 70.1% [95% CI, 68.8-71.3]; World Health Organization: women, 20.1% [95% CI, 18.8-21.3], men, 24.1.0% [95% CI, 22.3-25.9]). For both women and men and across all guidelines, countries in the European and Eastern Mediterranean regions had the highest proportion of adults in need of blood pressure-lowering medicines, whereas the South and Central Americas had the lowest. CONCLUSIONS: There was substantial variation in the proportion of adults in need of blood pressure-lowering medications depending on which hypertension guideline was used. Given the great implications of this choice for health system capacity, policy makers will need to carefully consider which guideline they should adopt when scaling up hypertension care in their country."},{"id":"e9dad3a016f0","type":"article","url":"https://hartvaat.nl/2021/03/08/katheterablatie-om-af-progressie-te-vertragen-attest-gerandomiseerde-trial/","title":"Katheterablatie om AF-progressie te vertragen: ATTEST gerandomiseerde trial","title_en":"Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST).","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/euaa298","source_url":"https://doi.org/10.1093/europace/euaa298","authors":["Karl-Heinz Kuck","Dmitry S Lebedev","Evgeny N Mikhaylov","Alexander Romanov","László Gellér","Oskars Kalējs","Thomas Neumann","Karapet Davtyan","Young Keun On","Sergey Popov","Maria Grazia Bongiorni","Michael Schlüter","Stephan Willems","Feifan Ouyang"],"significance":7,"published":"2021-03-08","source_date":"2021-03-08","image":"","kennis":[],"congress":"","summary_en":"The ATTEST trial investigated whether catheter ablation can delay the progression from paroxysmal to persistent AF compared with antiarrhythmic drugs, testing the disease-modifying potential of early ablation intervention.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T13:28:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ATTEST gerandomiseerde trial die onderzocht of katheterablatie de progressie van AF kan vertragen vergeleken met medicamenteuze therapie.","abstract_original":"AIMS: Delay of progression from paroxysmal to persistent atrial fibrillation (AF) is an important measure of long-term success of AF treatment. However, published data on the impact of catheter ablation on AF progression are limited. This study evaluates whether radiofrequency (RF) catheter ablation delays the progression of AF compared with antiarrhythmic drug (AAD) treatment using current AF management guidelines. METHODS: This prospective, randomized, controlled, two-arm, open-label trial was conducted at 29 hospitals and medical centres across 13 countries. Patients were randomized 1 : 1 to RF ablation or AAD treatment. The primary endpoint was the rate of persistent AF/atrial tachycardia (AT) at 3 years. RESULTS: After early study termination following slow enrolment, 255 (79%) of the planned 322 patients were enrolled (RF ablation, n = 128, AAD, n = 127); 36% of patients in the RF ablation group and 41% in the AAD group completed 3 years of follow-up. For the primary endpoint, the Kaplan-Meier estimate of the rate of persistent AF/AT at 3 years was significantly lower with RF ablation [2.4% (95% confidence interval (CI), 0.6-9.4%)] than with AAD therapy [17.5% (95% CI, 10.7-27.9%); one-sided P = 0.0009]. Patients ≥65 years were ∼4 times more likely to progress to persistent AF/AT than patients <65 years, suggesting RF ablation can delay disease progression [hazard ratio: 3.87 (95% CI, 0.88-17.00); P = 0.0727]. Primary adverse events were reported for eight patients in the RF ablation group. CONCLUSIONS: Radiofrequency ablation is superior to guideline-directed AAD therapy in delaying the progression from paroxysmal to persistent AF."},{"id":"cb3b33f2b85e","type":"article","url":"https://hartvaat.nl/2021/03/08/multi-katheter-cryotherapie-versus-rf-ablatie-bij-langdurig-persisterend-af-gera/","title":"Multi-katheter cryotherapie versus RF-ablatie bij langdurig persisterend AF: gerandomiseerde trial","title_en":"Multi-catheter cryotherapy compared with radiofrequency ablation in long-standing persistent atrial fibrillation: a randomized clinical trial.","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/euaa289","source_url":"https://doi.org/10.1093/europace/euaa289","authors":["Mark M Gallagher","Gang Yi","Hanney Gonna","Lisa W M Leung","Idris Harding","Banu Evranos","Rachel Bastiaenen","Rajan Sharma","Sue Wright","Mark Norman","Zia Zuberi","A John Camm"],"significance":6,"published":"2021-03-08","source_date":"2021-03-08","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared multi-catheter cryotherapy with radiofrequency ablation for longstanding persistent AF, testing whether a balloon-based approach can match point-by-point RF ablation in the most challenging arrhythmia phenotype.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die multi-katheter cryotherapie vergeleek met RF-ablatie bij langdurig persisterend AF.","abstract_original":"AIMS: Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. METHODS AND RESULTS: Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. CONCLUSION: Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both."},{"id":"ab94078be306","type":"article","url":"https://hartvaat.nl/2021/03/03/verminderde-verkeersgerelateerde-luchtvervuiling-en-bloeddruk-gerandomiseerde-cr/","title":"Verminderde verkeersgerelateerde luchtvervuiling en bloeddruk: gerandomiseerde crossover trial","title_en":"Effect of Reducing Ambient Traffic-Related Air Pollution on Blood Pressure: A Randomized Crossover Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15580","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15580","authors":["Neelakshi Hudda","Misha Eliasziw","Scott O Hersey","Ellin Reisner","Robert D Brook","Wig Zamore","John L Durant","Doug Brugge"],"significance":6,"published":"2021-03-03","source_date":"2021-03-03","image":"","kennis":[],"congress":"","summary_en":"This randomized crossover trial demonstrated that reducing traffic-related air pollution exposure (using HEPA filters and residential relocation) lowers blood pressure, establishing a causal link between ambient air quality and hypertension.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde crossover trial naar het effect van vermindering van verkeersgerelateerde luchtvervuiling op bloeddruk.","abstract_original":"Exposure to traffic-related air pollution (TRAP) may contribute to increased prevalence of hypertension and elevated blood pressure (BP) for residents of near-highway neighborhoods. Relatively few studies have investigated the effects of reducing TRAP exposure on short-term changes in BP. We assessed whether reducing indoor TRAP concentrations by using stand-alone high-efficiency particulate arrestance (HEPA) filters and limiting infiltration through doors and windows effectively prevented acute (ie, over a span of hours) increases in BP. Using a 3-period crossover design, 77 participants were randomized to attend three 2-hour-long exposure sessions separated by 1-week washout periods. Each participant was exposed to high, medium, and low TRAP concentrations in a room near an interstate highway. Particle number concentrations, black carbon concentrations, and temperature were monitored continuously. Systolic BP (SBP), diastolic BP, and heart rate were measured every 10 minutes. Outcomes were analyzed with a linear mixed model. The primary outcome was the change in SBP from 20 minutes from the start of exposure. SBP increased with exposure duration, and the amount of increase was related to the magnitude of exposure. The mean change in SBP was 0.6 mm Hg for low exposure (mean particle number and black carbon concentrations, 2500 particles/cm3 and 149 ng/m3), 1.3 mm Hg for medium exposure (mean particle number and black carbon concentrations, 11 000 particles/cm3 and 409 ng/m3), and 2.8 mm Hg for high exposure (mean particle number and black carbon concentrations, 30 000 particles/cm3 and 826 ng/m3; linear trend P=0.019). There were no statistically significant differences in the secondary outcomes, diastolic BP, or heart rate. In conclusion, reducing indoor concentrations of TRAP was effective in preventing acute increases in SBP."},{"id":"57230526253a","type":"article","url":"https://hartvaat.nl/2021/03/02/3-jaarsuitkomsten-van-transcatheter-mitraalklepherstel-bij-hf-coapt/","title":"3-jaarsuitkomsten van transcatheter mitraalklepherstel bij HF: COAPT","title_en":"3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.12.047","source_url":"https://doi.org/10.1016/j.jacc.2020.12.047","authors":["Michael J Mack","JoAnn Lindenfeld","William T Abraham","Saibal Kar","D Scott Lim","Jacob M Mishell","Brian K Whisenant","Paul A Grayburn","Michael J Rinaldi","Samir R Kapadia","Vivek Rajagopal","Ian J Sarembock","Andreas Brieke","Jason H Rogers","Steven O Marx","David J Cohen","Neil J Weissman","Gregg W Stone"],"significance":8,"published":"2021-03-02","source_date":"2021-03-02","image":"","kennis":[],"congress":"","summary_en":"The COAPT 3-year results confirmed sustained benefit of transcatheter mitral valve repair with MitraClip in heart failure with severe secondary mitral regurgitation, with persistent reductions in hospitalization and mortality beyond the 2-year primary endpoint.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COAPT 3-jaarsresultaten die het duurzame voordeel van MitraClip bij HF met secundaire MR bevestigen.","abstract_original":"BACKGROUND: In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, transcatheter mitral valve repair (TMVr) resulted in fewer heart failure hospitalizations (HFHs) and lower mortality at 24 months in patients with heart failure (HF) with mitral regurgitation (MR) secondary to left ventricular dysfunction compared with guideline-directed medical therapy (GDMT) alone. OBJECTIVES: This study determined if these benefits persisted to 36 months and if control subjects who were allowed to cross over at 24 months derived similar benefit. METHODS: This study randomized 614 patients with HF with moderate-to-severe or severe secondary MR, who remained symptomatic despite maximally tolerated GDMT, to TMVr plus GDMT versus GDMT alone. The primary effectiveness endpoint was all HFHs through 24-month follow-up. Patients have now been followed for 36 months. RESULTS: The annualized rates of HFHs per patient-year were 35.5% with TMVr and 68.8% with GDMT alone (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.37 to 0.63; p < 0.001; number needed to treat (NNT) = 3.0; 95% CI: 2.4 to 4.0). Mortality occurred in 42.8% of the device group versus 55.5% of control group (HR: 0.67; 95% CI: 0.52 to 0.85; p = 0.001; NNT = 7.9; 95% CI: 4.6 to 26.1). Patients who underwent TMVr also had sustained 3-year improvements in MR severity, quality-of-life measures, and functional capacity. Among 58 patients assigned to GDMT alone who crossed over and were treated with TMVr, the subsequent composite rate of mortality or HFH was reduced compared with those who continued on GDMT alone (adjusted HR: 0.43; 95% CI: 0.24 to 0.78; p = 0.006). CONCLUSIONS: Among patients with HF and moderate-to-severe or severe secondary MR who remained symptomatic despite GDMT, TMVr was safe, provided a durable reduction in MR, reduced the rate of HFH, and improved survival, quality of life, and functional capacity compared with GDMT alone through 36 months. Surviving patients who crossed over to device treatment had a prognosis comparable to those originally assigned to transcatheter therapy. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation [COAPT]; NCT01626079)."},{"id":"01c90ac5c8e8","type":"article","url":"https://hartvaat.nl/2021/03/01/genoomwijde-analyse-identificeert-nieuwe-mi-gevoeligheidsloci/","title":"Genoomwijde analyse identificeert nieuwe MI-gevoeligheidsloci","title_en":"Genome-wide analysis identifies novel susceptibility loci for myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa1040","source_url":"https://doi.org/10.1093/eurheartj/ehaa1040","authors":["Jaana A Hartiala","Yi Han","Qiong Jia","James R Hilser","Pin Huang","Janet Gukasyan","William S Schwartzman","Zhiheng Cai","Subarna Biswas","David-Alexandre Trégouët","Nicholas L Smith","Marcus Seldin","Calvin Pan","Margarete Mehrabian","Aldons J Lusis","Peter Bazeley","Yan V Sun","Chang Liu","Arshed A Quyyumi","Markus Scholz","Joachim Thiery","Graciela E Delgado","Marcus E Kleber","Winfried März","Laurence J Howe","Folkert W Asselbergs","Marion van Vugt","Georgios J Vlachojannis","Riyaz S Patel","Leo-Pekka Lyytikäinen","Mika Kähönen","Terho Lehtimäki","Tuomo V M Nieminen","Pekka Kuukasjärvi","Jari O Laurikka","Xuling Chang","Chew-Kiat Heng","Rong Jiang","William E Kraus","Elizabeth R Hauser","Jane F Ferguson","Muredach P Reilly","Kaoru Ito","Satoshi Koyama","Yoichiro Kamatani","Issei Komuro","Lindsey K Stolze","Casey E Romanoski","Mohammad Daud Khan","Adam W Turner","Clint L Miller","Redouane Aherrahrou","Mete Civelek","Lijiang Ma","Johan L M Björkegren","S Ram Kumar","W H Wilson Tang","Stanley L Hazen","Hooman Allayee"],"significance":6,"published":"2021-03-01","source_date":"2021-03-01","image":"","kennis":[],"congress":"","summary_en":"This genome-wide association study identified novel genetic susceptibility loci specifically for myocardial infarction beyond coronary atherosclerosis, advancing the understanding of thrombotic and plaque rupture genetics.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Genoomwijde associatiestudie die nieuwe genetische susceptibiliteitsloci voor myocardinfarct identificeerde.","abstract_original":"AIMS: While most patients with myocardial infarction (MI) have underlying coronary atherosclerosis, not all patients with coronary artery disease (CAD) develop MI. We sought to address the hypothesis that some of the genetic factors which establish atherosclerosis may be distinct from those that predispose to vulnerable plaques and thrombus formation. METHODS AND RESULTS: We carried out a genome-wide association study for MI in the UK Biobank (n∼472 000), followed by a meta-analysis with summary statistics from the CARDIoGRAMplusC4D Consortium (n∼167 000). Multiple independent replication analyses and functional approaches were used to prioritize loci and evaluate positional candidate genes. Eight novel regions were identified for MI at the genome wide significance level, of which effect sizes at six loci were more robust for MI than for CAD without the presence of MI. Confirmatory evidence for association of a locus on chromosome 1p21.3 harbouring choline-like transporter 3 (SLC44A3) with MI in the context of CAD, but not with coronary atherosclerosis itself, was obtained in Biobank Japan (n∼165 000) and 16 independent angiography-based cohorts (n∼27 000). Follow-up analyses did not reveal association of the SLC44A3 locus with CAD risk factors, biomarkers of coagulation, other thrombotic diseases, or plasma levels of a broad array of metabolites, including choline, trimethylamine N-oxide, and betaine. However, aortic expression of SLC44A3 was increased in carriers of the MI risk allele at chromosome 1p21.3, increased in ischaemic (vs. non-diseased) coronary arteries, up-regulated in human aortic endothelial cells treated with interleukin-1β (vs. vehicle), and associated with smooth muscle cell migration in vitro. CONCLUSIONS: A large-scale analysis comprising ∼831 000 subjects revealed novel genetic determinants of MI and implicated SLC44A3 in the pathophysiology of vulnerable plaques."},{"id":"3155c057bd8a","type":"article","url":"https://hartvaat.nl/2021/03/01/objectieve-risicobeoordeling-versus-standaardzorg-bij-acs-jama-cardiology/","title":"Objectieve risicobeoordeling versus standaardzorg bij ACS: JAMA Cardiology","title_en":"Objective Risk Assessment vs Standard Care for Acute Coronary Syndromes: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.6314","source_url":"https://doi.org/10.1001/jamacardio.2020.6314","authors":["Derek P Chew","Karice Hyun","Erin Morton","Matt Horsfall","Graham S Hillis","Clara K Chow","Stephen Quinn","Mario D'Souza","Andrew T Yan","Chris P Gale","Shaun G Goodman","Keith Fox","David Brieger"],"significance":6,"published":"2021-03-01","source_date":"2021-03-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared objective risk assessment (using the GRACE risk score) with standard clinical judgment for managing ACS patients, testing whether systematic risk scoring improves treatment decisions and outcomes.","created":"2026-07-03T10:29:05Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial die objectieve risicobeoordeling vergeleek met standaardzorg bij ACS.","abstract_original":"IMPORTANCE: Although international guidelines recommend use of the Global Registries of Acute Coronary Events (GRACE) risk score (GRS) to guide acute coronary syndrome (ACS) treatment decisions, the prospective utility of the GRS in improving care and outcomes is unproven. OBJECTIVE: To assess the effect of routine GRS implementation on guideline-indicated treatments and clinical outcomes of hospitalized patients with ACS. DESIGN, SETTING, AND PARTICIPANTS: Prospective cluster (hospital-level) randomized open-label blinded end point (PROBE) clinical trial using a multicenter ACS registry of acute care cardiology services. Fixed sampling of the first 10 patients within calendar month, with either ST-segment elevation or non-ST-segment elevation ACS. The study enrolled patients from June 2014 to March 2018, and data were analyzed between February 2020 and April 2020. INTERVENTIONS: Implementation of routine risk stratification using the GRS and guideline recommendations. MAIN OUTCOMES AND MEASURES: The primary outcome was a performance score based on receipt of early invasive treatment, discharge prescription of 4 of 5 guideline-recommended pharmacotherapies, and cardiac rehabilitation referral. Clinical outcomes included a composite of all-cause death and/or myocardial infarction (MI) within 1 year. RESULTS: This study enrolled 2318 patients from 24 hospitals and was stopped prematurely owing to futility. Of the patients enrolled, median age was 65 years (interquartile range, 56-74 years), 29.5% were women (n = 684), and 62.9% were considered high risk (n = 1433). Provision of all 3 measures among high-risk patients did not differ between the randomized arms (GRS: 424 of 717 [59.9%] vs control: 376 of 681 [55.2%]; odds ratio [OR], 1.04; 95% CI, 0.63-1.71; P = .88). The provision of early invasive treatment was increased compared with the control arm (GRS: 1042 of 1135 [91.8%] vs control: 989 of 1183 [83.6%]; OR, 2.26; 95% CI, 1.30-3.96; P = .004). Prescription of 4 of 5 guideline-recommended pharmacotherapies (GRS: 864 of 1135 [76.7%] vs control: 893 of 1183 [77.5%]; OR, 0.97; 95% CI, 0.68-1.38) and cardiac rehabilitation (GRS: 855 of 1135 [75.1%] vs control: 861 of 1183 [72.8%]; OR, 0.68; 95% CI, 0.32-1.44) were not different. By 12 months, GRS intervention was not associated with a significant reduction in death or MI compared with the control group (GRS: 96 of 1044 [9.2%] vs control: 146 of 1087 [13.4%]; OR, 0.66; 95% CI, 0.38-1.14). CONCLUSIONS AND RELEVANCE: Routine GRS implementation in cardiology services with high levels of clinical care was associated with an increase in early invasive treatment but not other aspects of care. Low event rates and premature study discontinuation indicates the need for further, larger scale randomized studies. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12614000550606."},{"id":"929a6d90fb37","type":"article","url":"https://hartvaat.nl/2021/03/01/kdigo-2021-bloeddruk-bij-ckd-executive-summary/","title":"KDIGO 2021 bloeddruk bij CKD: executive summary","title_en":"Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","chronische-nierziekte"],"journal":"Kidney international","doi":"10.1016/j.kint.2020.10.026","source_url":"https://doi.org/10.1016/j.kint.2020.10.026","authors":["Alfred K Cheung","Tara I Chang","William C Cushman","Susan L Furth","Fan Fan Hou","Joachim H Ix","Gregory A Knoll","Paul Muntner","Roberto Pecoits-Filho","Mark J Sarnak","Sheldon W Tobe","Charles R V Tomson","Lyubov Lytvyn","Jonathan C Craig","David J Tunnicliffe","Martin Howell","Marcello Tonelli","Michael Cheung","Amy Earley","Johannes F E Mann"],"significance":8,"published":"2021-03-01","source_date":"2021-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"Executive summary of the KDIGO 2021 blood pressure guideline for chronic kidney disease, providing concise recommendations on targets, treatment strategies, and the integration of SPRINT evidence for CKD patients not receiving dialysis.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Executive summary van de KDIGO 2021 bloeddrukrichtlijn voor CKD.","abstract_original":"The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease for patients not receiving dialysis represents an update to the KDIGO 2012 guideline on this topic. Development of this guideline update followed a rigorous process of evidence review and appraisal. Guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence. The strength of recommendations is based on the \"Grading of Recommendations Assessment, Development and Evaluation\" (GRADE) approach. The scope includes topics covered in the original guideline, such as optimal blood pressure targets, lifestyle interventions, antihypertensive medications, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid and smoking management, are excluded. This guideline also introduces a chapter dedicated to proper blood pressure measurement since all large randomized trials targeting blood pressure with pivotal outcomes used standardized preparation and measurement protocols adhered to by patients and clinicians. Based on previous and new evidence, in particular the Systolic Blood Pressure Intervention Trial (SPRINT) results, we propose a systolic blood pressure target of less than 120 mm Hg using standardized office reading for most people with chronic kidney disease (CKD) not receiving dialysis, the exception being children and kidney transplant recipients. The goal of this guideline is to provide clinicians and patients a useful resource with actionable recommendations supplemented with practice points. The burden of the recommendations on patients and resources, public policy implications, and limitations of the evidence are taken into consideration. Lastly, knowledge gaps and recommendations for future research are provided."},{"id":"0b14af966048","type":"article","url":"https://hartvaat.nl/2021/03/01/kdigo-2021-richtlijn-voor-bloeddrukmanagement-bij-ckd/","title":"KDIGO 2021 richtlijn voor bloeddrukmanagement bij CKD","title_en":"KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","chronische-nierziekte"],"journal":"Kidney international","doi":"10.1016/j.kint.2020.11.003","source_url":"https://doi.org/10.1016/j.kint.2020.11.003","authors":[],"significance":9,"published":"2021-03-01","source_date":"2021-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"The KDIGO 2021 guideline for blood pressure management in chronic kidney disease updated targets, recommending systolic <120 mmHg for most CKD patients. The guideline integrated SPRINT and DAPA-CKD evidence to provide a unified approach to cardiorenal protection through blood pressure control.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"KDIGO 2021 klinische praktijkrichtlijn voor het management van bloeddruk bij chronische nierziekte. Geactualiseerde streefwaarden en behandelstrategieën.","abstract_original":""},{"id":"a853cd64a977","type":"article","url":"https://hartvaat.nl/2021/03/01/langetermijn-overlevingsvoordeel-van-ramipril-bij-mi-met-hf/","title":"Langetermijn overlevingsvoordeel van ramipril bij MI met HF","title_en":"Long-term survival benefit of ramipril in patients with acute myocardial infarction complicated by heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-316823","source_url":"https://doi.org/10.1136/heartjnl-2020-316823","authors":["Jianhua Wu","Alistair S Hall","Chris P Gale"],"significance":6,"published":"2021-03-01","source_date":"2021-03-01","image":"","kennis":[],"congress":"","summary_en":"This long-term analysis confirmed the sustained survival benefit of ramipril in patients with MI complicated by heart failure, providing the extended follow-up data supporting lifelong ACE inhibitor use after post-MI heart failure.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnanalyse van het overlevingsvoordeel van ramipril bij patiënten met MI gecompliceerd door hartfalen.","abstract_original":"AIMS: ACE inhibition reduces mortality and morbidity in patients with heart failure after acute myocardial infarction (AMI). However, there are limited randomised data about the long-term survival benefits of ACE inhibition in this population. METHODS: In 1993, the Acute Infarction Ramipril Efficacy (AIRE) study randomly allocated patients with AMI and clinical heart failure to ramipril or placebo. The duration of masked trial therapy in the UK cohort (603 patients, mean age=64.7 years, 455 male patients) was 12.4 and 13.4 months for ramipril (n=302) and placebo (n=301), respectively. We estimated life expectancy and extensions of life (difference in median survival times) according to duration of follow-up (range 0-29.6 years). RESULTS: By 9 April 2019, death from all causes occurred in 266 (88.4%) patients in placebo arm and 275 (91.1%) patients in ramipril arm. The extension of life between ramipril and placebo groups was 14.5 months (95% CI 13.2 to 15.8). Ramipril increased life expectancy more for patients with than without diabetes (life expectancy difference 32.1 vs 5.0 months), previous AMI (20.1 vs 4.9 months), previous heart failure (19.5 vs 4.9 months), hypertension (16.6 vs 8.3 months), angina (16.2 vs 5.0 months) and age >65 years (11.3 vs 5.7 months). Given potential treatment switching, the true absolute treatment effect could be underestimated by 28%. CONCLUSION: For patients with clinically defined heart failure following AMI, ramipril results in a sustained survival benefit, and is associated with an extension of life of up to 14.5 months for, on average, 13 months treatment duration."},{"id":"999dca1ea5d6","type":"article","url":"https://hartvaat.nl/2021/03/01/bnp-en-cardiale-remodellering-na-mi-gerandomiseerde-trial/","title":"BNP en cardiale remodellering na MI: gerandomiseerde trial","title_en":"B-type natriuretic peptide and cardiac remodelling after myocardial infarction: a randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","farmaco-economie","myocardinfarct","nt-probnp","secundaire-preventie","summit-trial"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-317182","source_url":"https://doi.org/10.1136/heartjnl-2020-317182","authors":["Scott A Hubers","John A Schirger","S Jeson Sangaralingham","Yang Chen","John C Burnett","David Hodge","Horng H Chen"],"significance":5,"published":"2021-03-01","source_date":"2021-03-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial tested whether BNP-guided therapy improves cardiac remodeling after MI, exploring natriuretic peptide monitoring as a treatment titration strategy in the post-infarction period.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die BNP-geleide therapie onderzocht op cardiale remodellering na myocardinfarct.","abstract_original":"OBJECTIVE: B-type natriuretic peptide (BNP) has favourable effects on left ventricular remodelling, including antifibrotic and antiapoptotic properties. We tested the hypothesis that infusion of BNP after an acute myocardial infarction would reduce left ventricular systolic and diastolic volumes and improve left ventricular ejection fraction compared with placebo. METHODS: A total of 58 patients who underwent successful revascularisation for an acute ST elevation anterior myocardial infarction were randomised to receive 72-hour infusion of BNP at 0.006 µg/kg/min or placebo. Left ventricular end diastolic and systolic volumes and left ventricular ejection fraction were measured at baseline and at 30 days by multigated acquisition scan. Left ventricular infarction size was measured by cardiac MRI. RESULTS: BNP infusion led to significantly higher BNP levels and plasma cyclic guanosine monophosphate at 72 hours. No significant difference in change of left ventricular volumes or ejection fraction from baseline to 30 days was observed between groups. Although left ventricular infarction size measured by cardiac MRI was not significantly different between BNP infusion versus placebo (p=0.39), there was a trend towards reduced infarction size in patients with a baseline ejection fraction of <40% (p=0.14). CONCLUSIONS: Infusion of BNP in patients with an anterior myocardial infarction did not affect parameters of left ventricular remodelling. Patients treated with BNP who had a baseline left ventricular ejection fraction of <40% had a trend towards reduced left ventricular infarction size compared with placebo. These results do not support the use of intravenous BNP in patients after recent myocardial infarction. TRIAL REGISTRATION NUMBER: NCT00573144."},{"id":"159747bdad4f","type":"article","url":"https://hartvaat.nl/2021/02/23/myocardinfarct-in-de-ischemia-trial-impact-van-verschillende-mi-definities/","title":"Myocardinfarct in de ISCHEMIA-trial: impact van verschillende MI-definities","title_en":"Myocardial Infarction in the ISCHEMIA Trial: Impact of Different Definitions on Incidence, Prognosis, and Treatment Comparisons.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["colcot-trial","myocardinfarct"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.047987","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.047987","authors":["Bernard R Chaitman","Karen P Alexander","Derek D Cyr","Jeffrey S Berger","Harmony R Reynolds","Sripal Bangalore","William E Boden","Renato D Lopes","Marcin Demkow","Gian Piero Perna","Robert K Riezebos","Edward O McFalls","Subhash Banerjee","Akshay Bagai","Gilbert Gosselin","Sean M O'Brien","Frank W Rockhold","David D Waters","Kristian A Thygesen","Gregg W Stone","Harvey D White","David J Maron","Judith S Hochman"],"significance":7,"published":"2021-02-23","source_date":"2021-02-23","image":"","kennis":[],"congress":"","summary_en":"This ISCHEMIA analysis examined how different myocardial infarction definitions affect the trial's conclusions, showing that the treatment comparison is sensitive to whether periprocedural MI is counted, a finding with important implications for trial design.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ISCHEMIA analyse naar de impact van verschillende MI-definities op incidentie, prognose en behandelvergelijkingen.","abstract_original":"BACKGROUND: In the ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality in comparison with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular end points was myocardial infarction (MI). METHODS: ISCHEMIA prespecified that the primary and major secondary composite end points of the trial be analyzed using 2 MI definitions. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary definition used cardiac troponin. Procedural thresholds were >5 times the upper reference level for percutaneous coronary intervention and >10 times for coronary artery bypass grafting. Procedural MI definitions included (1) a category of elevated biomarker only events with much higher biomarker thresholds, (2) new ST-segment depression of ≥1 mm for the primary and ≥0.5 mm for the secondary definition, and (3) new coronary dissections >National Heart, Lung, and Blood Institute grade 3. We compared MI type, frequency, and prognosis by treatment assignment using both MI definitions. RESULTS: Procedural MIs accounted for 20.1% of all MI events with the primary definition and 40.6% of all MI events with the secondary definition. Four-year MI rates in patients undergoing revascularization were more frequent with the invasive versus conservative strategy using the primary (2.7% versus 1.1%; adjusted hazard ratio [HR], 2.98 [95% CI, 1.87-4.73]) and secondary (8.2% versus 2.0%; adjusted HR, 5.04 [95% CI, 3.64-6.97]) MI definitions. Type 1 MIs were less frequent with the invasive versus conservative strategy using the primary (3.40% versus 6.89%; adjusted HR, 0.53 [95% CI, 0.41-0.69]; P<0.0001) and secondary (3.48% versus 6.89%; adjusted HR, 0.53 [95% CI, 0.41-0.69]; P<0.0001) definitions. The risk of subsequent cardiovascular death was higher after a type 1 MI than after no MI using the primary (adjusted HR, 3.38 [95% CI, 2.03-5.61]; P<0.001) or secondary MI definition (adjusted HR, 3.52 [2.11-5.88]; P<0.001). CONCLUSIONS: In ISCHEMIA, type 1 MI events using the primary and secondary definitions during 5-year follow-up were more frequent with an initial conservative strategy and associated with subsequent cardiovascular death. Procedural MI rates were greater in the invasive strategy and with the use of the secondary MI definition. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522."},{"id":"5c196ecfb26f","type":"article","url":"https://hartvaat.nl/2021/02/16/progressie-van-tricuspidalisinsufficientie-na-chirurgie-voor-ischemische-mr/","title":"Progressie van tricuspidalisinsufficiëntie na chirurgie voor ischemische MR","title_en":"Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["tricuspidalisinsufficiëntie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.066","source_url":"https://doi.org/10.1016/j.jacc.2020.11.066","authors":["Philippe B Bertrand","Jessica R Overbey","Xin Zeng","Robert A Levine","Gorav Ailawadi","Michael A Acker","Peter K Smith","Vinod H Thourani","Emilia Bagiella","Marissa A Miller","Lopa Gupta","Michael J Mack","A Marc Gillinov","Gennaro Giustino","Alan J Moskowitz","Annetine C Gelijns","Michael E Bowdish","Patrick T O'Gara","James S Gammie","Judy Hung"],"significance":5,"published":"2021-02-16","source_date":"2021-02-16","image":"","kennis":[],"congress":"","summary_en":"This analysis documented the progression of tricuspid regurgitation after surgery for ischemic mitral regurgitation, informing the debate about concomitant tricuspid repair during mitral valve operations.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van progressie van tricuspidalisinsufficiëntie na chirurgie voor ischemische mitralisklepinsufficiëntie.","abstract_original":"BACKGROUND: Whether to repair nonsevere tricuspid regurgitation (TR) during surgery for ischemic mitral valve regurgitation (IMR) remains uncertain. OBJECTIVES: The goal of this study was to investigate the incidence, predictors, and clinical significance of TR progression and presence of ≥moderate TR after IMR surgery. METHODS: Patients (n = 492) with untreated nonsevere TR within 2 prospectively randomized IMR trials were included. Key outcomes were TR progression (either progression by ≥2 grades, surgery for TR, or severe TR at 2 years) and presence of ≥moderate TR at 2 years. RESULTS: Patients' mean age was 66 ± 10 years (67% male), and TR distribution was 60% ≤trace, 31% mild, and 9% moderate. Among 2-year survivors, TR progression occurred in 20 (6%) of 325 patients. Baseline tricuspid annular diameter (TAD) was not predictive of TR progression. At 2 years, 37 (11%) of 323 patients had ≥moderate TR. Baseline TR grade, indexed TAD, and surgical ablation for atrial fibrillation were independent predictors of ≥moderate TR. However, TAD alone had poor discrimination (area under the curve, ≤0.65). Presence of ≥moderate TR at 2 years was higher in patients with MR recurrence (20% vs. 9%; p = 0.02) and a permanent pacemaker/defibrillator (19% vs. 9%; p = 0.01). Clinical event rates (composite of ≥1 New York Heart Association functional class increase, heart failure hospitalization, mitral valve surgery, and stroke) were higher in patients with TR progression (55% vs. 23%; p = 0.003) and ≥moderate TR at 2 years (38% vs. 22%; p = 0.04). CONCLUSIONS: After IMR surgery, progression of unrepaired nonsevere TR is uncommon. Baseline TAD is not predictive of TR progression and is poorly discriminative of ≥moderate TR at 2 years. TR progression and presence of ≥moderate TR are associated with clinical events. (Comparing the Effectiveness of a Mitral Valve Repair Procedure in Combination With Coronary Artery Bypass Grafting [CABG] Versus CABG Alone in People With Moderate Ischemic Mitral Regurgitation, NCT00806988; Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation, NCT00807040)."},{"id":"3443e0eabad8","type":"article","url":"https://hartvaat.nl/2021/02/16/2021-acc-hf-behandeloptimalisatie-update-antwoorden-op-10-cruciale-vragen/","title":"2021 ACC HF-behandeloptimalisatie update: antwoorden op 10 cruciale vragen","title_en":"2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.022","source_url":"https://doi.org/10.1016/j.jacc.2020.11.022","authors":["Thomas M Maddox","James L Januzzi","Larry A Allen","Khadijah Breathett","Javed Butler","Leslie L Davis","Gregg C Fonarow","Nasrien E Ibrahim","JoAnn Lindenfeld","Frederick A Masoudi","Shweta R Motiwala","Estefania Oliveros","J Herbert Patterson","Mary Norine Walsh","Alan Wasserman","Clyde W Yancy","Quentin R Youmans"],"significance":9,"published":"2021-02-16","source_date":"2021-02-16","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"The 2021 ACC Expert Consensus update addressed 10 pivotal questions on heart failure treatment optimization, integrating evidence for SGLT2 inhibitors across the ejection fraction spectrum, vericiguat in recently decompensated HFrEF, and practical implementation of quadruple therapy.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC 2021 update van de HF-behandeloptimalisatie pathway met antwoorden op 10 cruciale vragen over SGLT2-remmers, vericiguat, en implementatie van quadruple therapie.","abstract_original":""},{"id":"9c497d90dd5d","type":"article","url":"https://hartvaat.nl/2021/02/16/2021-acc-consensus-same-day-ontslag-na-pci/","title":"2021 ACC consensus: same-day ontslag na PCI","title_en":"2021 ACC Expert Consensus Decision Pathway on Same-Day Discharge After Percutaneous Coronary Intervention: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.013","source_url":"https://doi.org/10.1016/j.jacc.2020.11.013","authors":["Sunil V Rao","Mladen I Vidovich","Ian C Gilchrist","Rajiv Gulati","J Antonio Gutierrez","Connie N Hess","Prashant Kaul","Sara C Martinez","Jennifer Rymer"],"significance":6,"published":"2021-02-16","source_date":"2021-02-16","image":"","kennis":[],"congress":"","summary_en":"This ACC expert consensus provided a structured decision pathway for same-day discharge after PCI, defining eligibility criteria and safety protocols for shortening the post-procedural hospitalization.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC 2021 expert consensus decision pathway over same-day ontslag na PCI.","abstract_original":""},{"id":"4776d1ba95ce","type":"article","url":"https://hartvaat.nl/2021/02/13/transdermaal-oestradiol-bij-prostaatkanker-langetermijn-cv-uitkomsten-lancet/","title":"Transdermaal oestradiol bij prostaatkanker: langetermijn CV-uitkomsten — Lancet","title_en":"Transdermal oestradiol for androgen suppression in prostate cancer: long-term cardiovascular outcomes from the randomised Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(21)00100-8","source_url":"https://doi.org/10.1016/S0140-6736(21)00100-8","authors":["Ruth E Langley","Duncan C Gilbert","Trinh Duong","Noel W Clarke","Matthew Nankivell","Stuart D Rosen","Stephen Mangar","Archie Macnair","Subramanian Kanaga Sundaram","Marc E Laniado","Sanjay Dixit","Sanjeev Madaan","Caroline Manetta","Alvan Pope","Christopher D Scrase","Stephen Mckay","Iqtedar A Muazzam","Gerald N Collins","Jane Worlding","Simon T Williams","Edgar Paez","Angus Robinson","Jonathan McFarlane","John V Deighan","John Marshall","Silvia Forcat","Melanie Weiss","Roger Kockelbergh","Abdulla Alhasso","Howard Kynaston","Mahesh Parmar"],"significance":6,"published":"2021-02-13","source_date":"2021-02-13","image":"","kennis":[],"congress":"","summary_en":"This Lancet long-term analysis showed that transdermal estradiol for androgen suppression in prostate cancer has favorable cardiovascular outcomes compared with LHRH agonists, relevant to the growing field of cardio-oncology.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet langetermijnanalyse van transdermaal oestradiol voor androgeen-suppressie bij prostaatkanker op cardiovasculaire uitkomsten.","abstract_original":"BACKGROUND: Androgen suppression is a central component of prostate cancer management but causes substantial long-term toxicity. Transdermal administration of oestradiol (tE2) circumvents first-pass hepatic metabolism and, therefore, should avoid the cardiovascular toxicity seen with oral oestrogen and the oestrogen-depletion effects seen with luteinising hormone releasing hormone agonists (LHRHa). We present long-term cardiovascular follow-up data from the Prostate Adenocarcinoma Transcutaneous Hormone (PATCH) trial programme. METHODS: PATCH is a seamless phase 2/3, randomised, multicentre trial programme at 52 study sites in the UK. Men with locally advanced or metastatic prostate cancer were randomly allocated (1:2 from August, 2007 then 1:1 from February, 2011) to either LHRHa according to local practice or tE2 patches (four 100 μg patches per 24 h, changed twice weekly, reducing to three patches twice weekly if castrate at 4 weeks [defined as testosterone ≤1·7 nmol/L]). Randomisation was done using a computer-based minimisation algorithm and was stratified by several factors, including disease stage, age, smoking status, and family history of cardiac disease. The primary outcome of this analysis was cardiovascular morbidity and mortality. Cardiovascular events, including heart failure, acute coronary syndrome, thromboembolic stroke, and other thromboembolic events, were confirmed using predefined criteria and source data. Sudden or unexpected deaths were attributed to a cardiovascular category if a confirmatory post-mortem report was available and as other relevant events if no post-mortem report was available. PATCH is registered with the ISRCTN registry, ISRCTN70406718; the study is ongoing and adaptive. FINDINGS: Between Aug 14, 2007, and July 30, 2019, 1694 men were randomly allocated either LHRHa (n=790) or tE2 patches (n=904). Overall, median follow-up was 3·9 (IQR 2·4-7·0) years. Respective castration rates at 1 month and 3 months were 65% and 93% among patients assigned LHRHa and 83% and 93% among those allocated tE2. 157 events from 145 men met predefined cardiovascular criteria, with a further ten sudden deaths with no post-mortem report (total 167 events in 153 men). 26 (2%) of 1694 patients had fatal cardiovascular events, 15 (2%) of 790 assigned LHRHa and 11 (1%) of 904 allocated tE2. The time to first cardiovascular event did not differ between treatments (hazard ratio 1·11, 95% CI 0·80-1·53; p=0·54 [including sudden deaths without post-mortem report]; 1·20, 0·86-1·68; p=0·29 [confirmed group only]). 30 (34%) of 89 cardiovascular events in patients assigned tE2 occurred more than 3 months after tE2 was stopped or changed to LHRHa. The most frequent adverse events were gynaecomastia (all grades), with 279 (38%) events in 730 patients who received LHRHa versus 690 (86%) in 807 patients who received tE2 (p<0·0001) and hot flushes (all grades) in 628 (86%) of those who received LHRHa versus 280 (35%) who received tE2 (p<0·0001). INTERPRETATION: Long-term data comparing tE2 patches with LHRHa show no evidence of a difference between treatments in cardiovascular mortality or morbidity. Oestrogens administered transdermally should be reconsidered for androgen suppression in the management of prostate cancer. FUNDING: Cancer Research UK, and Medical Research Council Clinical Trials Unit at University College London."},{"id":"45cff576b6a0","type":"article","url":"https://hartvaat.nl/2021/02/11/neprilysineremming-en-empagliflozine-bij-chronisch-hfref-emperor-reduced-interac/","title":"Neprilysineremming en empagliflozine bij chronisch HFrEF: EMPEROR-Reduced interactie","title_en":"Influence of neprilysin inhibition on the efficacy and safety of empagliflozin in patients with chronic heart failure and a reduced ejection fraction: the EMPEROR-Reduced trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa968","source_url":"https://doi.org/10.1093/eurheartj/ehaa968","authors":["Milton Packer","Stefan D Anker","Javed Butler","Gerasimos Filippatos","Joao Pedro Ferreira","Stuart J Pocock","Hans-Peter Brunner-La Rocca","Stefan Janssens","Hiroyuki Tsutsui","Jian Zhang","Martina Brueckmann","Waheed Jamal","Daniel Cotton","Tomoko Iwata","Janet Schnee","Faiez Zannad"],"significance":7,"published":"2021-02-11","source_date":"2021-02-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This EMPEROR-Reduced analysis showed that the benefit of empagliflozin is consistent regardless of whether patients are also taking sacubitril-valsartan, confirming that SGLT2 inhibitors provide additive benefit on top of ARNI therapy.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPEROR-Reduced analyse naar de interactie tussen neprilysineremming (ARNI-gebruik) en empagliflozine bij chronisch HFrEF.","abstract_original":"AIMS: We evaluated the influence of sacubitril/valsartan on the effects of sodium-glucose cotransporter 2 (SGLT2) inhibition with empagliflozin in patients with heart failure and a reduced ejection fraction. METHODS AND RESULTS: The EMPEROR-Reduced trial randomized 3730 patients with heart failure and an ejection fraction ≤40% to placebo or empagliflozin (10 mg/day), in addition to recommended treatment for heart failure, for a median of 16 months. A total of 727 patients (19.5%) received sacubitril/valsartan at baseline. Analysis of the effect of neprilysin inhibition was 1 of 12 pre-specified subgroups. Patients receiving a neprilysin inhibitor were particularly well-treated, as evidenced by lower systolic pressures, heart rates, N-terminal prohormone B-type natriuretic peptide, and greater use of cardiac devices (all P < 0.001) when compared with those not receiving sacubitril/valsartan. Nevertheless, when compared with placebo, empagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure in patients receiving or not receiving sacubitril/valsartan [hazard ratio 0.64 (95% CI 0.45-0.89), P = 0.009 and hazard ratio 0.77 (95% CI 0.66-0.90), P = 0.0008, respectively, interaction P = 0.31]. Empagliflozin slowed the rate of decline in estimated glomerular filtration rate by 1.92 ± 0.80 mL/min/1.73 m2/year in patients taking a neprilysin inhibitor (P = 0.016) and by 1.71 ± 0.35 mL/min/1.73 m2/year in patients not taking a neprilysin inhibitor (P < 0.0001), interaction P = 0.81. Combined inhibition of SGLT2 and neprilysin was well-tolerated. CONCLUSION: The effects on empagliflozin to reduce the risk of heart failure and renal events are not diminished in intensively treated patients who are receiving sacubitril/valsartan. Combined treatment with both SGLT2 and neprilysin inhibitors can be expected to yield substantial additional benefits."},{"id":"75c2d2e0a539","type":"article","url":"https://hartvaat.nl/2021/02/11/empagliflozine-en-inspanningsvermogen-bij-hfref-en-hfpef-emperial/","title":"Empagliflozine en inspanningsvermogen bij HFrEF en HFpEF: EMPERIAL","title_en":"Effect of empagliflozin on exercise ability and symptoms in heart failure patients with reduced and preserved ejection fraction, with and without type 2 diabetes.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","emperor-trials","step-hfpef","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa943","source_url":"https://doi.org/10.1093/eurheartj/ehaa943","authors":["William T Abraham","JoAnn Lindenfeld","Piotr Ponikowski","Piergiuseppe Agostoni","Javed Butler","Akshay S Desai","Gerasimos Filippatos","Jacek Gniot","Michael Fu","Lars Gullestad","Jonathan G Howlett","Stephen J Nicholls","Josep Redon","Isabelle Schenkenberger","José Silva-Cardoso","Stefan Störk","Jerzy Krzysztof Wranicz","Gianluigi Savarese","Martina Brueckmann","Waheed Jamal","Matias Nordaby","Barbara Peil","Ivana Ritter","Anastasia Ustyugova","Cordula Zeller","Afshin Salsali","Stefan D Anker"],"significance":7,"published":"2021-02-11","source_date":"2021-02-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"The EMPERIAL trials evaluated the effect of empagliflozin on exercise ability (6-minute walk distance) and symptoms in patients with both HFrEF and HFpEF, finding modest improvements in symptom burden but no significant change in exercise capacity.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPERIAL trial naar het effect van empagliflozine op inspanningsvermogen en symptomen bij HFrEF en HFpEF.","abstract_original":"AIMS: The EMPERIAL (Effect of EMPagliflozin on ExeRcise ability and HF symptoms In patients with chronic heArt faiLure) trials evaluated the effects of empagliflozin on exercise ability and patient-reported outcomes in heart failure (HF) with reduced and preserved ejection fraction (EF), with and without type 2 diabetes (T2D), reporting, for the first time, the effects of sodium-glucose co-transporter-2 inhibition in HF with preserved EF (HFpEF). METHODS AND RESULTS: HF patients with reduced EF (HFrEF) (≤40%, N = 312, EMPERIAL-Reduced) or preserved EF (>40%, N = 315, EMPERIAL-Preserved), with and without T2D, were randomized to empagliflozin 10 mg or placebo for 12 weeks. The primary endpoint was 6-minute walk test distance (6MWTD) change to Week 12. Key secondary endpoints included Kansas City Cardiomyopathy Questionnaire Total Symptom Score (KCCQ-TSS) and Chronic Heart Failure Questionnaire Self-Administered Standardized format (CHQ-SAS) dyspnoea score. 6MWTD median (95% confidence interval) differences, empagliflozin vs. placebo, at Week 12 were -4.0 m (-16.0, 6.0; P = 0.42) and 4.0 m (-5.0, 13.0; P = 0.37) in EMPERIAL-Reduced and EMPERIAL-Preserved, respectively. As the primary endpoint was non-significant, all secondary endpoints were considered exploratory. Changes in KCCQ-TSS and CHQ-SAS dyspnoea score were non-significant. Improvements with empagliflozin in exploratory pre-specified analyses of KCCQ-TSS responder rates, congestion score, and diuretic use in EMPERIAL-Reduced are hypothesis generating. Empagliflozin adverse events were consistent with those previously reported. CONCLUSION: The primary outcome for both trials was neutral. Empagliflozin was well tolerated in HF patients, with and without T2D, with a safety profile consistent with that previously reported in T2D. Hypothesis-generating improvements in exploratory analyses of secondary endpoints with empagliflozin in HFrEF were observed."},{"id":"93fc383ca3a0","type":"article","url":"https://hartvaat.nl/2021/02/11/spironolacton-en-cardiovasculaire-functie-bij-risico-op-hf-ehj/","title":"Spironolacton en cardiovasculaire functie bij risico op HF: EHJ","title_en":"The effect of spironolactone on cardiovascular function and markers of fibrosis in people at increased risk of developing heart failure: the heart 'OMics' in AGEing (HOMAGE) randomized clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","menopauze","roken","slaapapneu"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa758","source_url":"https://doi.org/10.1093/eurheartj/ehaa758","authors":["John G F Cleland","João Pedro Ferreira","Beatrice Mariottoni","Pierpaolo Pellicori","Joe Cuthbert","Job A J Verdonschot","Johannes Petutschnigg","Fozia Z Ahmed","Franco Cosmi","Hans-Peter Brunner La Rocca","Mamas A Mamas","Andrew L Clark","Frank Edelmann","Burkert Pieske","Javed Khan","Ken McDonald","Philippe Rouet","Jan A Staessen","Blerim Mujaj","Arantxa González","Javier Diez","Mark Hazebroek","Stephane Heymans","Roberto Latini","Stéphanie Grojean","Anne Pizard","Nicolas Girerd","Patrick Rossignol","Tim J Collier","Faiez Zannad"],"significance":6,"published":"2021-02-11","source_date":"2021-02-11","image":"","kennis":[],"congress":"","summary_en":"This study showed that spironolactone reduces fibrosis markers and improves cardiac function in people at increased risk of developing heart failure, supporting early MRA use for heart failure prevention.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van spironolacton op cardiovasculaire functie en fibrosemarkers bij personen met verhoogd HF-risico.","abstract_original":"AIMS: To investigate the effects of spironolactone on fibrosis and cardiac function in people at increased risk of developing heart failure. METHODS AND RESULTS: Randomized, open-label, blinded-endpoint trial comparing spironolactone (50 mg/day) or control for up to 9 months in people with, or at high risk of, coronary disease and raised plasma B-type natriuretic peptides. The primary endpoint was the interaction between baseline serum galectin-3 and changes in serum procollagen type-III N-terminal pro-peptide (PIIINP) in participants assigned to spironolactone or control. Procollagen type-I C-terminal pro-peptide (PICP) and collagen type-1 C-terminal telopeptide (CITP), reflecting synthesis and degradation of type-I collagen, were also measured. In 527 participants (median age 73 years, 26% women), changes in PIIINP were similar for spironolactone and control [mean difference (mdiff): -0.15; 95% confidence interval (CI) -0.44 to 0.15 μg/L; P = 0.32] but those receiving spironolactone had greater reductions in PICP (mdiff: -8.1; 95% CI -11.9 to -4.3 μg/L; P < 0.0001) and PICP/CITP ratio (mdiff: -2.9; 95% CI -4.3 to -1.5; <0.0001). No interactions with serum galectin were observed. Systolic blood pressure (mdiff: -10; 95% CI -13 to -7 mmHg; P < 0.0001), left atrial volume (mdiff: -1; 95% CI -2 to 0 mL/m2; P = 0.010), and NT-proBNP (mdiff: -57; 95% CI -81 to -33 ng/L; P < 0.0001) were reduced in those assigned spironolactone. CONCLUSIONS: Galectin-3 did not identify greater reductions in serum concentrations of collagen biomarkers in response to spironolactone. However, spironolactone may influence type-I collagen metabolism. Whether spironolactone can delay or prevent progression to symptomatic heart failure should be investigated."},{"id":"4cf278f51181","type":"article","url":"https://hartvaat.nl/2021/02/09/restrictieve-versus-liberale-transfusie-bij-acuut-mi-jama-reality/","title":"Restrictieve versus liberale transfusie bij acuut MI: JAMA REALITY","title_en":"Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.0135","source_url":"https://doi.org/10.1001/jama.2021.0135","authors":["Gregory Ducrocq","Jose R Gonzalez-Juanatey","Etienne Puymirat","Gilles Lemesle","Marine Cachanado","Isabelle Durand-Zaleski","Joan Albert Arnaiz","Manuel Martínez-Sellés","Johanne Silvain","Albert Ariza-Solé","Emile Ferrari","Gonzalo Calvo","Nicolas Danchin","Cristina Avendaño-Solá","Jerome Frenkiel","Alexandra Rousseau","Eric Vicaut","Tabassome Simon","Philippe Gabriel Steg"],"significance":7,"published":"2021-02-09","source_date":"2021-02-09","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This JAMA REALITY trial preliminary analysis compared restrictive versus liberal transfusion strategies in patients with acute MI and anemia, addressing the optimal hemoglobin threshold for transfusion in this high-risk population.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA REALITY trial die restrictief versus liberaal transfusiebeleid vergeleek bij patiënten met acuut MI. Transfusiestrategie bij ACS.","abstract_original":"IMPORTANCE: The optimal transfusion strategy in patients with acute myocardial infarction and anemia is unclear. OBJECTIVE: To determine whether a restrictive transfusion strategy would be clinically noninferior to a liberal strategy. DESIGN, SETTING, AND PARTICIPANTS: Open-label, noninferiority, randomized trial conducted in 35 hospitals in France and Spain including 668 patients with myocardial infarction and hemoglobin level between 7 and 10 g/dL. Enrollment could be considered at any time during the index admission for myocardial infarction. The first participant was enrolled in March 2016 and the last was enrolled in September 2019. The final 30-day follow-up was accrued in November 2019. INTERVENTIONS: Patients were randomly assigned to undergo a restrictive (transfusion triggered by hemoglobin ≤8; n = 342) or a liberal (transfusion triggered by hemoglobin ≤10 g/dL; n = 324) transfusion strategy. MAIN OUTCOMES AND MEASURES: The primary clinical outcome was major adverse cardiovascular events (MACE; composite of all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia) at 30 days. Noninferiority required that the upper bound of the 1-sided 97.5% CI for the relative risk of the primary outcome be less than 1.25. The secondary outcomes included the individual components of the primary outcome. RESULTS: Among 668 patients who were randomized, 666 patients (median [interquartile range] age, 77 [69-84] years; 281 [42.2%] women) completed the 30-day follow-up, including 342 in the restrictive transfusion group (122 [35.7%] received transfusion; 342 total units of packed red blood cells transfused) and 324 in the liberal transfusion group (323 [99.7%] received transfusion; 758 total units transfused). At 30 days, MACE occurred in 36 patients (11.0% [95% CI, 7.5%-14.6%]) in the restrictive group and in 45 patients (14.0% [95% CI, 10.0%-17.9%]) in the liberal group (difference, -3.0% [95% CI, -8.4% to 2.4%]). The relative risk of the primary outcome was 0.79 (1-sided 97.5% CI, 0.00-1.19), meeting the prespecified noninferiority criterion. In the restrictive vs liberal group, all-cause death occurred in 5.6% vs 7.7% of patients, recurrent myocardial infarction occurred in 2.1% vs 3.1%, emergency revascularization prompted by ischemia occurred in 1.5% vs 1.9%, and nonfatal ischemic stroke occurred in 0.6% of patients in both groups. CONCLUSIONS AND RELEVANCE: Among patients with acute myocardial infarction and anemia, a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of MACE after 30 days. However, the CI included what may be a clinically important harm. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02648113."},{"id":"26dbf2ca833a","type":"article","url":"https://hartvaat.nl/2021/02/09/hiit-matig-continu-of-richtlijnadvies-en-piek-vo2-bij-hfref-jama-smartex-hf/","title":"HIIT, matig continu of richtlijnadvies en piek-VO2 bij HFrEF: JAMA SMARTEX-HF","title_en":"Effect of High-Intensity Interval Training, Moderate Continuous Training, or Guideline-Based Physical Activity Advice on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.26812","source_url":"https://doi.org/10.1001/jama.2020.26812","authors":["Stephan Mueller","Ephraim B Winzer","André Duvinage","Andreas B Gevaert","Frank Edelmann","Bernhard Haller","Elisabeth Pieske-Kraigher","Paul Beckers","Anna Bobenko","Jennifer Hommel","Caroline M Van de Heyning","Katrin Esefeld","Pia von Korn","Jeffrey W Christle","Mark J Haykowsky","Axel Linke","Ulrik Wisløff","Volker Adams","Burkert Pieske","Emeline M van Craenenbroeck","Martin Halle"],"significance":8,"published":"2021-02-09","source_date":"2021-02-09","image":"","kennis":[],"congress":"","summary_en":"The SMARTEX-HF trial showed that high-intensity interval training was not superior to moderate continuous training for improving peak VO2 in patients with HFrEF. The result supported moderate exercise as safe and effective, without an incremental benefit from more intense training in heart failure.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA SMARTEX-HF trial die HIIT, matig continue training en richtlijnadvies vergeleek op piek-VO2 bij HFrEF. HIIT niet superieur aan matig — maar beide beter dan advies.","abstract_original":"IMPORTANCE: Endurance exercise is effective in improving peak oxygen consumption (peak V̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects. OBJECTIVE: To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V̇o2 in patients with HFpEF. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded. INTERVENTIONS: Patients were randomly assigned (1:1:1; n = 60 per group) to high-intensity interval training (3 × 38 minutes/week), moderate continuous training (5 × 40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise). MAIN OUTCOMES AND MEASURES: Primary end point was change in peak V̇o2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months. RESULTS: Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak V̇o2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs -0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs -0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, -0.4 [95% CI, -1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%). CONCLUSIONS AND RELEVANCE: Among patients with HFpEF, there was no statistically significant difference in change in peak V̇o2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02078947."},{"id":"583b74da1828","type":"article","url":"https://hartvaat.nl/2021/02/09/10-jaarsmortaliteit-na-pci-of-cabg-bij-totale-coronairocclusie/","title":"10-jaarsmortaliteit na PCI of CABG bij totale coronairocclusie","title_en":"Mortality 10 Years After Percutaneous or Surgical Revascularization in Patients With Total Coronary Artery Occlusions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-bypass","perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.055","source_url":"https://doi.org/10.1016/j.jacc.2020.11.055","authors":["Hideyuki Kawashima","Kuniaki Takahashi","Masafumi Ono","Hironori Hara","Rutao Wang","Chao Gao","Faisal Sharif","Michael J Mack","David R Holmes","Marie-Claude Morice","Stuart J Head","Arie Pieter Kappetein","Daniel J F M Thuijs","Milan Milojevic","Thilo Noack","Friedrich-Wilhelm Mohr","Piroze M Davierwala","Patrick W Serruys","Yoshinobu Onuma"],"significance":6,"published":"2021-02-09","source_date":"2021-02-09","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This 10-year mortality comparison of PCI versus CABG in patients with total coronary occlusions provided the longest follow-up data for revascularization strategy selection in this challenging anatomy.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van 10-jaarsmortaliteit na percutane of chirurgische revascularisatie bij patiënten met totale coronairocclusies.","abstract_original":"BACKGROUND: The long-term clinical benefit after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with total occlusions (TOs) and complex coronary artery disease has not yet been clarified. OBJECTIVES: The objective of this analysis was to assess 10-year all-cause mortality in patients with TOs undergoing PCI or CABG. METHODS: This is a subanalysis of patients with at least 1 TO in the SYNTAXES (Synergy Between PCI With Taxus and Cardiac Surgery Extended Survival) study, which investigated 10-year all-cause mortality in the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) trial, beyond its original 5-year follow-up. Patients with TOs were further stratified according to the status of TO recanalization or revascularization. RESULTS: Of 1,800 randomized patients to the PCI or CABG arm, 460 patients had at least 1 lesion of TO. In patients with TOs, the status of TO recanalization or revascularization was not associated with 10-year all-cause mortality, irrespective of the assigned treatment (PCI arm: 29.9% vs. 29.4%; adjusted hazard ratio [HR]: 0.992; 95% confidence interval [CI]: 0.474 to 2.075; p = 0.982; and CABG arm: 28.0% vs. 21.4%; adjusted HR: 0.656; 95% CI: 0.281 to 1.533; p = 0.330). When TOs existed in left main and/or left anterior descending artery, the status of TO recanalization or revascularization did not have an impact on the mortality (34.5% vs. 26.9%; adjusted HR: 0.896; 95% CI: 0.314 to 2.555; p = 0.837). CONCLUSIONS: At 10-year follow-up, the status of TO recanalization or revascularization did not affect mortality, irrespective of the assigned treatment and location of TOs. The present study might support contemporary practice among high-volume chronic TO-PCI centers where recanalization is primarily offered to patients for the management of angina refractory to medical therapy when myocardial viability is confirmed. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)."},{"id":"9ac9b0c18b2e","type":"article","url":"https://hartvaat.nl/2021/02/09/2020-acc-consensus-anticoagulatie-en-antiplaatjestherapie-bij-af-of-vte/","title":"2020 ACC consensus: anticoagulatie en antiplaatjestherapie bij AF of VTE","title_en":"2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia","anticoagulatie-kwetsbare-ouderen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.09.011","source_url":"https://doi.org/10.1016/j.jacc.2020.09.011","authors":["Dharam J Kumbhani","Christopher P Cannon","Craig J Beavers","Deepak L Bhatt","Adam Cuker","Ty J Gluckman","Joseph E Marine","Roxana Mehran","Steven R Messe","Nimesh S Patel","Benjamin E Peterson","Kenneth Rosenfield","Sarah A Spinler","Vinod H Thourani"],"significance":8,"published":"2021-02-09","source_date":"2021-02-09","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The 2020 ACC Expert Consensus provided a comprehensive decision pathway for managing antithrombotic therapy in patients with atrial fibrillation or venous thromboembolism who require antiplatelet agents, with practical algorithms for diverse clinical scenarios.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC 2020 expert consensus decision pathway voor antistollings- en antiplaatjestherapie bij AF of VTE.","abstract_original":""},{"id":"6507c3492a78","type":"article","url":"https://hartvaat.nl/2021/02/09/finerenon-en-cardiovasculaire-uitkomsten-bij-ckd-met-diabetes-type-2-fidelio-dkd/","title":"Finerenon en cardiovasculaire uitkomsten bij CKD met diabetes type 2: FIDELIO-DKD","title_en":"Finerenone and Cardiovascular Outcomes in Patients With Chronic Kidney Disease and Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anemie-ckd","cardio-renaal-metabool","cardiorenal-behandelstrategie","chronische-nierziekte","dapagliflozine","diabetes-en-hart","diabetes-type-2","fidelio-dkd","fidelity","figaro-dkd","finerenon","finerenon-hartfalen-nierziekte","ijzertekort","menopauze","mra-aldosteronantagonisten","roken","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.051898","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.051898","authors":["Gerasimos Filippatos","Stefan D Anker","Rajiv Agarwal","Bertram Pitt","Luis M Ruilope","Peter Rossing","Peter Kolkhof","Patrick Schloemer","Ingo Tornus","Amer Joseph","George L Bakris"],"significance":10,"published":"2021-02-09","source_date":"2021-02-09","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"The FIDELIO-DKD trial demonstrated that finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly reduced both kidney failure progression and cardiovascular events in patients with chronic kidney disease and type 2 diabetes. This established finerenone as a new therapeutic pillar in cardiorenal protection alongside SGLT2 inhibitors and GLP-1 receptor agonists.","created":"2026-07-03T10:29:03Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark FIDELIO-DKD trial die aantoonde dat finerenon (niet-steroïdale MRA) cardiovasculaire events significant vermindert bij CKD met diabetes type 2. Naast SGLT2-remmers en GLP-1-agonisten de derde pijler voor cardiorenal-metabole bescherming.","abstract_original":"BACKGROUND: The FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) evaluated the effect of the nonsteroidal, selective mineralocorticoid receptor antagonist finerenone on kidney and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes with optimized renin-angiotensin system blockade. Compared with placebo, finerenone reduced the composite kidney and cardiovascular outcomes. We report the effect of finerenone on individual cardiovascular outcomes and in patients with and without history of atherosclerotic cardiovascular disease (CVD). METHODS: This randomized, double-blind, placebo-controlled trial included patients with type 2 diabetes and urine albumin-to-creatinine ratio 30 to 5000 mg/g and an estimated glomerular filtration rate ≥25 to <75 mL per min per 1.73 m2, treated with optimized renin-angiotensin system blockade. Patients with a history of heart failure with reduced ejection fraction were excluded. Patients were randomized 1:1 to receive finerenone or placebo. The composite cardiovascular outcome included time to cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. Prespecified cardiovascular analyses included analyses of the components of this composite and outcomes according to CVD history at baseline. RESULTS: Between September 2015 and June 2018, 13 911 patients were screened and 5674 were randomized; 45.9% of patients had CVD at baseline. Over a median follow-up of 2.6 years (interquartile range, 2.0-3.4 years), finerenone reduced the risk of the composite cardiovascular outcome compared with placebo (hazard ratio, 0.86 [95% CI, 0.75-0.99]; P=0.034), with no significant interaction between patients with and without CVD (hazard ratio, 0.85 [95% CI, 0.71-1.01] in patients with a history of CVD; hazard ratio, 0.86 [95% CI, 0.68-1.08] in patients without a history of CVD; P value for interaction, 0.85). The incidence of treatment-emergent adverse events was similar between treatment arms, with a low incidence of hyperkalemia-related permanent treatment discontinuation (2.3% with finerenone versus 0.8% with placebo in patients with CVD and 2.2% with finerenone versus 1.0% with placebo in patients without CVD). CONCLUSIONS: Among patients with chronic kidney disease and type 2 diabetes, finerenone reduced incidence of the composite cardiovascular outcome, with no evidence of differences in treatment effect based on preexisting CVD status. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02540993."},{"id":"9c1cf6317423","type":"article","url":"https://hartvaat.nl/2021/02/09/omega-3-vetzuren-bij-oudere-mi-patienten-omemi-gerandomiseerde-trial/","title":"Omega-3 vetzuren bij oudere MI-patiënten: OMEMI gerandomiseerde trial","title_en":"Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction: A Randomized, Controlled Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.052209","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.052209","authors":["Are Annesønn Kalstad","Peder Langeland Myhre","Kristian Laake","Sjur Hansen Tveit","Erik Berg Schmidt","Paal Smith","Dennis Winston Trygve Nilsen","Arnljot Tveit","Morten Wang Fagerland","Svein Solheim","Ingebjørg Seljeflot","Harald Arnesen"],"significance":7,"published":"2021-02-09","source_date":"2021-02-09","image":"","kennis":[],"congress":"","summary_en":"The OMEMI randomized trial found that omega-3 fatty acid supplementation did not reduce cardiovascular events in elderly patients after myocardial infarction, consistent with the negative findings of other recent omega-3 trials in secondary prevention.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"OMEMI gerandomiseerde trial van omega-3 vetzuren bij oudere patiënten na MI. Negatief — geen voordeel bij ouderen.","abstract_original":"BACKGROUND: High intake of marine n-3 polyunsaturated fatty acids (PUFA) has been associated with reduced risk of cardiovascular events; however, this has not been confirmed in patients with a recent acute myocardial infarction (AMI). Elderly patients are at particularly increased cardiovascular risk after myocardial infarction, but few trials address this group specifically. Omega-3 fatty acids hold the potential to reduce cardiovascular events with limited adverse effects in this vulnerable group. The hypothesis was that daily addition of 1.8g n-3 PUFA to standard of care secondary prophylaxis in elderly patients who have survived an AMI would reduce the risk of subsequent cardiovascular events during 2 years follow-up. METHODS: The OMEMI trial (Omega-3 Fatty acids in Elderly with Myocardial Infarction) is an investigator-initiated, multicenter, randomized clinical trial adding 1.8 g n-3 PUFA (930 mg eicosapentaenoic acid and 660 mg docosohexaenoic acid) versus placebo (corn oil) daily to standard of care in patients aged 70 to 82 years with recent (2-8 weeks) AMI. The primary endpoint was a composite of nonfatal AMI, unscheduled revascularization, stroke, all-cause death, heart failure hospitalization after 2 years. The secondary outcome was new atrial fibrillation. The safety outcome was major bleeding. Serum fatty acids were measured as biomarkers of adherence. RESULTS: In total, 1027 patients were randomized. Follow-up data were available for 1014 patients who were included in the intention-to-treat analysis. Mean±SD age was 75±3.6 years, 294 (29%) were female, and mean triglycerides were 111.4±61.9 mg/dL. The primary endpoint occurred in 108 (21.4%) patients on n-3 PUFA versus 102 (20.0%) on placebo (hazard ratio, 1.08 [95% CI, 0.82-1.41]; P=0.60). The secondary endpoint occurred in 28 (7.2%) patients on n-3 PUFA versus 15 (4.0%) on placebo (1.84 [0.98-3.45]; P=0.06). Median changes in eicosapentaenoic acid and docosahexaenoic acid were +87% and +16% for n-3 PUFA versus -13% and -8% for placebo. Major bleeding occurred in 54 (10.7%) and 56 (11.0%) in the n-3 PUFA and placebo groups, respectively (P=0.87). Similar results were found in per-protocol analysis (n=893). CONCLUSIONS: We could not detect reduction in clinical events in our elderly patients with recent AMI who were treated with 1.8 g n-3 PUFAs daily for 2 years. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01841944."},{"id":"86d5325d4229","type":"article","url":"https://hartvaat.nl/2021/02/09/empagliflozine-en-lv-volumes-bij-diabetes-prediabetes-met-hfref-sugar-dm-hf/","title":"Empagliflozine en LV-volumes bij diabetes/prediabetes met HFrEF: SUGAR-DM-HF","title_en":"Effect of Empagliflozin on Left Ventricular Volumes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure With Reduced Ejection Fraction (SUGAR-DM-HF).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.052186","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.052186","authors":["Matthew M Y Lee","Katriona J M Brooksbank","Kirsty Wetherall","Kenneth Mangion","Giles Roditi","Ross T Campbell","Colin Berry","Victor Chong","Liz Coyle","Kieran F Docherty","John G Dreisbach","Catherine Labinjoh","Ninian N Lang","Vera Lennie","Alex McConnachie","Clare L Murphy","Colin J Petrie","John R Petrie","Iain A Speirits","Steven Sourbron","Paul Welsh","Rosemary Woodward","Aleksandra Radjenovic","Patrick B Mark","John J V McMurray","Pardeep S Jhund","Mark C Petrie","Naveed Sattar"],"significance":7,"published":"2021-02-09","source_date":"2021-02-09","image":"","kennis":[],"congress":"","summary_en":"The SUGAR-DM-HF trial demonstrated that empagliflozin reduces left ventricular end-diastolic and end-systolic volumes in patients with diabetes or prediabetes and HFrEF, providing evidence for reverse remodeling with SGLT2 inhibition.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SUGAR-DM-HF trial die het effect van empagliflozine op LV-volumes onderzocht bij patiënten met diabetes/prediabetes en HFrEF.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 inhibitors reduce the risk of heart failure hospitalization and cardiovascular death in patients with heart failure and reduced ejection fraction (HFrEF). However, their effects on cardiac structure and function in HFrEF are uncertain. METHODS: We designed a multicenter, randomized, double-blind, placebo-controlled trial (the SUGAR-DM-HF trial [Studies of Empagliflozin and Its Cardiovascular, Renal and Metabolic Effects in Patients With Diabetes Mellitus, or Prediabetes, and Heart Failure]) to investigate the cardiac effects of empagliflozin in patients in New York Heart Association functional class II to IV with a left ventricular (LV) ejection fraction ≤40% and type 2 diabetes or prediabetes. Patients were randomly assigned 1:1 to empagliflozin 10 mg once daily or placebo, stratified by age (<65 and ≥65 years) and glycemic status (diabetes or prediabetes). The coprimary outcomes were change from baseline to 36 weeks in LV end-systolic volume indexed to body surface area and LV global longitudinal strain both measured using cardiovascular magnetic resonance. Secondary efficacy outcomes included other cardiovascular magnetic resonance measures (LV end-diastolic volume index, LV ejection fraction), diuretic intensification, symptoms (Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, B-lines on lung ultrasound, and biomarkers (including N-terminal pro-B-type natriuretic peptide). RESULTS: From April 2018 to August 2019, 105 patients were randomly assigned: mean age 68.7 (SD, 11.1) years, 77 (73.3%) male, 82 (78.1%) diabetes and 23 (21.9%) prediabetes, mean LV ejection fraction 32.5% (9.8%), and 81 (77.1%) New York Heart Association II and 24 (22.9%) New York Heart Association III. Patients received standard treatment for HFrEF. In comparison with placebo, empagliflozin reduced LV end-systolic volume index by 6.0 (95% CI, -10.8 to -1.2) mL/m2 (P=0.015). There was no difference in LV global longitudinal strain. Empagliflozin reduced LV end-diastolic volume index by 8.2 (95% CI, -13.7 to -2.6) mL/m2 (P=0.0042) and reduced N-terminal pro-B-type natriuretic peptide by 28% (2%-47%), P=0.038. There were no between-group differences in other cardiovascular magnetic resonance measures, diuretic intensification, Kansas City Cardiomyopathy Questionnaire Total Symptom Score, 6-minute walk distance, or B-lines. CONCLUSIONS: The sodium-glucose cotransporter 2 inhibitor empagliflozin reduced LV volumes in patients with HFrEF and type 2 diabetes or prediabetes. Favorable reverse LV remodeling may be a mechanism by which sodium-glucose cotransporter 2 inhibitors reduce heart failure hospitalization and mortality in HFrEF. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03485092."},{"id":"0114720b0e72","type":"article","url":"https://hartvaat.nl/2021/02/05/laa-isolatie-tijdens-af-ablatie-geactualiseerde-meta-analyse/","title":"LAA-isolatie tijdens AF-ablatie: geactualiseerde meta-analyse","title_en":"Efficacy and safety of left atrial appendage electrical isolation during catheter ablation of atrial fibrillation: an updated 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/euaa266","source_url":"https://doi.org/10.1093/europace/euaa266","authors":["Jorge Romero","Mohamed Gabr","Kavisha Patel","David Briceno","Juan Carlos Diaz","Isabella Alviz","Chintan Trivedi","Sanghamitra Mohanty","Dalvert Polanco","Domenico Giovanni Della Rocca","Dhanunjaya Lakkireddy","Andrea Natale","Luigi Di Biase"],"significance":6,"published":"2021-02-05","source_date":"2021-02-05","image":"","kennis":[],"congress":"","summary_en":"This updated meta-analysis of left atrial appendage electrical isolation during AF ablation confirmed improved freedom from arrhythmia recurrence with LAAEI, supporting this technique as an adjunctive strategy in non-paroxysmal AF.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geactualiseerde meta-analyse naar werkzaamheid en veiligheid van linker-hartoorisolatie tijdens katheterablatie voor AF.","abstract_original":"AIMS: Left atrial appendage electrical isolation (LAAEI) has been shown to improve freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal atrial fibrillation (AF). The aim of this study is to investigate the long-term efficacy and safety outcomes of LAAEI in patients with non-paroxysmal AF undergoing catheter ablation. METHODS AND RESULTS: A systematic review of Medline, Cochrane, and Embase was performed for clinical studies evaluating the benefit of LAAEI in non-paroxysmal AF. Nine studies with a total of 2336 patients were included (mean age: 65 ± 9 years, 63% male). All studies included patients with persistent AF, long-standing persistent AF, or both. At a mean follow-up of 40.5 months, patients who underwent LAAEI had significantly higher freedom from all-atrial arrhythmia recurrence than patients who underwent standard ablation alone [69.3% vs. 46.4%; risk ratio (RR) 0.54; 95% confidence interval (CI) 0.42-0.69; P < 0.0001]. A 46% relative risk reduction and 22.9% absolute risk reduction in atrial-arrhythmia recurrence was noted with LAAEI. Rates of cerebral thromboembolism were not significantly different between the two groups (LAAEI 3% vs. standard ablation 1.6%, respectively; RR 1.76; 95% CI 0.61-5.04; P = 0.29). Furthermore, there was no significant difference in the acute procedural complication rates between the two groups (LAAEI 4% vs. standard ablation 3%, respectively; RR 1.29; 95% CI 0.83-2.02; P = 0.26). CONCLUSION: At long-term follow-up, LAAEI led to a significantly higher improvement in freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal AF, when compared to standard ablation alone. Importantly, this benefit was achieved without an increased risk of acute procedural complications or cerebral thromboembolic events."},{"id":"25848998f711","type":"article","url":"https://hartvaat.nl/2021/02/05/slokdarmbescherming-met-temperatuurcontroleren-bij-af-ablatie-impact/","title":"Slokdarmbescherming met temperatuurcontroleren bij AF-ablatie: IMPACT","title_en":"Randomized comparison of oesophageal protection with a temperature control device: results of the IMPACT 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/euaa276","source_url":"https://doi.org/10.1093/europace/euaa276","authors":["Lisa W M Leung","Abhay Bajpai","Zia Zuberi","Anthony Li","Mark Norman","Riyaz A Kaba","Zaki Akhtar","Banu Evranos","Hanney Gonna","Idris Harding","Manav Sohal","Nawaf Al-Subaie","John Louis-Auguste","Jamal Hayat","Mark M Gallagher"],"significance":5,"published":"2021-02-05","source_date":"2021-02-05","image":"","kennis":[],"congress":"","summary_en":"The IMPACT randomized trial evaluated an esophageal temperature control device during AF ablation, testing active esophageal protection as a strategy to prevent thermal injury during posterior wall ablation.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IMPACT gerandomiseerde trial naar slokdarmbescherming met een temperatuurcontrolerend device bij AF-ablatie.","abstract_original":"AIMS: Thermal injury to the oesophagus is an important cause of life-threatening complication after ablation for atrial fibrillation (AF). Thermal protection of the oesophageal lumen by infusing cold liquid reduces thermal injury to a limited extent. We tested the ability of a more powerful method of oesophageal temperature control to reduce the incidence of thermal injury. METHODS AND RESULTS: A single-centre, prospective, double-blinded randomized trial was used to investigate the ability of the ensoETM device to protect the oesophagus from thermal injury. This device was compared in a 1:1 randomization with a control group of standard practice utilizing a single-point temperature probe. In the protected group, the device maintained the luminal temperature at 4°C during radiofrequency (RF) ablation for AF under general anaesthesia. Endoscopic examination was performed at 7 days post-ablation and oesophageal injury was scored. The patient and the endoscopist were blinded to the randomization. We recruited 188 patients, of whom 120 underwent endoscopy. Thermal injury to the mucosa was significantly more common in the control group than in those receiving oesophageal protection (12/60 vs. 2/60; P = 0.008), with a trend toward reduction in gastroparesis (6/60 vs. 2/60, P = 0.27). There was no difference between groups in the duration of RF or in the force applied (P value range= 0.2-0.9). Procedure duration and fluoroscopy duration were similar (P = 0.97, P = 0.91, respectively). CONCLUSION: Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared with standard care. This method of oesophageal protection is safe and does not compromise the efficacy or efficiency of the ablation procedure."},{"id":"c95caa8de638","type":"article","url":"https://hartvaat.nl/2021/02/02/dalend-hemoglobine-en-prognose-bij-acs-hospitalisatie/","title":"Dalend hemoglobine en prognose bij ACS-hospitalisatie","title_en":"Prognostic Implications of Declining Hemoglobin Content in Patients Hospitalized With Acute Coronary Syndromes.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.046","source_url":"https://doi.org/10.1016/j.jacc.2020.11.046","authors":["Sergio Leonardi","Felice Gragnano","Greta Carrara","Giuseppe Gargiulo","Enrico Frigoli","Pascal Vranckx","Dario Di Maio","Vanessa Spedicato","Emanuele Monda","Luigi Fimiani","Vincenzo Fioretti","Fabrizio Esposito","Marisa Avvedimento","Fabio Magliulo","Attilio Leone","Salvatore Chianese","Michele Franzese","Martina Scalise","Alessandra Schiavo","Paolo Mazzone","Giovanni Esposito","Giuseppe Andò","Paolo Calabrò","Stephan Windecker","Marco Valgimigli"],"significance":5,"published":"2021-02-02","source_date":"2021-02-02","image":"","kennis":[],"congress":"","summary_en":"This study showed that hemoglobin decline during ACS hospitalization, even without overt bleeding, independently predicts worse outcomes, supporting hemoglobin monitoring as a prognostic tool beyond clinical bleeding events.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prognostische implicaties van dalend hemoglobinegehalte bij patiënten gehospitaliseerd met ACS.","abstract_original":"BACKGROUND: Contemporary definitions of bleeding endpoints are restricted mostly to clinically overt events. Whether hemoglobin drop per se, with or without overt bleeding, adversely affects the prognosis of patients with acute coronary syndrome (ACS) remains unclear. OBJECTIVES: The aim of this study was to examine in the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial the incidence, predictors, and prognostic implications of in-hospital hemoglobin drop in patients with ACS managed invasively stratified by the presence of in-hospital bleeding. METHODS: Patients were categorized by the presence and amount of in-hospital hemoglobin drop on the basis of baseline and nadir hemoglobin values and further stratified by the occurrence of adjudicated in-hospital bleeding. Hemoglobin drop was defined as minimal (<3 g/dl), minor (≥3 and <5 g/dl), or major (≥5 g/dl). Using multivariate Cox regression, we modeled the association between hemoglobin drop and mortality in patients with and without overt bleeding. RESULTS: Among 7,781 patients alive 24 h after randomization with available hemoglobin data, 6,504 patients (83.6%) had hemoglobin drop, of whom 5,756 (88.5%) did not have overt bleeding and 748 (11.5%) had overt bleeding. Among patients without overt bleeding, minor (hazard ratio [HR]: 2.37; 95% confidence interval [CI]: 1.32 to 4.24; p = 0.004) and major (HR: 2.58; 95% CI: 0.98 to 6.78; p = 0.054) hemoglobin drop were independently associated with higher 1-year mortality. Among patients with overt bleeding, the association of minor and major hemoglobin drop with 1-year mortality was directionally similar but had wider CIs (minor: HR: 3.53 [95% CI: 1.06 to 11.79]; major: HR: 13.32 [95% CI: 3.01 to 58.98]). CONCLUSIONS: Among patients with ACS managed invasively, in-hospital hemoglobin drop ≥3 g/dl, even in the absence of overt bleeding, is common and is independently associated with increased risk for 1-year mortality. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox; NCT01433627)."},{"id":"b7e54c019252","type":"article","url":"https://hartvaat.nl/2021/02/01/zelfzorginterventie-en-90-daags-uitkomsten-bij-acuut-hf-na-seh-ontslag-jama-card/","title":"Zelfzorginterventie en 90-daags uitkomsten bij acuut HF na SEH-ontslag: JAMA Cardiology","title_en":"Effect of a Self-care Intervention on 90-Day Outcomes in Patients With Acute Heart Failure Discharged From the Emergency Department: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["answer-hf","dapa-hf","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.5763","source_url":"https://doi.org/10.1001/jamacardio.2020.5763","authors":["Sean P Collins","Dandan Liu","Cathy A Jenkins","Alan B Storrow","Phillip D Levy","Peter S Pang","Anna Marie Chang","Douglas Char","Deborah J Diercks","Gregory J Fermann","Jin H Han","Brian Hiestand","Christopher Hogan","Christina J Kampe","Yosef Khan","Sangil Lee","JoAnn Lindenfeld","Jennifer Martindale","Candace D McNaughton","Karen F Miller","Carolyn Miller-Reilly","Kelly Moser","W Frank Peacock","Chad Robichaux","Russell Rothman","Jon Schrock","Wesley H Self","Adam J Singer","Sarah A Sterling","Michael J Ward","Cheryl Walsh","Javed Butler"],"significance":6,"published":"2021-02-01","source_date":"2021-02-01","image":"","kennis":[],"congress":"","summary_en":"This trial of a self-care intervention for patients with acute heart failure discharged from the emergency department showed improved 90-day outcomes, addressing the underserved population of non-hospitalized AHF patients.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology trial van een zelfzorginterventie op 90-daags uitkomsten bij patiënten met acuut HF ontslagen van de SEH.","abstract_original":"IMPORTANCE: Up to 20% of patients who present to the emergency department (ED) with acute heart failure (AHF) are discharged without hospitalization. Compared with rates in hospitalized patients, readmission and mortality are worse for ED patients. OBJECTIVE: To assess the impact of a self-care intervention on 90-day outcomes in patients with AHF who are discharged from the ED. DESIGN, SETTING, AND PARTICIPANTS: Get With the Guidelines in Emergency Department Patients With Heart Failure was an unblinded, parallel-group, multicenter randomized trial. Patients were randomized 1:1 to usual care vs a tailored self-care intervention. Patients with AHF discharged after ED-based management at 15 geographically diverse EDs were included. The trial was conducted from October 28, 2015, to September 5, 2019. INTERVENTIONS: Home visit within 7 days of discharge and twice-monthly telephone-based self-care coaching for 3 months. MAIN OUTCOMES AND MEASURES: The primary outcome was a global rank of cardiovascular death, HF-related events (unscheduled clinic visit due to HF, ED revisit, or hospitalization), and changes in the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) summary score (SS) at 90 days. Key secondary outcomes included the global rank outcome at 30 days and changes in the KCCQ-12 SS score at 30 and 90 days. Intention-to-treat analysis was performed for the primary, secondary, and safety outcomes. Per-protocol analysis was conducted including patients who completed a home visit and had scheduled outpatient follow-up in the intervention arm. RESULTS: Owing to slow enrollment, 479 of a planned 700 patients were randomized: 235 to the intervention arm and 244 to the usual care arm. The median age was 63.0 years (interquartile range, 54.7-70.2), 302 patients (63%) were African American, 305 patients (64%) were men, and 178 patients (37%) had a previous ejection fraction greater than 50%. There was no significant difference in the primary outcome between patients in the intervention vs usual care arm (hazard ratio [HR], 0.89; 95% CI, 0.73-1.10; P = .28). At day 30, patients in the intervention arm had significantly better global rank (HR, 0.80; 95% CI, 0.64-0.99; P = .04) and a 5.5-point higher KCCQ-12 SS (95% CI, 1.3-9.7; P = .01), while at day 90, the KCCQ-12 SS was 2.7 points higher (95% CI, -1.9 to 7.2; P = .25). CONCLUSIONS AND RELEVANCE: The self-care intervention did not improve the primary global rank outcome at 90 days in this trial. However, benefit was observed in the global rank and KCCQ-12 SS at 30 days, suggesting that an early benefit of a tailored self-care program initiated at an ED visit for AHF was not sustained through 90 days. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02519283."},{"id":"35c7c926cbdf","type":"article","url":"https://hartvaat.nl/2021/02/01/sglt2-remmers-en-cv-renale-uitkomsten-bij-diabetes-type-2-jama-cardiology-meta-a/","title":"SGLT2-remmers en CV/renale uitkomsten bij diabetes type 2: JAMA Cardiology meta-analyse","title_en":"Association of SGLT2 Inhibitors With Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes: A Meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["canagliflozine","diabetes-type-2","sglt2-remmers"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.4511","source_url":"https://doi.org/10.1001/jamacardio.2020.4511","authors":["Darren K McGuire","Weichung J Shih","Francesco Cosentino","Bernard Charbonnel","David Z I Cherney","Samuel Dagogo-Jack","Richard Pratley","Michelle Greenberg","Shuai Wang","Susan Huyck","Ira Gantz","Steven G Terra","Urszula Masiukiewicz","Christopher P Cannon"],"significance":8,"published":"2021-02-01","source_date":"2021-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis updated the evidence on SGLT2 inhibitor cardiovascular and kidney outcomes in type 2 diabetes, confirming class-consistent reductions in heart failure hospitalization, cardiovascular death, and kidney disease progression across all available agents.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology meta-analyse van SGLT2-remmers op cardiovasculaire en renale uitkomsten bij diabetes type 2. Geactualiseerde klasse-effectanalyse.","abstract_original":"IMPORTANCE: Sodium-glucose cotransporter 2 (SGLT2) inhibitors favorably affect cardiovascular (CV) and kidney outcomes; however, the consistency of outcomes across the class remains uncertain. OBJECTIVE: To perform meta-analyses that assess the CV and kidney outcomes of all 4 available SGLT2 inhibitors in patients with type 2 diabetes. DATA SOURCES: A systematic literature search was conducted in PubMed from January 1, 2015, to January 31, 2020. STUDY SELECTION: One hundred forty-five records were initially identified; 137 were excluded because of study design or topic of interest. As a result, a total of 6 randomized, placebo-controlled CV and kidney outcomes trials of SGLT2 inhibitors in patients with type 2 diabetes were identified, with contributory data from 9 publications. All analyses were conducted on the total patient population of these trials. DATA EXTRACTION AND SYNTHESIS: Standardized data search and abstraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement. Data were analyzed using a fixed-effect model. MAIN OUTCOMES AND MEASURES: Outcomes included time to the first event of (1) the composite of major adverse CV events of myocardial infarction, stroke, or CV death, and each component, (2) the composite of hospitalization for heart failure (HHF) or CV death (HHF/CV death) and each component, and (3) kidney composite outcomes. For outcomes in the overall trial populations and in selected subgroups, hazard ratios (HRs) and 95% CIs were pooled and meta-analyzed across trials. RESULTS: Data from 6 trials comprised 46 969 unique patients with type 2 diabetes, including 31 116 (66.2%) with atherosclerotic CV disease. The mean (SD) age of all trial participants was 63.7 (7.9) years; 30 939 (65.9%) were men, and 36 849 (78.5%) were White. The median number of participants per trial was 8246 (range, 4401-17 160). Overall, SGLT2 inhibitors were associated with a reduced risk of major adverse CV events (HR, 0.90; 95% CI, 0.85-0.95; Q statistic, P = .27), HHF/CV death (HR, 0.78; 95% CI, 0.73-0.84; Q statistic, P = .09), and kidney outcomes (HR, 0.62; 95% CI, 0.56-0.70; Q statistic, P = .09), with no significant heterogeneity of associations with outcome. Associated risk reduction for HHF was consistent across the trials (HR, 0.68; 95% CI, 0.61-0.76; I2 = 0.0%), whereas significant heterogeneity of associations with outcome was observed for CV death (HR, 0.85; 95% CI, 0.78-0.93; Q statistic, P = .02; I2 = 64.3%). The presence or absence of atherosclerotic CV disease did not modify the association with outcomes for major adverse CV events (HR, 0.89; 95% CI, 0.84-0.95 and HR, 0.94; 95% CI, 0.83-1.07, respectively; P = .63 for interaction), with similar absence of associations with outcome modification by prevalent atherosclerotic CV disease for HHF/CV death (P = .62 for interaction), HHF (P = .26 for interaction), or kidney outcomes (P = .73 for interaction). CONCLUSIONS AND RELEVANCE: In this meta-analysis, SGLT2 inhibitors were associated with a reduced risk of major adverse CV events; in addition, results suggest significant heterogeneity in associations with CV death. The largest benefit across the class was for an associated reduction in risk for HHF and kidney outcomes, with benefits for HHF risk being the most consistent observation across the trials."},{"id":"190d4628c6d5","type":"article","url":"https://hartvaat.nl/2021/02/01/evolocumab-bij-metabool-syndroom-na-acs-fourier/","title":"Evolocumab bij metabool syndroom na ACS: FOURIER","title_en":"Efficacy and Safety of PCSK9 Inhibition With Evolocumab in Reducing Cardiovascular Events in Patients With Metabolic Syndrome Receiving Statin Therapy: Secondary Analysis From the FOURIER Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.3151","source_url":"https://doi.org/10.1001/jamacardio.2020.3151","authors":["Prakash Deedwania","Sabina A Murphy","Andre Scheen","Jolita Badariene","Armando Lira Pineda","Narimon Honarpour","Anthony C Keech","Peter S Sever","Terje R Pedersen","Marc S Sabatine","Robert P Giugliano"],"significance":6,"published":"2021-02-01","source_date":"2021-02-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This FOURIER analysis confirmed that evolocumab provides consistent cardiovascular event reduction in patients with metabolic syndrome, showing that the PCSK9 inhibitor benefit extends to this high-risk metabolic phenotype.","created":"2026-07-03T10:29:02Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"FOURIER analyse naar werkzaamheid en veiligheid van evolocumab bij patiënten met metabool syndroom na ACS.","abstract_original":"IMPORTANCE: The PCSK9 inhibitor evolocumab reduced low-density lipoprotein cholesterol and cardiovascular events in the FOURIER randomized clinical trial. Patients with metabolic syndrome (MetS) are at increased cardiovascular risk. OBJECTIVE: To investigate outcomes with evolocumab in patients with and without MetS. DESIGN, SETTING, AND PARTICIPANTS: The FOURIER trial randomized patients worldwide with stable atherosclerotic cardiovascular disease receiving statin to evolocumab vs placebo with follow-up for a median of 2.2 years. Data were collected February 2013 to November 2016. For this prespecified analysis, patients with the requisite data were stratified based on the National Cholesterol Education Program Adult Treatment Panel III MetS criteria; in secondary analyses, patients were further substratified by diabetes at baseline. Analysis was intention to treat. Analysis began March 2018 and ended April 2020. INTERVENTIONS: Patients were randomized to evolocumab or placebo. MAIN OUTCOMES AND MEASURES: The primary end point was cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The key secondary end point was cardiovascular death, myocardial infarction, or stroke. RESULTS: Of 27 342 patients (mean [SD] age, 63 [9] years; 20 623 men [75.4%]) included in this analysis, 16 361 (59.8%) with baseline MetS were, when compared with patients without MetS, at higher risk of cardiovascular events (adjusted hazard ratio [95% CI], 1.31 [1.18-1.46]; P < .001 for the primary and 1.38 [1.20-1.57]; P < .001 for the key secondary end point). Evolocumab reduced low-density lipoprotein cholesterol similarly in patients with MetS (median [interquartile range], 92 [79-109] mg/dL vs 30 [19-48] mg/dL; P < .001) and without MetS (median [interquartile range], 92 [81-108] mg/dL vs 29 [18-44] mg/dl; P < .001). For the primary end point, the hazard ratios (95% CI) with evolocumab vs placebo were 0.83 (0.76-0.91) and 0.89 (0.79-1.01) in patients with and without MetS (P for interaction = .39). For the key secondary end point, the corresponding hazard ratios (95% CIs) were 0.76 (0.68-0.86) and 0.86 (0.74-1.01) (P for interaction = .23), respectively. Evolocumab did not increase the risk of new-onset diabetes or other major safety outcomes including worsening glycemic control, compared with placebo in patients with MetS. CONCLUSIONS AND RELEVANCE: Patients with atherosclerotic cardiovascular disease and MetS have substantial residual risk of cardiovascular events despite statin therapy. Evolocumab significantly reduced low-density lipoprotein cholesterol and cardiovascular risk in patients with MetS without increasing new-onset diabetes, worsening glycemic control, or other major safety events. These data suggest the addition of evolocumab to statin therapy in patients with atherosclerotic cardiovascular disease and MetS is safe and efficacious to reduce residual cardiovascular risk. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01764633."},{"id":"5d0b35e7033b","type":"article","url":"https://hartvaat.nl/2021/02/01/therapietrouw-aan-single-pill-versus-vrije-combinatietherapie-bij-hypertensie-me/","title":"Therapietrouw aan single-pill versus vrije combinatietherapie bij hypertensie: meta-analyse","title_en":"Adherence to Single-Pill Versus Free-Equivalent Combination Therapy in Hypertension: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.15781","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.15781","authors":["Gianfranco Parati","Sverre Kjeldsen","Antonio Coca","William C Cushman","Jiguang Wang"],"significance":8,"published":"2021-02-01","source_date":"2021-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/combinatietherapie-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This meta-analysis demonstrated that single-pill combination therapy achieves significantly higher adherence compared with free-equivalent combinations of the same drugs in hypertension. The data provided the pharmacological rationale for recommending fixed-dose combinations as the preferred prescribing strategy.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die hogere therapietrouw aantoont bij single-pill versus vrije equivalente combinatietherapie bij hypertensie. Onderbouwt de polypilstrategie.","abstract_original":"Poor adherence to antihypertensive therapy is a major cause of poor blood pressure (BP) control in patients with hypertension. Regimen simplification may improve adherence and BP control. This systematic review assessed whether single-pill combination (SPC) therapy led to improved adherence, persistence, and better BP control compared with free-equivalent combination (FEC) therapy in patients with hypertension. PubMed, Medline, Embase, and the Cochrane Library were searched until July 2020, in addition to manual searching of relevant congress abstracts from 2014 to 2020 for studies including adults with hypertension aged ≥18 years receiving SPC or FEC antihypertensive therapy measuring any of the following: adherence, persistence, and reductions in systolic BP and/or diastolic BP. Adherence and persistence were summarized in a narrative analysis; direct pair-wise meta-analysis was conducted to compare BP reductions with SPC therapy versus FEC therapy using fixed-effect and random-effects models. Following screening, 44 studies were included. The majority (18 of 23) of studies measuring adherence showed adherence was significantly improved in patients receiving SPCs versus FECs. Overall, 16 studies measured persistence, of which 14 showed that patients receiving SPCs had significantly improved persistence or were significantly less likely to discontinue therapy than patients receiving FECs. Systolic BP (mean difference, -3.99 [95% CI, -7.92 to -0.07]; P=0.05) and diastolic BP (-1.54 [95% CI, -2.67 to -0.41]; P=0.0076) were both significantly reduced with SPC therapy compared with FEC therapy at week 12. SPC therapy leads to improved adherence and persistence compared with FEC therapy and may lead to better BP control in patients with hypertension."},{"id":"80911c6e3e6d","type":"article","url":"https://hartvaat.nl/2021/02/01/polsdruk-prognose-en-sacubitril-valsartan-bij-hfpef-paragon-hf/","title":"Polsdruk, prognose en sacubitril/valsartan bij HFpEF: PARAGON-HF","title_en":"Pulse Pressure, Prognosis, and Influence of Sacubitril/Valsartan in Heart Failure With Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16277","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16277","authors":["Kota Suzuki","Brian Claggett","Masatoshi Minamisawa","Kotaro Nochioka","Gary F Mitchell","Inder S Anand","Faiez Zannad","Sanjiv J Shah","Martin Lefkowitz","Victor Shi","Marc A Pfeffer","John J V McMurray","Scott D Solomon"],"significance":5,"published":"2021-02-01","source_date":"2021-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This PARAGON-HF analysis showed that pulse pressure is a prognostic marker and may modify the effect of sacubitril-valsartan in HFpEF, linking arterial stiffness to treatment response in preserved ejection fraction.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PARAGON-HF analyse naar polsdruk als prognostische marker en modificator van het sacubitril/valsartan-effect bij HFpEF.","abstract_original":"Arterial stiffness is increased with increasing age, and pulse pressure (PP), a marker of arterial stiffness, is a predictor of incident cardiovascular disease and mortality. However, the prognostic relevance of PP in heart failure (HF) with preserved ejection fraction has not been fully understood. We studied 4796 patients with HF with preserved ejection fraction from the PARAGON-HF trial. All patients underwent sequential run-in phases of valsartan and sacubitril/valsartan before randomization. We categorized patients by PP quartile and evaluated the influence of baseline PP on the PARAGON-HF primary end point (total HF hospitalizations and cardiovascular death). At screening, the median PP was 58 mm Hg (interquartile range, 50-69 mm Hg). There was a nonlinear, J-shaped association between PP and outcomes. Multivariable Cox proportional hazards models showed that patients in the highest PP quartile had a higher risk of the primary end point (adjusted hazard ratio, 1.39 [95% CI, 1.14-1.69]; P=0.001), total HF hospitalizations (adjusted hazard ratio, 1.43 [95% CI, 1.15-1.79]; P=0.001), and myocardial infarction (adjusted hazard ratio, 1.54 [95% CI, 1.06-2.23]; P=0.022) compared with those in the second (lowest risk) PP quartile. Reductions in PP during sacubitril/valsartan run-in were associated with a decreased risk of the primary end point and total HF hospitalizations. One year after randomization, PP was significantly lower in the sacubitril/valsartan group compared with the valsartan group (3.0 mm Hg decrease [95% CI, 2.4-3.5]; P<0.001). In conclusion, PP was an independent predictor of cardiovascular events in patients with HF with preserved ejection fraction enrolled in PARAGON-HF. Sacubitril/valsartan lowered PP compared with valsartan."},{"id":"98fa19810f4c","type":"article","url":"https://hartvaat.nl/2021/02/01/urinezuur-bloeddruk-en-cv-ziekte-mendeliaanse-randomisatie-en-meta-analyse/","title":"Urinezuur, bloeddruk en CV-ziekte: Mendeliaanse randomisatie en meta-analyse","title_en":"Urate, Blood Pressure, and Cardiovascular Disease: Evidence From Mendelian Randomization and Meta-Analysis of Clinical Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16547","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16547","authors":["Dipender Gill","Alan C Cameron","Stephen Burgess","Xue Li","Daniel J Doherty","Ville Karhunen","Azmil H Abdul-Rahim","Martin Taylor-Rowan","Verena Zuber","Philip S Tsao","Derek Klarin","Evangelos Evangelou","Paul Elliott","Scott M Damrauer","Terence J Quinn","Abbas Dehghan","Evropi Theodoratou","Jesse Dawson","Ioanna Tzoulaki"],"significance":6,"published":"2021-02-01","source_date":"2021-02-01","image":"","kennis":[],"congress":"","summary_en":"This Mendelian randomization and meta-analysis study showed that genetically determined serum urate levels are not causally associated with blood pressure or cardiovascular disease, suggesting that the observational association is confounded.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Mendeliaanse randomisatie en meta-analyse van trials naar het verband tussen urinezuur, bloeddruk en CV-ziekte.","abstract_original":"Serum urate has been implicated in hypertension and cardiovascular disease, but it is not known whether it is exerting a causal effect. To investigate this, we performed Mendelian randomization analysis using data from UK Biobank, Million Veterans Program and genome-wide association study consortia, and meta-analysis of randomized controlled trials. The main Mendelian randomization analyses showed that every 1-SD increase in genetically predicted serum urate was associated with an increased risk of coronary heart disease (odds ratio, 1.19 [95% CI, 1.10-1.30]; P=4×10-5), peripheral artery disease (1.12 [95% CI, 1.03-1.21]; P=9×10-3), and stroke (1.11 [95% CI, 1.05-1.18]; P=2×10-4). In Mendelian randomization mediation analyses, elevated blood pressure was estimated to mediate approximately one-third of the effect of urate on cardiovascular disease risk. Systematic review and meta-analysis of randomized controlled trials showed a favorable effect of urate-lowering treatment on systolic blood pressure (mean difference, -2.55 mm Hg [95% CI, -4.06 to -1.05]; P=1×10-3) and major adverse cardiovascular events in those with previous cardiovascular disease (odds ratio, 0.40 [95% CI, 0.22-0.73]; P=3×10-3) but no significant effect on major adverse cardiovascular events in all individuals (odds ratio, 0.67 [95% CI, 0.44-1.03]; P=0.07). In summary, these Mendelian randomization and clinical trial data support an effect of higher serum urate on increasing blood pressure, which may mediate a consequent effect on cardiovascular disease risk. High-quality trials are necessary to provide definitive evidence on the specific clinical contexts where urate lowering may be of cardiovascular benefit."},{"id":"16217e73274f","type":"article","url":"https://hartvaat.nl/2021/02/01/revascularisatie-bij-ernstig-verminderde-lvef-korte-en-langetermijnuitkomsten/","title":"Revascularisatie bij ernstig verminderde LVEF: korte- en langetermijnuitkomsten","title_en":"Short-term and long-term outcomes of revascularization interventions for patients with severely reduced left ventricular ejection fraction: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","diabetes-en-hart","ouderen","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13141","source_url":"https://doi.org/10.1002/ehf2.13141","authors":["Junyu Pei","Xiaopu Wang","Zhenhua Xing","Keyang Zheng","Xinqun Hu"],"significance":5,"published":"2021-02-01","source_date":"2021-02-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis compared CABG with PCI outcomes in patients with severely reduced LVEF, providing evidence to guide revascularization strategy selection in the most depressed ventricular function.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van korte- en langetermijnuitkomsten van revascularisatie bij patiënten met ernstig verminderde LVEF.","abstract_original":"AIMS: This meta-analysis aimed to determine whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) should be preferred in patients with severely reduced left ventricular (LV) ejection fraction. METHODS AND RESULTS: We searched the PubMed, EMBASE, and Cochrane Library databases from the conception of the databases till 1 May 2020 for studies on patients with severely reduced LV ejection fraction undergoing CABG and PCI. The primary clinical endpoints were 30 day and long-term mortalities. The secondary endpoints were 30 day and long-term incidences of myocardial infarction (MI) and stroke, long-term cardiovascular mortality, and repeat revascularization. Eighteen studies involving 11 686 patients were analysed. Compared with PCI, CABG had lower long-term mortality [hazard ratio (HR): 0.70, 95% confidence interval (CI): 0.61-0.80, P < 0.01], cardiovascular mortality (HR: 0.60, 95% CI: 0.43-0.85, P < 0.01), MI (HR: 0.51, 95% CI: 0.36-0.72, P < 0.01), and repeat revascularization (HR: 0.32, 95% CI: 0.23-0.47, P < 0.01) risk. Significant differences were not observed for long-term stroke (HR: 1.18, 95% CI: 0.74-1.87, P = 0.49), 30 day mortality (HR: 1.18, 95% CI: 0.89-1.56, P = 0.25), and MI (HR: 0.42, 95% CI: 0.16-1.11, P = 0.08) risk. CABG was associated with a higher risk of stroke within 30 days (HR: 2.88, 95% CI: 1.07-7.77, P = 0.04). In a subgroup analysis of propensity score-matched studies, CABG was associated with a higher long-term risk of stroke (HR: 1.61, 95% CI: 1.20-2.16, P < 0.01). CONCLUSIONS: Among patients with severely reduced LV ejection fraction, CABG resulted in a lower mortality rate and an increased risk of stroke."},{"id":"5b67d2d4fb08","type":"article","url":"https://hartvaat.nl/2021/01/28/inhalatietreprostinil-bij-pulmonale-hypertensie-door-interstitiele-longziekte-ne/","title":"Inhalatietreprostinil bij pulmonale hypertensie door interstitiële longziekte: NEJM INCREASE","title_en":"Inhaled Treprostinil in Pulmonary Hypertension Due to Interstitial Lung Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["pulmonale-hypertensie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2008470","source_url":"https://doi.org/10.1056/NEJMoa2008470","authors":["Aaron Waxman","Ricardo Restrepo-Jaramillo","Thenappan Thenappan","Ashwin Ravichandran","Peter Engel","Abubakr Bajwa","Roblee Allen","Jeremy Feldman","Rahul Argula","Peter Smith","Kristan Rollins","Chunqin Deng","Leigh Peterson","Heidi Bell","Victor Tapson","Steven D Nathan"],"significance":8,"published":"2021-01-28","source_date":"2021-01-28","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/therapietrouw-hypertensie/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"The INCREASE trial demonstrated that inhaled treprostinil improved exercise capacity in patients with pulmonary hypertension associated with interstitial lung disease. This was the first therapy proven effective for this specific, previously untreatable form of pulmonary hypertension.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM INCREASE trial die inhalatietreprostinil onderzocht bij PH geassocieerd met interstitiële longziekte. Eerste bewezen therapie voor deze indicatie.","abstract_original":"BACKGROUND: No therapies are currently approved for the treatment of pulmonary hypertension in patients with interstitial lung disease. The safety and efficacy of inhaled treprostinil for patients with this condition are unclear. METHODS: We enrolled patients with interstitial lung disease and pulmonary hypertension (documented by right heart catheterization) in a multicenter, randomized, double-blind, placebo-controlled, 16-week trial. Patients were assigned in a 1:1 ratio to receive inhaled treprostinil, administered by means of an ultrasonic, pulsed-delivery nebulizer in up to 12 breaths (total, 72 μg) four times daily, or placebo. The primary efficacy end point was the difference between the two groups in the change in peak 6-minute walk distance from baseline to week 16. Secondary end points included the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) level at week 16 and the time to clinical worsening. RESULTS: A total of 326 patients underwent randomization, with 163 assigned to inhaled treprostinil and 163 to placebo. Baseline characteristics were similar in the two groups. At week 16, the least-squares mean difference between the treprostinil group and the placebo group in the change from baseline in the 6-minute walk distance was 31.12 m (95% confidence interval [CI], 16.85 to 45.39; P<0.001). There was a reduction of 15% in NT-proBNP levels from baseline with inhaled treprostinil as compared with an increase of 46% with placebo (treatment ratio, 0.58; 95% CI, 0.47 to 0.72; P<0.001). Clinical worsening occurred in 37 patients (22.7%) in the treprostinil group as compared with 54 patients (33.1%) in the placebo group (hazard ratio, 0.61; 95% CI, 0.40 to 0.92; P = 0.04 by the log-rank test). The most frequently reported adverse events were cough, headache, dyspnea, dizziness, nausea, fatigue, and diarrhea. CONCLUSIONS: In patients with pulmonary hypertension due to interstitial lung disease, inhaled treprostinil improved exercise capacity from baseline, assessed with the use of a 6-minute walk test, as compared with placebo. (Funded by United Therapeutics; INCREASE ClinicalTrials.gov number, NCT02630316.)."},{"id":"f0286e6faef9","type":"article","url":"https://hartvaat.nl/2021/01/28/cryoablatie-of-medicatie-als-initiele-af-behandeling-nejm-stop-af-first/","title":"Cryoablatie of medicatie als initiële AF-behandeling: NEJM STOP AF First","title_en":"Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2029980","source_url":"https://doi.org/10.1056/NEJMoa2029980","authors":["Jason G Andrade","George A Wells","Marc W Deyell","Matthew Bennett","Vidal Essebag","Jean Champagne","Jean-Francois Roux","Derek Yung","Allan Skanes","Yaariv Khaykin","Carlos Morillo","Umjeet Jolly","Paul Novak","Evan Lockwood","Guy Amit","Paul Angaran","John Sapp","Stephan Wardell","Sandra Lauck","Laurent Macle","Atul Verma"],"significance":9,"published":"2021-01-28","source_date":"2021-01-28","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/"],"congress":"","summary_en":"The STOP AF First trial confirmed that cryoablation was superior to antiarrhythmic drug therapy as initial treatment for paroxysmal atrial fibrillation, with significantly fewer patients experiencing treatment failure at 1 year. Together with EARLY-AF, the trial established the evidence base for first-line ablation in AF.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM STOP AF First trial die cryoablatie vergeleek met antiaritmische medicatie als eerste behandeling bij AF. Bevestigt EARLY-AF: ablatie superieur aan medicatie als eerstelijnsbehandeling.","abstract_original":"BACKGROUND: Guidelines recommend a trial of one or more antiarrhythmic drugs before catheter ablation is considered in patients with atrial fibrillation. However, first-line ablation may be more effective in maintaining sinus rhythm. METHODS: We randomly assigned 303 patients with symptomatic, paroxysmal, untreated atrial fibrillation to undergo catheter ablation with a cryothermy balloon or to receive antiarrhythmic drug therapy for initial rhythm control. All the patients received an implantable cardiac monitoring device to detect atrial tachyarrhythmia. The follow-up period was 12 months. The primary end point was the first documented recurrence of any atrial tachyarrhythmia (atrial fibrillation, atrial flutter, or atrial tachycardia) between 91 and 365 days after catheter ablation or the initiation of an antiarrhythmic drug. The secondary end points included freedom from symptomatic arrhythmia, the atrial fibrillation burden, and quality of life. RESULTS: At 1 year, a recurrence of atrial tachyarrhythmia had occurred in 66 of 154 patients (42.9%) assigned to undergo ablation and in 101 of 149 patients (67.8%) assigned to receive antiarrhythmic drugs (hazard ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66; P<0.001). Symptomatic atrial tachyarrhythmia had recurred in 11.0% of the patients who underwent ablation and in 26.2% of those who received antiarrhythmic drugs (hazard ratio, 0.39; 95% CI, 0.22 to 0.68). The median percentage of time in atrial fibrillation was 0% (interquartile range, 0 to 0.08) with ablation and 0.13% (interquartile range, 0 to 1.60) with antiarrhythmic drugs. Serious adverse events occurred in 5 patients (3.2%) who underwent ablation and in 6 patients (4.0%) who received antiarrhythmic drugs. CONCLUSIONS: Among patients receiving initial treatment for symptomatic, paroxysmal atrial fibrillation, there was a significantly lower rate of atrial fibrillation recurrence with catheter cryoballoon ablation than with antiarrhythmic drug therapy, as assessed by continuous cardiac rhythm monitoring. (Funded by the Cardiac Arrhythmia Network of Canada and others; EARLY-AF ClinicalTrials.gov number, NCT02825979.)."},{"id":"d7d8dcafdb3e","type":"article","url":"https://hartvaat.nl/2021/01/28/cryoballonablatie-als-initiele-therapie-voor-af-nejm-early-af/","title":"Cryoballonablatie als initiële therapie voor AF: NEJM EARLY-AF","title_en":"Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2029554","source_url":"https://doi.org/10.1056/NEJMoa2029554","authors":["Oussama M Wazni","Gopi Dandamudi","Nitesh Sood","Robert Hoyt","Jaret Tyler","Sarfraz Durrani","Mark Niebauer","Kevin Makati","Blair Halperin","Andre Gauri","Gustavo Morales","Mingyuan Shao","Jeffrey Cerkvenik","Rachelle E Kaplon","Steven E Nissen"],"significance":9,"published":"2021-01-28","source_date":"2021-01-28","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The EARLY-AF trial showed that cryoballoon ablation as initial therapy for symptomatic paroxysmal atrial fibrillation was superior to antiarrhythmic drug therapy in maintaining sinus rhythm at 1 year. This landmark result challenged the guideline recommendation of a drug-first approach and supported ablation as a first-line strategy.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM EARLY-AF trial die cryoballonablatie als initiële therapie (vóór antiaritmica) onderzocht bij paroxysmaal AF. Ablatie-first strategie met continue monitoring als eindpunt.","abstract_original":"BACKGROUND: In patients with symptomatic paroxysmal atrial fibrillation that has not responded to medication, catheter ablation is more effective than antiarrhythmic drug therapy for maintaining sinus rhythm. However, the safety and efficacy of cryoballoon ablation as initial first-line therapy have not been established. METHODS: We performed a multicenter trial in which patients 18 to 80 years of age who had paroxysmal atrial fibrillation for which they had not previously received rhythm-control therapy were randomly assigned (1:1) to receive treatment with antiarrhythmic drugs (class I or III agents) or pulmonary vein isolation with a cryoballoon. Arrhythmia monitoring included 12-lead electrocardiography conducted at baseline and at 1, 3, 6, and 12 months; patient-activated telephone monitoring conducted weekly and when symptoms were present during months 3 through 12; and 24-hour ambulatory monitoring conducted at 6 and 12 months. The primary efficacy end point was treatment success (defined as freedom from initial failure of the procedure or atrial arrhythmia recurrence after a 90-day blanking period to allow recovery from the procedure or drug dose adjustment, evaluated in a Kaplan-Meier analysis). The primary safety end point was assessed in the ablation group only and was a composite of several procedure-related and cryoballoon system-related serious adverse events. RESULTS: Of the 203 participants who underwent randomization and received treatment, 104 underwent ablation, and 99 initially received drug therapy. In the ablation group, initial success of the procedure was achieved in 97% of patients. The Kaplan-Meier estimate of the percentage of patients with treatment success at 12 months was 74.6% (95% confidence interval [CI], 65.0 to 82.0) in the ablation group and 45.0% (95% CI, 34.6 to 54.7) in the drug-therapy group (P<0.001 by log-rank test). Two primary safety end-point events occurred in the ablation group (Kaplan-Meier estimate of the percentage of patients with an event within 12 months, 1.9%; 95% CI, 0.5 to 7.5). CONCLUSIONS: Cryoballoon ablation as initial therapy was superior to drug therapy for the prevention of atrial arrhythmia recurrence in patients with paroxysmal atrial fibrillation. Serious procedure-related adverse events were uncommon. (Supported by Medtronic; STOP AF First ClinicalTrials.gov number, NCT03118518.)."},{"id":"3ee2d9072802","type":"article","url":"https://hartvaat.nl/2021/01/27/periprocedurele-antistolling-bij-eliminate-af-ononderbroken-edoxaban-versus-vka/","title":"Periprocedurele antistolling bij ELIMINATE-AF: ononderbroken edoxaban versus VKA","title_en":"Periprocedural anticoagulation in the uninterrupted edoxaban vs. vitamin K antagonists for ablation of atrial fibrillation (ELIMINATE-AF) trial.","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/euaa199","source_url":"https://doi.org/10.1093/europace/euaa199","authors":["Stefan H Hohnloser","A John Camm","Riccardo Cappato","Hans-Christoph Diener","Hein Heidbüchel","Lluís Mont","Carlos A Morillo","Hans-Joachim Lanz","Heiko Rauer","Paul-Egbert Reimitz","Rüdiger Smolnik","Josef Kautzner"],"significance":5,"published":"2021-01-27","source_date":"2021-01-27","image":"","kennis":[],"congress":"","summary_en":"This ELIMINATE-AF subanalysis characterized heparin dosing requirements and procedure-related bleeding during AF ablation with uninterrupted edoxaban versus VKA, informing periprocedural anticoagulation management.","created":"2026-07-03T10:29:01Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ELIMINATE-AF subanalyse naar periprocedurele antistolling bij AF-ablatie met edoxaban versus VKA.","abstract_original":"AIMS: This post hoc analysis of ELIMINATE-AF evaluated requirements of unfractionated heparin (UFH) and procedure-related bleeding in atrial fibrillation (AF) patients undergoing ablation with uninterrupted edoxaban or vitamin K antagonist (VKA) therapy. METHODS AND RESULTS: Patients were randomized 2:1 to once-daily edoxaban 60 mg (or dose-reduced 30 mg) or dose-adjusted VKA (target international normalized ratio: 2.0-3.0). Uninterrupted anticoagulation was mandated for 21-28 days' pre-ablation and 90 days' post-ablation. During ablation, UFH administration targeted an activated clotting time (ACT) of 300-400 s. Periprocedural bleeding was differentiated between procedure-related (bleeding at puncture side, cardiac tamponade) and unrelated events. Of 614 randomized patients, 553 received study drug and underwent catheter ablation (edoxaban n = 375; VKA n = 178). The median (Q1-Q3) time from last dose to ablation procedure was 14.8 (13.3-16.5) vs. 16.5 (14.8-19.5) h (edoxaban vs. VKA group, respectively). Mean ACT (SD) ≥300 s was observed in 52% edoxaban- vs. 76% VKA-treated patients, despite a higher mean (SD) UFH dose in the edoxaban vs. VKA group [14 261 (6397) IU vs. 11 473 (4300) IU; exploratory P-value < 0.0001]. In the edoxaban group, 13 patients (3.5%) had procedure-related bleeds of whom 9 had received an UFH dose above the median (13 000 IU). In the VKA arm, 7 patients (3.9%) had procedure-related bleeds of whom 3 had received an UFH dose above the median (10 225 IU). CONCLUSION: The rate of procedure-related major/clinically relevant non-major bleeding did not differ between the treatment arms despite higher doses of UFH used with edoxaban vs. VKA to achieve a target ACT during AF ablation."},{"id":"79eb78f04826","type":"article","url":"https://hartvaat.nl/2021/01/27/doac-s-en-fractuurrisico-systematische-review-en-meta-analyse/","title":"DOAC's en fractuurrisico: systematische review en meta-analyse","title_en":"Non-vitamin K oral anticoagulants and risk of fractures: a systematic review and meta-analysis.","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/euaa242","source_url":"https://doi.org/10.1093/europace/euaa242","authors":["Pajaree Mongkhon","Laura Fanning","Kirstie H T W Wong","Kenneth K C Man","Ian C K Wong","Wallis C Y Lau"],"significance":5,"published":"2021-01-27","source_date":"2021-01-27","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/"],"congress":"","summary_en":"This meta-analysis showed that DOACs are not associated with increased fracture risk compared with VKAs in AF patients, providing reassurance on the skeletal safety of non-vitamin K anticoagulants.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse naar het risico op fracturen bij DOAC-gebruik. Veiligheidsaspect voorbij bloedingen.","abstract_original":"AIMS: Comparative fracture risk for non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) among patients with atrial fibrillation (AF) remains unclear. This study aimed to provide summary relative risk (RR) estimates for associations between NOACs vs. VKAs and fracture risk. METHODS AND RESULTS: PubMed, EMBASE, and Cochrane Library were searched from 2010 to 26 May 2020. Observational studies investigating the association between NOACs vs. VKAs and fracture risk in patients with AF were included. The adjusted effect estimates were pooled using the DerSimonian-Laird random effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiological (MOOSE) guidelines were followed. Five observational studies comprising 269 922 patients and 4289 fractures were included. Non-vitamin K antagonist oral anticoagulants use was associated with a lower risk of any fractures compared to VKAs use, with moderate heterogeneity [pooled RR = 0.83, 95% confidence interval (CI): 0.75-0.92, P < 0.001, I2 = 73.0%]. When comparing individual NOAC to VKAs, a statistically significant lower risk of any fractures was found for rivaroxaban (pooled RR = 0.79, 95% CI: 0.71-0.88, P < 0.001, I2 = 55.2%) and apixaban (pooled RR = 0.75, 95% CI: 0.60-0.92, P = 0.007, I2 = 54.5%), but not dabigatran (pooled RR = 0.87, 95% CI: 0.74-1.01, P = 0.061, I2 = 74.6%). No differences were observed in all head-to-head comparisons between NOACs. CONCLUSION: This large meta-analysis suggests that NOACs use was associated with a lower risk of fractures compared with VKAs. Fracture risks were similar between NOACs. These findings may help inform the optimal anticoagulant choice for patients with AF at high risk of fracture."},{"id":"b0267df007a3","type":"article","url":"https://hartvaat.nl/2021/01/27/mobiele-gezondheidstoepassingen-voor-af-detectie-systematische-review/","title":"Mobiele gezondheidstoepassingen voor AF-detectie: systematische review","title_en":"Mobile health applications for the detection of atrial fibrillation: a systematic review.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["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/euaa139","source_url":"https://doi.org/10.1093/europace/euaa139","authors":["Carlos Ruben Lopez Perales","Harriette G C Van Spall","Shingo Maeda","Alejandro Jimenez","Decebal Gabriel Laţcu","Anat Milman","Fati Kirakoya-Samadoulougou","Mamas A Mamas","Daniele Muser","Ruben Casado Arroyo"],"significance":6,"published":"2021-01-27","source_date":"2021-01-27","image":"","kennis":[],"congress":"","summary_en":"This systematic review of mobile health applications for AF detection assessed the accuracy, usability, and clinical validation of consumer smartphone and wearable technologies for arrhythmia screening.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review van mobiele apps voor detectie van AF. Evaluatie van consumer-technologie.","abstract_original":"AIMS: Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart failure. We aimed to conduct a systematic review of the literature and summarize the performance of mobile health (mHealth) devices in diagnosing and screening for AF. METHODS AND RESULTS: We conducted a systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Forty-three studies met the inclusion criteria and were divided into two groups: 28 studies aimed at validating smart devices for AF diagnosis, and 15 studies used smart devices to screen for AF. Evaluated technologies included smartphones, with photoplethysmographic (PPG) pulse waveform measurement or accelerometer sensors, smartbands, external electrodes that can provide a smartphone single-lead electrocardiogram (iECG), such as AliveCor, Zenicor and MyDiagnostick, and earlobe monitor. The accuracy of these devices depended on the technology and the population, AliveCor and smartphone PPG sensors being the most frequent systems analysed. The iECG provided by AliveCor demonstrated a sensitivity and specificity between 66.7% and 98.5% and 99.4% and 99.0%, respectively. The PPG sensors detected AF with a sensitivity of 85.0-100% and a specificity of 93.5-99.0%. The incidence of newly diagnosed arrhythmia ranged from 0.12% in a healthy population to 8% among hospitalized patients. CONCLUSION: Although the evidence for clinical effectiveness is limited, these devices may be useful in detecting AF. While mHealth is growing in popularity, its clinical, economic, and policy implications merit further investigation. More head-to-head comparisons between mHealth and medical devices are needed to establish their comparative effectiveness."},{"id":"eee87bfda453","type":"article","url":"https://hartvaat.nl/2021/01/26/2020-acc-aha-kwaliteitsmaten-voor-af-geactualiseerd/","title":"2020 ACC/AHA kwaliteitsmaten voor AF: geactualiseerd","title_en":"2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.08.037","source_url":"https://doi.org/10.1016/j.jacc.2020.08.037","authors":["Paul A Heidenreich","N A Mark Estes","Gregg C Fonarow","Corrine Y Jurgens","Michelle M Kittleson","Joseph E Marine","David D McManus","Robert L McNamara"],"significance":6,"published":"2021-01-26","source_date":"2021-01-26","image":"","kennis":[],"congress":"","summary_en":"This 2020 update to the ACC/AHA clinical performance and quality measures for adults with AF incorporated new anticoagulation metrics and guideline-directed management benchmarks for quality assessment.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geactualiseerde ACC/AHA klinische prestatie- en kwaliteitsmaten voor volwassenen met AF.","abstract_original":""},{"id":"3d222215b93f","type":"article","url":"https://hartvaat.nl/2021/01/26/empagliflozine-bij-niet-diabetische-hfref-emperor-reduced-subanalyse/","title":"Empagliflozine bij niet-diabetische HFrEF: EMPEROR-Reduced subanalyse","title_en":"Randomized Trial of Empagliflozin in Nondiabetic Patients With Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","emperor-trials","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.008","source_url":"https://doi.org/10.1016/j.jacc.2020.11.008","authors":["Carlos G Santos-Gallego","Ariana P Vargas-Delgado","Juan Antonio Requena-Ibanez","Alvaro Garcia-Ropero","Donna Mancini","Sean Pinney","Frank Macaluso","Samantha Sartori","Merce Roque","Fernando Sabatel-Perez","Anderly Rodriguez-Cordero","M Urooj Zafar","Icilma Fergus","Farah Atallah-Lajam","Johanna P Contreras","Cathleen Varley","Pedro R Moreno","Vivian M Abascal","Anuradha Lala","Ronald Tamler","Javier Sanz","Valentin Fuster","Juan J Badimon"],"significance":8,"published":"2021-01-26","source_date":"2021-01-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This EMPEROR-Reduced subanalysis in nondiabetic patients confirmed that empagliflozin reduces cardiovascular death and heart failure hospitalization regardless of diabetes status. The finding was pivotal for regulatory approval of SGLT2 inhibitors in heart failure independent of glycemic indication.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPEROR-Reduced subanalyse bij niet-diabetische patiënten met HFrEF. Bevestigt voordeel ongeacht diabetesstatus — cruciaal voor indicatie-uitbreiding.","abstract_original":"BACKGROUND: Large clinical trials established the benefits of sodium-glucose cotransporter 2 inhibitors in patients with diabetes and with heart failure with reduced ejection fraction (HFrEF). The early and significant improvement in clinical outcomes is likely explained by effects beyond a reduction in hyperglycemia. OBJECTIVES: The purpose of this study was to assess the effect of empagliflozin on left ventricular (LV) function and volumes, functional capacity, and quality of life (QoL) in nondiabetic HFrEF patients. METHODS: In this double-blind, placebo-controlled trial, nondiabetic HFrEF patients (n = 84) were randomized to empagliflozin 10 mg daily or placebo for 6 months. The primary endpoint was change in LV end-diastolic and -systolic volume assessed by cardiac magnetic resonance. Secondary endpoints included changes in LV mass, LV ejection fraction, peak oxygen consumption in the cardiopulmonary exercise test, 6-min walk test, and quality of life. RESULTS: Empagliflozin was associated with a significant reduction of LV end-diastolic volume (-25.1 ± 26.0 ml vs. -1.5 ± 25.4 ml for empagliflozin vs. placebo, respectively; p < 0.001) and LV end-systolic volume (-26.6 ± 20.5 ml vs. -0.5 ± 21.9 ml for empagliflozin vs. placebo; p < 0.001). Empagliflozin was associated with reductions in LV mass (-17.8 ± 31.9 g vs. 4.1 ± 13.4 g, for empagliflozin vs. placebo, respectively; p < 0.001) and LV sphericity, and improvements in LV ejection fraction (6.0 ± 4.2 vs. -0.1 ± 3.9; p < 0.001). Patients who received empagliflozin had significant improvements in peak O2 consumption (1.1 ± 2.6 ml/min/kg vs. -0.5 ± 1.9 ml/min/kg for empagliflozin vs. placebo, respectively; p = 0.017), oxygen uptake efficiency slope (111 ± 267 vs. -145 ± 318; p < 0.001), as well as in 6-min walk test (81 ± 64 m vs. -35 ± 68 m; p < 0.001) and quality of life (Kansas City Cardiomyopathy Questionnaire-12: 21 ± 18 vs. 2 ± 15; p < 0.001). CONCLUSIONS: Empagliflozin administration to nondiabetic HFrEF patients significantly improves LV volumes, LV mass, LV systolic function, functional capacity, and quality of life when compared with placebo. Our observations strongly support a role for sodium-glucose cotransporter 2 inhibitors in the treatment of HFrEF patients independently of their glycemic status. (Are the \"Cardiac Benefits\" of Empagliflozin Independent of Its Hypoglycemic Activity? [ATRU-4] [EMPA-TROPISM]; NCT03485222)."},{"id":"6abe65f265cf","type":"article","url":"https://hartvaat.nl/2021/01/26/empagliflozine-en-klinische-stabiliteit-bij-hfref-emperor-reduced/","title":"Empagliflozine en klinische stabiliteit bij HFrEF: EMPEROR-Reduced","title_en":"Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","emperor-trials","hfref"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.051783","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.051783","authors":["Milton Packer","Stefan D Anker","Javed Butler","Gerasimos Filippatos","João Pedro Ferreira","Stuart J Pocock","Peter Carson","Inder Anand","Wolfram Doehner","Markus Haass","Michel Komajda","Alan Miller","Steen Pehrson","John R Teerlink","Martina Brueckmann","Waheed Jamal","Cordula Zeller","Sven Schnaidt","Faiez Zannad"],"significance":7,"published":"2021-01-26","source_date":"2021-01-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This EMPEROR-Reduced analysis showed that empagliflozin improves the overall clinical stability of patients with HFrEF, reducing the rate of clinical deterioration across multiple dimensions of disease progression.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPEROR-Reduced analyse naar het effect van empagliflozine op klinische stabiliteit bij HFrEF.","abstract_original":"BACKGROUND: Empagliflozin reduces the risk of cardiovascular death or hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, with or without diabetes, but additional data are needed about the effect of the drug on inpatient and outpatient events that reflect worsening heart failure. METHODS: We randomly assigned 3730 patients with class II to IV heart failure with an ejection fraction of ≤40% to double-blind treatment with placebo or empagliflozin (10 mg once daily), in addition to recommended treatments for heart failure, for a median of 16 months. We prospectively collected information on inpatient and outpatient events reflecting worsening heart failure and prespecified their analysis in individual and composite end points. RESULTS: Empagliflozin reduced the combined risk of death, hospitalization for heart failure or an emergent/urgent heart failure visit requiring intravenous treatment (415 versus 519 patients; empagliflozin versus placebo, respectively; hazard ratio [HR], 0.76; 95% CI, 0.67-0.87; P<0.0001). This benefit reached statistical significance at 12 days after randomization. Empagliflozin reduced the total number of heart failure hospitalizations that required intensive care (HR, 0.67; 95% CI, 0.50-0.90; P=0.008) and that required a vasopressor or positive inotropic drug or mechanical or surgical intervention (HR, 0.64; 95% CI, 0.47-0.87; P=0.005). As compared with placebo, fewer patients in the empagliflozin group reported intensification of diuretics (297 versus 414 [HR, 0.67; 95% CI, 0.56-0.78; P<0.0001]). Additionally, patients assigned to empagliflozin were 20% to 40% more likely to experience an improvement in New York Heart Association functional class and were 20% to 40% less likely to experience worsening of New York Heart Association functional class, with statistically significant effects that were apparent 28 days after randomization and maintained during long-term follow-up. The risk of any inpatient or outpatient worsening heart failure event in the placebo group was high (48.1 per 100 patient-years of follow-up), and it was reduced by empagliflozin (HR, 0.70; 95% CI, 0.63-0.78; P<0.0001). CONCLUSIONS: In patients with heart failure and a reduced ejection fraction, empagliflozin reduced the risk and total number of inpatient and outpatient worsening heart failure events, with benefits seen early after initiation of treatment and sustained for the duration of double-blind therapy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03057977."},{"id":"47ff2b8f942e","type":"article","url":"https://hartvaat.nl/2021/01/21/korte-dapt-gevolgd-door-p2y12-mono-versus-verlengde-dapt-meta-analyse/","title":"Korte DAPT gevolgd door P2Y12 mono versus verlengde DAPT: meta-analyse","title_en":"Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa739","source_url":"https://doi.org/10.1093/eurheartj/ehaa739","authors":["Daniele Giacoppo","Yuji Matsuda","Luca Nai Fovino","Gianpiero D'Amico","Giuseppe Gargiulo","Robert A Byrne","Davide Capodanno","Marco Valgimigli","Roxana Mehran","Giuseppe Tarantini"],"significance":8,"published":"2021-01-21","source_date":"2021-01-21","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that short DAPT followed by P2Y12 inhibitor monotherapy significantly reduces bleeding compared with prolonged DAPT after PCI with second-generation DES, without increasing ischemic events. The pooled evidence consolidated the de-escalation paradigm.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die korte DAPT gevolgd door P2Y12-monotherapie vergeleek met verlengde DAPT na PCI. Consolideert het de-escalatiebewijs.","abstract_original":"AIMS: After percutaneous coronary intervention (PCI) with second-generation drug-eluting stent (DES), whether short dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with a P2Y12 receptor inhibitor confers benefits compared with prolonged DAPT is unclear. METHODS AND RESULTS: Multiple electronic databases, including PubMed, Scopus, Web of Sciences, Ovid, and ScienceDirect, were searched to identify randomized clinical trials comparing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT after PCI with second-generation DES implantation. The primary and co-primary outcomes of interest were major bleeding and stent thrombosis 1 year after randomization. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fixed-effect and random-effects models. Multiple sensitivity analyses including random-effects models 95% CI adjustment were applied. A sensitivity analysis comparing trials using P2Y12 inhibitor SAPT with those using aspirin SAPT was performed. A total of five randomized clinical trials (32 145 patients) were available. Major bleeding was significantly lower in the patients assigned to short DAPT followed by P2Y12 inhibitor SAPT compared with those assigned to 12-month DAPT (random-effects model: HR 0.63, 95% 0.45-0.86). No significant differences between groups were observed in terms of stent thrombosis (random-effects model: HR 1.19, 95% CI 0.86-1.65) and the secondary endpoints of all-cause death (random-effects model: HR 0.85, 95% CI 0.70-1.03), myocardial infarction (random-effects model: HR 1.05, 95% CI 0.89-1.23), and stroke (random-effects model: HR 1.08, 95% CI 0.68-1.74). Sensitivity analyses showed overall consistent results. By comparing trials testing ≤3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT with trials testing ≤3 months of DAPT followed by aspirin SAPT vs. 12-month of DAPT, there was no treatment-by-subgroup interaction for each endpoint. By combining all these trials, regardless of the type of SAPT, short DAPT was associated with lower major bleeding (random-effects model: HR 0.63, 95% CI 0.48-0.83) and no differences in stent thrombosis, all-cause death, myocardial infarction, and stroke were observed between regimens. CONCLUSION: After second-generation DES implantation, 1-3 months of DAPT followed by P2Y12 inhibitor SAPT is associated with lower major bleeding and similar stent thrombosis, all-cause death, myocardial infarction, and stroke compared with prolonged DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs further investigation."},{"id":"8d1288c37a67","type":"article","url":"https://hartvaat.nl/2021/01/21/polypil-met-of-zonder-aspirine-bij-personen-zonder-cvd-nejm-polypill-tips-3/","title":"Polypil met of zonder aspirine bij personen zonder CVD: NEJM PolyPill-TIPS-3","title_en":"Polypill with or without Aspirin in Persons without Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["aspirine","rosuvastatine","statines"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2028220","source_url":"https://doi.org/10.1056/NEJMoa2028220","authors":["Salim Yusuf","Philip Joseph","Antonio Dans","Peggy Gao","Koon Teo","Denis Xavier","Patricio López-Jaramillo","Khalid Yusoff","Anwar Santoso","Habib Gamra","Shamim Talukder","Courtney Christou","Preeti Girish","Karen Yeates","Freeda Xavier","Gilles Dagenais","Catalina Rocha","Tara McCready","Jessica Tyrwhitt","Jackie Bosch","Prem Pais"],"significance":10,"published":"2021-01-21","source_date":"2021-01-21","image":"","kennis":["https://hartvaat.nl/kennis/preventie/primaire-preventie-overzicht/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"The PolyPill-TIPS-3 trial showed that a polypill containing a statin and two blood-pressure-lowering drugs, with or without aspirin, reduced the incidence of cardiovascular disease in intermediate-risk individuals without established CVD. The study validated the polypill strategy as a practical approach to primary cardiovascular prevention at the population level.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM PolyPill-TIPS-3 trial die een polypil (statine + antihypertensiva) met of zonder aspirine onderzocht bij personen zonder CVD. Definitief bewijs voor de polypilstrategie in primaire preventie.","abstract_original":"BACKGROUND: A polypill comprising statins, multiple blood-pressure-lowering drugs, and aspirin has been proposed to reduce the risk of cardiovascular disease. METHODS: Using a 2-by-2-by-2 factorial design, we randomly assigned participants without cardiovascular disease who had an elevated INTERHEART Risk Score to receive a polypill (containing 40 mg of simvastatin, 100 mg of atenolol, 25 mg of hydrochlorothiazide, and 10 mg of ramipril) or placebo daily, aspirin (75 mg) or placebo daily, and vitamin D or placebo monthly. We report here the outcomes for the polypill alone as compared with matching placebo, for aspirin alone as compared with matching placebo, and for the polypill plus aspirin as compared with double placebo. For the polypill-alone and polypill-plus-aspirin comparisons, the primary outcome was death from cardiovascular causes, myocardial infarction, stroke, resuscitated cardiac arrest, heart failure, or revascularization. For the aspirin comparison, the primary outcome was death from cardiovascular causes, myocardial infarction, or stroke. Safety was also assessed. RESULTS: A total of 5713 participants underwent randomization, and the mean follow-up was 4.6 years. The low-density lipoprotein cholesterol level was lower by approximately 19 mg per deciliter and systolic blood pressure was lower by approximately 5.8 mm Hg with the polypill and with combination therapy than with placebo. The primary outcome for the polypill comparison occurred in 126 participants (4.4%) in the polypill group and in 157 (5.5%) in the placebo group (hazard ratio, 0.79; 95% confidence interval [CI], 0.63 to 1.00). The primary outcome for the aspirin comparison occurred in 116 participants (4.1%) in the aspirin group and in 134 (4.7%) in the placebo group (hazard ratio, 0.86; 95% CI, 0.67 to 1.10). The primary outcome for the polypill-plus-aspirin comparison occurred in 59 participants (4.1%) in the combined-treatment group and in 83 (5.8%) in the double-placebo group (hazard ratio, 0.69; 95% CI, 0.50 to 0.97). The incidence of hypotension or dizziness was higher in groups that received the polypill than in their respective placebo groups. CONCLUSIONS: Combined treatment with a polypill plus aspirin led to a lower incidence of cardiovascular events than did placebo among participants without cardiovascular disease who were at intermediate cardiovascular risk. (Funded by the Wellcome Trust and others; TIPS-3 ClinicalTrials.gov number, NCT01646437.)."},{"id":"c7f7e8d1133d","type":"article","url":"https://hartvaat.nl/2021/01/19/stoppen-versus-doorgaan-met-ace-remmers-arb-s-bij-gehospitaliseerde-patienten-ja/","title":"Stoppen versus doorgaan met ACE-remmers/ARB's bij gehospitaliseerde patiënten: JAMA REPLACE-COVID","title_en":"Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.25864","source_url":"https://doi.org/10.1001/jama.2020.25864","authors":["Renato D Lopes","Ariane V S Macedo","Pedro G M de Barros E Silva","Renata J Moll-Bernardes","Tiago M Dos Santos","Lilian Mazza","André Feldman","Guilherme D'Andréa Saba Arruda","Denílson C de Albuquerque","Angelina S Camiletti","Andréa S de Sousa","Thiago C de Paula","Karla G D Giusti","Rafael A M Domiciano","Márcia M Noya-Rabelo","Alan M Hamilton","Vitor A Loures","Rodrigo M Dionísio","Thyago A B Furquim","Fábio A De Luca","Ítalo B Dos Santos Sousa","Bruno S Bandeira","Cleverson N Zukowski","Ricardo G G de Oliveira","Noara B Ribeiro","Jeffer L de Moraes","João L F Petriz","Adriana M Pimentel","Jacqueline S Miranda","Bárbara E de Jesus Abufaiad","C Michael Gibson","Christopher B Granger","John H Alexander","Olga F de Souza"],"significance":7,"published":"2021-01-19","source_date":"2021-01-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arb-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/ace-remmers-bijwerkingen/"],"congress":"","summary_en":"The REPLACE-COVID trial showed that discontinuing versus continuing ACE inhibitors or ARBs in hospitalized COVID-19 patients made no significant difference in clinical outcomes, definitively supporting continuation of RAAS inhibitors during COVID-19 hospitalization.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA REPLACE-COVID trial die het staken versus voortzetten van ACE-remmers/ARB's onderzocht bij gehospitaliseerde COVID-patiënten.","abstract_original":"IMPORTANCE: It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). OBJECTIVE: To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled: April 9-June 26, 2020; final follow-up: July 26, 2020). INTERVENTIONS: Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs. MAIN OUTCOMES AND MEASURES: The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression. RESULTS: Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%). CONCLUSIONS AND RELEVANCE: Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04364893."},{"id":"745bb0757e7a","type":"article","url":"https://hartvaat.nl/2021/01/19/residuele-syntax-score-bij-cardiogene-shock/","title":"Residuele SYNTAX-score bij cardiogene shock","title_en":"Predictive Value of the Residual SYNTAX Score in Patients With Cardiogenic Shock.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.025","source_url":"https://doi.org/10.1016/j.jacc.2020.11.025","authors":["Olivier Barthélémy","Stéphanie Rouanet","Delphine Brugier","Nicolas Vignolles","Benjamin Bertin","Michel Zeitouni","Paul Guedeney","Marie Hauguel-Moreau","Georges Hage","Pavel Overtchouk","Ibrahim Akin","Steffen Desch","Eric Vicaut","Uwe Zeymer","Holger Thiele","Gilles Montalescot"],"significance":5,"published":"2021-01-19","source_date":"2021-01-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study evaluated the residual SYNTAX score as a prognostic tool in cardiogenic shock patients, assessing whether completeness of revascularization measured by anatomical complexity predicts outcomes in the most critically ill.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prognostische waarde van de residuele SYNTAX-score bij patiënten met cardiogene shock.","abstract_original":"BACKGROUND: In hemodynamically stable patients, complete revascularization (CR) following percutaneous coronary intervention (PCI) is associated with a better prognosis in chronic and acute coronary syndromes. OBJECTIVES: This study sought to assess the extent, severity, and prognostic value of remaining coronary stenoses following PCI, by using the residual SYNTAX score (rSS), in patients with cardiogenic shock (CS) related to myocardial infarction (MI). METHODS: The CULPRIT-SHOCK (Culprit Lesion Only Percutaneous Coronary Intervention [PCI] Versus Multivessel PCI in Cardiogenic Shock) trial compared a multivessel PCI (MV-PCI) strategy with a culprit lesion-only PCI (CLO-PCI) strategy in patients with multivessel coronary artery disease who presented with MI-related CS. The rSS was assessed by a central core laboratory. The study group was divided in 4 subgroups according to tertiles of rSS of the participants, thereby isolating patients with an rSS of 0 (CR). The predictive value of rSS for the 30-day primary endpoint (mortality or severe renal failure) and for 30-day and 1-year mortality was assessed using multivariate logistic regression. RESULTS: Among the 587 patients with an rSS available, the median rSS was 9.0 (interquartile range: 3.0 to 17.0); 102 (17.4%), 100 (17.0%), 196 (33.4%), and 189 (32.2%) patients had rSS = 0, 0 < rSS ≤5, 5 < rSS ≤14, and rSS >14, respectively. CR was achieved in 75 (25.2%; 95% confidence interval [CI]: 20.3% to 30.5%) and 27 (9.3%; 95% CI: 6.2% to 13.3%) of patients treated using the MV-PCI and CLO-PCI strategies, respectively. After multiple adjustments, rSS was independently associated with 30-day mortality (adjusted odds ratio per 10 units: 1.49; 95% CI: 1.11 to 2.01) and 1-year mortality (adjusted odds ratio per 10 units: 1.52; 95% CI: 1.11 to 2.07). CONCLUSIONS: Among patients with multivessel disease and MI-related CS, CR is achieved only in one-fourth of the patients treated using an MV-PCI strategy. and the residual SYNTAX score is independently associated with early and late mortality."},{"id":"23da2de28b9c","type":"article","url":"https://hartvaat.nl/2021/01/14/sotagliflozine-bij-diabetes-met-recent-verslechterend-hf-nejm-soloist-whf/","title":"Sotagliflozine bij diabetes met recent verslechterend HF: NEJM SOLOIST-WHF","title_en":"Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2030183","source_url":"https://doi.org/10.1056/NEJMoa2030183","authors":["Deepak L Bhatt","Michael Szarek","P Gabriel Steg","Christopher P Cannon","Lawrence A Leiter","Darren K McGuire","Julia B Lewis","Matthew C Riddle","Adriaan A Voors","Marco Metra","Lars H Lund","Michel Komajda","Jeffrey M Testani","Christopher S Wilcox","Piotr Ponikowski","Renato D Lopes","Subodh Verma","Pablo Lapuerta","Bertram Pitt"],"significance":9,"published":"2021-01-14","source_date":"2021-01-14","image":"","kennis":[],"congress":"","summary_en":"The SOLOIST-WHF trial demonstrated that sotagliflozin initiated before or shortly after hospital discharge for worsening heart failure significantly reduced cardiovascular death and heart failure events in patients with diabetes. The study provided the first evidence for starting SGLT inhibitor therapy during an acute heart failure hospitalization.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM SOLOIST-WHF trial van sotagliflozine bij diabetes met recent verslechterend hartfalen. In-hospital start van SGLT-remming bij gedecompenseerd HF.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure or death from cardiovascular causes among patients with stable heart failure. However, the safety and efficacy of SGLT2 inhibitors when initiated soon after an episode of decompensated heart failure are unknown. METHODS: We performed a multicenter, double-blind trial in which patients with type 2 diabetes mellitus who were recently hospitalized for worsening heart failure were randomly assigned to receive sotagliflozin or placebo. The primary end point was the total number of deaths from cardiovascular causes and hospitalizations and urgent visits for heart failure (first and subsequent events). The trial ended early because of loss of funding from the sponsor. RESULTS: A total of 1222 patients underwent randomization (608 to the sotagliflozin group and 614 to the placebo group) and were followed for a median of 9.0 months; the first dose of sotagliflozin or placebo was administered before discharge in 48.8% and a median of 2 days after discharge in 51.2%. Among these patients, 600 primary end-point events occurred (245 in the sotagliflozin group and 355 in the placebo group). The rate (the number of events per 100 patient-years) of primary end-point events was lower in the sotagliflozin group than in the placebo group (51.0 vs. 76.3; hazard ratio, 0.67; 95% confidence interval [CI], 0.52 to 0.85; P<0.001). The rate of death from cardiovascular causes was 10.6 in the sotagliflozin group and 12.5 in the placebo group (hazard ratio, 0.84; 95% CI, 0.58 to 1.22); the rate of death from any cause was 13.5 in the sotagliflozin group and 16.3 in the placebo group (hazard ratio, 0.82; 95% CI, 0.59 to 1.14). Diarrhea was more common with sotagliflozin than with placebo (6.1% vs. 3.4%), as was severe hypoglycemia (1.5% vs. 0.3%). The percentage of patients with hypotension was similar in the sotagliflozin group and the placebo group (6.0% and 4.6%, respectively), as was the percentage with acute kidney injury (4.1% and 4.4%, respectively). The benefits of sotagliflozin were consistent in the prespecified subgroups of patients stratified according to the timing of the first dose. CONCLUSIONS: In patients with diabetes and recent worsening heart failure, sotagliflozin therapy, initiated before or shortly after discharge, resulted in a significantly lower total number of deaths from cardiovascular causes and hospitalizations and urgent visits for heart failure than placebo. (Funded by Sanofi and Lexicon Pharmaceuticals; SOLOIST-WHF ClinicalTrials.gov number, NCT03521934.)."},{"id":"694bd36d3655","type":"article","url":"https://hartvaat.nl/2021/01/14/sotagliflozine-bij-diabetes-met-ckd-nejm-scored/","title":"Sotagliflozine bij diabetes met CKD: NEJM SCORED","title_en":"Sotagliflozin in Patients with Diabetes and Chronic Kidney Disease.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["credence-trial","dapagliflozine","fidelio-dkd","figaro-dkd","flow-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2030186","source_url":"https://doi.org/10.1056/NEJMoa2030186","authors":["Deepak L Bhatt","Michael Szarek","Bertram Pitt","Christopher P Cannon","Lawrence A Leiter","Darren K McGuire","Julia B Lewis","Matthew C Riddle","Silvio E Inzucchi","Mikhail N Kosiborod","David Z I Cherney","Jamie P Dwyer","Benjamin M Scirica","Clifford J Bailey","Rafael Díaz","Kausik K Ray","Jacob A Udell","Renato D Lopes","Pablo Lapuerta","P Gabriel Steg"],"significance":9,"published":"2021-01-14","source_date":"2021-01-14","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The SCORED trial showed that sotagliflozin, a dual SGLT1/SGLT2 inhibitor, reduced cardiovascular death, heart failure hospitalization, and urgent heart failure visits in patients with type 2 diabetes and chronic kidney disease. The results established dual SGLT inhibition as an effective cardiorenal strategy.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM SCORED trial van sotagliflozine (duale SGLT1/SGLT2-remmer) bij diabetes met CKD. CV-events en HF-hospitalisatie verminderd — eerste duale SGLT-remmer.","abstract_original":"BACKGROUND: The efficacy and safety of sodium-glucose cotransporter 2 inhibitors such as sotagliflozin in preventing cardiovascular events in patients with diabetes with chronic kidney disease with or without albuminuria have not been well studied. METHODS: We conducted a multicenter, double-blind trial in which patients with type 2 diabetes mellitus (glycated hemoglobin level, ≥7%), chronic kidney disease (estimated glomerular filtration rate, 25 to 60 ml per minute per 1.73 m2 of body-surface area), and risks for cardiovascular disease were randomly assigned in a 1:1 ratio to receive sotagliflozin or placebo. The primary end point was changed during the trial to the composite of the total number of deaths from cardiovascular causes, hospitalizations for heart failure, and urgent visits for heart failure. The trial ended early owing to loss of funding. RESULTS: Of 19,188 patients screened, 10,584 were enrolled, with 5292 assigned to the sotagliflozin group and 5292 assigned to the placebo group, and followed for a median of 16 months. The rate of primary end-point events was 5.6 events per 100 patient-years in the sotagliflozin group and 7.5 events per 100 patient-years in the placebo group (hazard ratio, 0.74; 95% confidence interval [CI], 0.63 to 0.88; P<0.001). The rate of deaths from cardiovascular causes per 100 patient-years was 2.2 with sotagliflozin and 2.4 with placebo (hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P = 0.35). For the original coprimary end point of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, the hazard ratio was 0.84 (95% CI, 0.72 to 0.99); for the original coprimary end point of the first occurrence of death from cardiovascular causes or hospitalization for heart failure, the hazard ratio was 0.77 (95% CI, 0.66 to 0.91). Diarrhea, genital mycotic infections, volume depletion, and diabetic ketoacidosis were more common with sotagliflozin than with placebo. CONCLUSIONS: In patients with diabetes and chronic kidney disease, with or without albuminuria, sotagliflozin resulted in a lower risk of the composite of deaths from cardiovascular causes, hospitalizations for heart failure, and urgent visits for heart failure than placebo but was associated with adverse events. (Funded by Sanofi and Lexicon Pharmaceuticals; SCORED ClinicalTrials.gov number, NCT03315143.)."},{"id":"557cef47a00e","type":"article","url":"https://hartvaat.nl/2021/01/14/omecamtiv-mecarbil-bij-systolisch-hartfalen-nejm-galactic-hf/","title":"Omecamtiv mecarbil bij systolisch hartfalen: NEJM GALACTIC-HF","title_en":"Cardiac Myosin Activation with Omecamtiv Mecarbil in Systolic Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2025797","source_url":"https://doi.org/10.1056/NEJMoa2025797","authors":["John R Teerlink","Rafael Diaz","G Michael Felker","John J V McMurray","Marco Metra","Scott D Solomon","Kirkwood F Adams","Inder Anand","Alexandra Arias-Mendoza","Tor Biering-Sørensen","Michael Böhm","Diana Bonderman","John G F Cleland","Ramon Corbalan","Maria G Crespo-Leiro","Ulf Dahlström","Luis E Echeverria","James C Fang","Gerasimos Filippatos","Cândida Fonseca","Eva Goncalvesova","Assen R Goudev","Jonathan G Howlett","David E Lanfear","Jing Li","Mayanna Lund","Peter Macdonald","Viacheslav Mareev","Shin-Ichi Momomura","Eileen O'Meara","Alexander Parkhomenko","Piotr Ponikowski","Felix J A Ramires","Pranas Serpytis","Karen Sliwa","Jindrich Spinar","Thomas M Suter","Janos Tomcsanyi","Hans Vandekerckhove","Dragos Vinereanu","Adriaan A Voors","Mehmet B Yilmaz","Faiez Zannad","Lucie Sharpsten","Jason C Legg","Claire Varin","Narimon Honarpour","Siddique A Abbasi","Fady I Malik","Christopher E Kurtz"],"significance":9,"published":"2021-01-14","source_date":"2021-01-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The GALACTIC-HF trial demonstrated that omecamtiv mecarbil, a selective cardiac myosin activator, modestly reduced the composite of heart failure events or cardiovascular death in patients with HFrEF. The trial validated a novel mechanism targeting cardiac contractility without increasing intracellular calcium or myocardial oxygen demand.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM GALACTIC-HF trial die aantoonde dat omecamtiv mecarbil (selectieve cardiale myosineactivator) HF-events vermindert bij systolisch hartfalen. Nieuw werkingsmechanisme — directe versterking van myocardcontractiliteit.","abstract_original":"BACKGROUND: The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS: We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS: During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS: Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016-002299-28.)."},{"id":"ee2b933339d3","type":"article","url":"https://hartvaat.nl/2021/01/07/antisense-tegen-microrna-132-bij-hartfalen-fase-1b-resultaten/","title":"Antisense tegen microRNA-132 bij hartfalen: fase 1b resultaten","title_en":"Novel antisense therapy targeting microRNA-132 in patients with heart failure: results of a first-in-human Phase 1b randomized, double-blind, placebo-controlled study.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaa898","source_url":"https://doi.org/10.1093/eurheartj/ehaa898","authors":["Jörg Täubel","Wilfried Hauke","Steffen Rump","Janika Viereck","Sandor Batkai","Jenny Poetzsch","Laura Rode","Henning Weigt","Celina Genschel","Ulrike Lorch","Carmen Theek","Arthur A Levin","Johann Bauersachs","Scott D Solomon","Thomas Thum"],"significance":7,"published":"2021-01-07","source_date":"2021-01-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This first-in-human phase 1b study of an antisense oligonucleotide targeting microRNA-132 in heart failure demonstrated safety and favorable effects on cardiac biomarkers, establishing a novel RNA-based therapeutic approach for cardiac remodeling.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Eerste resultaten van een fase 1b studie van antisense-therapie gericht tegen microRNA-132 bij hartfalen. Nieuwe RNA-gebaseerde HF-therapie.","abstract_original":"AIMS: Cardiac microRNA-132-3p (miR-132) levels are increased in patients with heart failure (HF) and mechanistically drive cardiac remodelling processes. CDR132L, a specific antisense oligonucleotide, is a first-in-class miR-132 inhibitor that attenuates and even reverses HF in preclinical models. The aim of the current clinical Phase 1b study was to assess safety, pharmacokinetics, target engagement, and exploratory pharmacodynamic effects of CDR132L in patients on standard-of-care therapy for chronic ischaemic HF in a randomized, placebo-controlled, double-blind, dose-escalation study (NCT04045405). METHODS AND RESULTS: Patients had left ventricular ejection fraction between ≥30% and <50% or amino terminal fragment of pro-brain natriuretic peptide (NT-proBNP) >125 ng/L at screening. Twenty-eight patients were randomized to receive CDR132L (0.32, 1, 3, and 10 mg/kg body weight) or placebo (0.9% saline) in two intravenous infusions, 4 weeks apart in four cohorts of seven (five verum and two placebo) patients each. CDR132L was safe and well tolerated, without apparent dose-limiting toxicity. A pharmacokinetic/pharmacodynamic dose modelling approach suggested an effective dose level at ≥1 mg/kg CDR132L. CDR132L treatment resulted in a dose-dependent, sustained miR-132 reduction in plasma. Patients given CDR132L ≥1 mg/kg displayed a median 23.3% NT-proBNP reduction, vs. a 0.9% median increase in the control group. CDR132L treatment induced significant QRS narrowing and encouraging positive trends for relevant cardiac fibrosis biomarkers. CONCLUSION: This study is the first clinical trial of an antisense drug in HF patients. CDR132L was safe and well tolerated, confirmed linear plasma pharmacokinetics with no signs of accumulation, and suggests cardiac functional improvements. Although this study is limited by the small patient numbers, the indicative efficacy of this drug is very encouraging justifying additional clinical studies to confirm the beneficial CDR132L pharmacodynamic effects for the treatment of HF."},{"id":"0f14ea95fc72","type":"article","url":"https://hartvaat.nl/2021/01/05/calcium-geinduceerde-autonome-denervatie-bij-postoperatief-af/","title":"Calcium-geïnduceerde autonome denervatie bij postoperatief AF","title_en":"Calcium-Induced Autonomic Denervation in Patients With Post-Operative Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["renale-denervatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.10.049","source_url":"https://doi.org/10.1016/j.jacc.2020.10.049","authors":["Huishan Wang","Yuji Zhang","Fangran Xin","Hui Jiang","Dengshun Tao","Yan Jin","Yuanchen He","Qiang Wang","Sunny S Po"],"significance":5,"published":"2021-01-05","source_date":"2021-01-05","image":"","kennis":[],"congress":"","summary_en":"This study tested calcium-induced autonomic denervation for preventing postoperative atrial fibrillation after cardiac surgery, exploring a targeted autonomic intervention for this common surgical complication.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar calcium-geïnduceerde autonome denervatie bij patiënten met postoperatief atriumfibrilleren.","abstract_original":"BACKGROUND: Post-operative atrial fibrillation (POAF) is associated with worse long-term cardiovascular outcomes. OBJECTIVES: This study hypothesized that injecting calcium chloride (CaCl2) into the major atrial ganglionated plexi (GPs) during isolated coronary artery bypass grafting (CABG) can reduce the incidence of POAF by calcium-induced autonomic neurotoxicity. METHODS: This proof-of-concept study randomized 200 patients undergoing isolated, off-pump CABG to CaCl2 (n = 100) or sodium chloride (sham, n = 100) injection. Two milliliters of CaCl2 (5%) or sodium chloride (0.9%) was injected into the 4 major atrial GPs during CABG. All patients received 7-day continuous telemetry and Holter monitoring. The primary outcome was incidence of POAF (≥30 s) in 7 days. Secondary outcomes included length of hospitalization, POAF burden, average ventricular rate during AF, plasma level of inflammatory markers, and actionable antiarrhythmic therapy to treat POAF. RESULTS: The POAF incidence was reduced from 36% to 15% (hazard ratio: 0.366; 95% confidence interval: 0.211 to 0.635; p = 0.001). Length of hospitalization did not differ between the 2 groups. POAF burden (first 7 post-operative days), the use of amiodarone or esmolol, and the incidence of atrial couplets and nonsustained atrial tachyarrhythmias were significantly reduced in the CaCl2 group. Heart rate variability data showed a decrease in both high-frequency and low-frequency power in the CaCl2 group with a preserved low-frequency/high-frequency ratio, suggesting that the sympathetic/parasympathetic balance was not perturbed by CaCl2 injection. CONCLUSIONS: Injection of CaCl2 into the 4 major atrial GPs reduced the POAF hazard by 63%. Inhibition of GP function by Ca-mediated neurotoxicity may underlie the therapeutic effect. (Calcium Autonomic Denervation Prevents Postoperative Atrial Fibrillation; ChiCTR1800019276)."},{"id":"73e521cf3256","type":"article","url":"https://hartvaat.nl/2021/01/05/leeftijd-en-10-jaarsuitkomsten-na-cabg-art-trial/","title":"Leeftijd en 10-jaarsuitkomsten na CABG: ART-trial","title_en":"Association of Age With 10-Year Outcomes After Coronary Surgery in the Arterial Revascularization Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.10.047","source_url":"https://doi.org/10.1016/j.jacc.2020.10.047","authors":["Mario Gaudino","Antonino Di Franco","Marcus Flather","Stephen Gerry","Emilia Bagiella","Alastair Gray","Leon Pearcey","Teng-Hui Saw","Belinda Lees","Umberto Benedetto","Stephen E Fremes","David P Taggart"],"significance":6,"published":"2021-01-05","source_date":"2021-01-05","image":"","kennis":[],"congress":"","summary_en":"This ART trial analysis showed that the relative benefit of bilateral versus single internal thoracic artery grafts in CABG is modified by age, with younger patients potentially deriving more benefit from the bilateral approach.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ART-trial analyse naar de associatie van leeftijd met 10-jaarsuitkomsten na coronaire chirurgie.","abstract_original":"BACKGROUND: The association of age with the outcomes of bilateral internal thoracic arteries (BITAs) versus single internal thoracic arteries (SITAs) for coronary bypass grafting (CABG) remains to be determined. OBJECTIVES: The purpose of this study was to evaluate the association between age and BITA versus SITA outcomes in the Arterial Revascularization Trial. METHODS: The primary endpoints were all-cause mortality and a composite of major adverse events, including all-cause mortality, myocardial infarction, or stroke. Secondary endpoints were bleeding complications and sternal wound complications up to 6 months after surgery. Multivariable fractional polynomials analysis and log-rank tests were used. RESULTS: Age did not affect any of the explored outcomes in the overall BITA versus SITA comparison in the intention-to-treat analysis and in the analysis based on the number of arterial grafts received. However, when the intention-to-treat analysis was restricted to the populations of patients between age 50 and 70 years, younger patients in the BITA arm had a significantly lower incidence of major adverse events (p = 0.03). CONCLUSIONS: Our results suggest that BITA may improve long-term outcome in younger patients, although more randomized data are needed to confirm this hypothesis."},{"id":"5084797dcbc8","type":"article","url":"https://hartvaat.nl/2021/01/05/management-van-pfo-patienten-met-cva-of-tia-jama-klinisch-overzicht/","title":"Management van PFO-patiënten met CVA of TIA: JAMA klinisch overzicht","title_en":"Management of Patients With a Patent Foramen Ovale With History of Stroke or TIA.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.22176","source_url":"https://doi.org/10.1001/jama.2020.22176","authors":["AbdulRahman Dia","Adam S Cifu","Atman P Shah"],"significance":7,"published":"2021-01-05","source_date":"2021-01-05","image":"","kennis":[],"congress":"","summary_en":"This JAMA clinical review provided a comprehensive overview of managing patients with patent foramen ovale and history of stroke or TIA, covering diagnostic workup, closure decision-making, and long-term follow-up strategies.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA klinisch overzicht over het management van patiënten met patent foramen ovale en voorgeschiedenis van beroerte of TIA.","abstract_original":""},{"id":"d632d0a3e9fe","type":"article","url":"https://hartvaat.nl/2021/01/05/hoog-dosis-versus-standaarddosis-griepvaccin-en-mortaliteit-bij-ouderen-jama/","title":"Hoog-dosis versus standaarddosis griepvaccin en mortaliteit bij ouderen: JAMA","title_en":"Effect of High-Dose Trivalent vs Standard-Dose Quadrivalent Influenza Vaccine on Mortality or Cardiopulmonary Hospitalization in Patients With High-risk Cardiovascular Disease: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2020.23649","source_url":"https://doi.org/10.1001/jama.2020.23649","authors":["Orly Vardeny","KyungMann Kim","Jacob A Udell","Jacob Joseph","Akshay S Desai","Michael E Farkouh","Sheila M Hegde","Adrian F Hernandez","Allison McGeer","H Keipp Talbot","Inder Anand","Deepak L Bhatt","Christopher P Cannon","David DeMets","J Michael Gaziano","Shaun G Goodman","Kristin Nichol","Matthew C Tattersall","Jonathan L Temte","Janet Wittes","Clyde Yancy","Brian Claggett","Yi Chen","Lu Mao","Thomas C Havighurst","Lawton S Cooper","Scott D Solomon"],"significance":7,"published":"2021-01-05","source_date":"2021-01-05","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial comparing high-dose trivalent with standard-dose quadrivalent influenza vaccine on cardiovascular-related outcomes in elderly patients explored whether enhanced immunogenicity translates to cardiovascular protection in the highest-risk population.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA trial die hoog-dosis versus standaarddosis griepvaccin vergeleek op mortaliteit en cardiopulmonale hospitalisatie bij ouderen.","abstract_original":"IMPORTANCE: Influenza is temporally associated with cardiopulmonary morbidity and mortality among those with cardiovascular disease who may mount a less vigorous immune response to vaccination. Higher influenza vaccine dose has been associated with reduced risk of influenza illness. OBJECTIVE: To evaluate whether high-dose trivalent influenza vaccine compared with standard-dose quadrivalent influenza vaccine would reduce all-cause death or cardiopulmonary hospitalization in high-risk patients with cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS: Pragmatic multicenter, double-blind, active comparator randomized clinical trial conducted in 5260 participants vaccinated for up to 3 influenza seasons in 157 sites in the US and Canada between September 21, 2016, and January 31, 2019. Patients with a recent acute myocardial infarction or heart failure hospitalization and at least 1 additional risk factor were eligible. INTERVENTIONS: Participants were randomly assigned to receive high-dose trivalent (n = 2630) or standard-dose quadrivalent (n = 2630) inactivated influenza vaccine and could be revaccinated for up to 3 seasons. MAIN OUTCOMES AND MEASURES: The primary outcome was the time to the composite of all-cause death or cardiopulmonary hospitalization during each enrolling season. The final date of follow-up was July 31, 2019. Vaccine-related adverse events were also assessed. RESULTS: Among 5260 randomized participants (mean [SD] age, 65.5 [12.6] years; 3787 [72%] men; 3289 [63%] with heart failure) over 3 influenza seasons, there were 7154 total vaccinations administered and 5226 (99.4%) participants completed the trial. In the high-dose trivalent vaccine group, there were 975 primary outcome events (883 hospitalizations for cardiovascular or pulmonary causes and 92 deaths from any cause) among 884 participants during 3577 participant-seasons (event rate, 45 per 100 patient-years), whereas in the standard-dose quadrivalent vaccine group, there were 924 primary outcome events (846 hospitalizations for cardiovascular or pulmonary causes and 78 deaths from any cause) among 837 participants during 3577 participant-seasons (event rate, 42 per 100 patient-years) (hazard ratio, 1.06 [95% CI, 0.97-1.17]; P = .21). In the high-dose vs standard-dose groups, vaccine-related adverse reactions occurred in 1449 (40.5%) vs 1229 (34.4%) participants and severe adverse reactions occurred in 55 (2.1%) vs 44 (1.7%) participants. CONCLUSIONS AND RELEVANCE: In patients with high-risk cardiovascular disease, high-dose trivalent inactivated influenza vaccine, compared with standard-dose quadrivalent inactivated influenza vaccine, did not significantly reduce all-cause mortality or cardiopulmonary hospitalizations. Influenza vaccination remains strongly recommended in this population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02787044."},{"id":"ece8547ce021","type":"article","url":"https://hartvaat.nl/2021/01/05/revascularisatiereductie-met-icosapent-ethyl-reduce-it-analyse/","title":"Revascularisatiereductie met icosapent-ethyl: REDUCE-IT analyse","title_en":"Reduction in Revascularization With Icosapent Ethyl: Insights From REDUCE-IT Revascularization Analyses.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.050276","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.050276","authors":["Benjamin E Peterson","Deepak L Bhatt","Ph Gabriel Steg","Michael Miller","Eliot A Brinton","Terry A Jacobson","Steven B Ketchum","Rebecca A Juliano","Lixia Jiao","Ralph T Doyle","Craig Granowitz","C Michael Gibson","Duane Pinto","Robert P Giugliano","Matthew J Budoff","Jean-Claude Tardif","Subodh Verma","Christie M Ballantyne"],"significance":6,"published":"2021-01-05","source_date":"2021-01-05","image":"","kennis":[],"congress":"","summary_en":"This REDUCE-IT analysis showed that icosapent ethyl significantly reduces the need for coronary revascularization procedures in statin-treated patients with elevated triglycerides, demonstrating a direct impact on interventional cardiology burden.","created":"2026-07-03T10:28:59Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"REDUCE-IT analyse naar de reductie in revascularisatieprocedures met icosapent-ethyl.","abstract_original":"BACKGROUND: Patients with elevated triglycerides despite statin therapy have increased risk for ischemic events, including coronary revascularizations. METHODS: REDUCE-IT (The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a multicenter, double-blind, placebo-controlled trial, randomly assigned statin-treated patients with elevated triglycerides (135-499 mg/dL), controlled low-density lipoprotein (41-100 mg/dL), and either established cardiovascular disease or diabetes plus other risk factors to receive icosapent ethyl 4 g/d or placebo. The primary and key secondary composite end points were significantly reduced. Prespecified analyses examined all coronary revascularizations, recurrent revascularizations, and revascularization subtypes. RESULTS: A total of 8179 randomly assigned patients were followed for 4.9 years (median). First revascularizations were reduced to 9.2% (22.5/1000 patient-years) with icosapent ethyl versus 13.3% (33.7/1000 patient-years) with placebo (hazard ratio, 0.66 [95% CI, 0.58-0.76]; P<0.0001; number needed to treat for 4.9 years=24); similar reductions were observed in total (first and subsequent) revascularizations (negative binomial rate ratio, 0.64 [95% CI, 0.56-0.74]; P<0.0001), and across elective, urgent, and emergent revascularizations. Icosapent ethyl significantly reduced percutaneous coronary intervention (hazard ratio, 0.68 [95% CI, 0.59-0.79]; P<0.0001) and coronary artery bypass grafting (hazard ratio, 0.61 [95% CI, 0.45-0.81]; P=0.0005). CONCLUSIONS: Icosapent ethyl reduced the need for first and subsequent coronary revascularizations in statin-treated patients with elevated triglycerides and increased cardiovascular risk. To our knowledge, icosapent ethyl is the first non-low-density lipoprotein-lowering treatment that has been shown to reduce coronary artery bypass grafting in a blinded, randomized trial. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01492361."},{"id":"99715b7bd949","type":"article","url":"https://hartvaat.nl/2021/01/01/passive-choice-en-active-choice-interventies-voor-statinevoorschrijving-jama-car/","title":"Passive choice en active choice interventies voor statinevoorschrijving: JAMA Cardiology","title_en":"Effect of Passive Choice and Active Choice Interventions in the Electronic Health Record to Cardiologists on Statin Prescribing: A Cluster Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":["atleten","farmaco-economie","hartrevalidatie","select-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.4730","source_url":"https://doi.org/10.1001/jamacardio.2020.4730","authors":["Srinath Adusumalli","Julie E Westover","Douglas S Jacoby","Dylan S Small","Christine VanZandbergen","Jessica Chen","Ann M Cavella","Rebecca Pepe","Charles A L Rareshide","Christopher K Snider","Kevin G Volpp","David A Asch","Mitesh S Patel"],"significance":6,"published":"2021-01-01","source_date":"2021-01-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial tested electronic health record-based nudging interventions (passive choice and active choice) to increase statin prescribing by cardiologists, evaluating behavioral economics approaches to closing the treatment gap.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial van elektronisch patiëntendossier-interventies (nudging) voor statinevoorschrijving door cardiologen.","abstract_original":"IMPORTANCE: Statin therapy is underused for many patients who could benefit. OBJECTIVE: To evaluate the effect of passive choice and active choice interventions in the electronic health record (EHR) to promote guideline-directed statin therapy. DESIGN, SETTING, AND PARTICIPANTS: Three-arm randomized clinical trial with a 6-month preintervention period and 6-month intervention. Randomization conducted at the cardiologist level at 16 cardiology practices in Pennsylvania and New Jersey. The study included 82 cardiologists and 11 693 patients. Data were analyzed between May 8, 2019, and January 9, 2020. INTERVENTIONS: In passive choice, cardiologists had to manually access an alert embedded in the EHR to select options to initiate or increase statin therapy. In active choice, an interruptive EHR alert prompted the cardiologist to accept or decline guideline-directed statin therapy. Cardiologists in the control group were informed of the trial but received no other interventions. MAIN OUTCOMES AND MEASURES: Primary outcome was statin therapy at optimal dose based on clinical guidelines. Secondary outcome was statin therapy at any dose. RESULTS: The sample comprised 11 693 patients with a mean (SD) age of 63.8 (9.1) years; 58% were male (n = 6749 of 11 693), 66% were White (n = 7683 of 11 693), and 24% were Black (n = 2824 of 11 693). The mean (SD) 10-year atherosclerotic cardiovascular disease (ASCVD) risk score was 15.4 (10.0); 68% had an ASVCD clinical diagnosis. Baseline statin prescribing rates at the optimal dose were 40.3% in the control arm, 39.1% in the passive choice arm, and 41.2% in the active choice arm. In adjusted analyses, the change in statin prescribing rates at optimal dose over time was not significantly different from control for passive choice (adjusted difference in percentage points, 0.2; 95% CI, -2.9 to 2.8; P = .86) or active choice (adjusted difference in percentage points, 2.4; 95% CI, -0.6 to 5.0; P = .08). In adjusted analyses of the subset of patients with clinical ASCVD, the active choice intervention resulted in a significant increase in statin prescribing at optimal dose relative to control (adjusted difference in percentage points, 3.8; 95% CI, 1.0-6.4; P = .008). No other subset analyses were significant. There were no significant changes in statin prescribing at any dose for either intervention. CONCLUSIONS AND RELEVANCE: The passive choice and active choice interventions did not change statin prescribing. In the subgroup of patients with clinical ASCVD, the active choice intervention led to a small increase in statin prescribing at the optimal dose, which could inform the design or targeting of future interventions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03271931."},{"id":"e526bdaa5e58","type":"article","url":"https://hartvaat.nl/2021/01/01/rivaroxaban-plus-aspirine-bij-symptomatisch-pav-compass-subanalyse/","title":"Rivaroxaban plus aspirine bij symptomatisch PAV: COMPASS subanalyse","title_en":"Rivaroxaban and Aspirin in Patients With Symptomatic Lower Extremity Peripheral Artery Disease: A Subanalysis of the COMPASS Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2020.4390","source_url":"https://doi.org/10.1001/jamacardio.2020.4390","authors":["Eric Kaplovitch","John W Eikelboom","Leanne Dyal","Victor Aboyans","Maria Teresa Abola","Peter Verhamme","Alvaro Avezum","Keith A A Fox","Scott D Berkowitz","Shrikant I Bangdiwala","Salim Yusuf","Sonia S Anand"],"significance":6,"published":"2021-01-01","source_date":"2021-01-01","image":"","kennis":[],"congress":"","summary_en":"This COMPASS subanalysis confirmed that rivaroxaban plus aspirin reduces major vascular events specifically in patients with symptomatic lower extremity peripheral artery disease, supporting dual-pathway inhibition in the PAD population.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COMPASS subanalyse bij patiënten met symptomatisch perifeer arterieel vaatlijden van de onderste extremiteiten.","abstract_original":"IMPORTANCE: Patients with symptomatic lower extremity peripheral artery disease (LE-PAD) experience an increased risk of major vascular events. There is limited information on what clinical features of symptomatic LE-PAD prognosticate major vascular events and whether patients at high risk have a greater absolute benefit from low-dose rivaroxaban and aspirin. OBJECTIVE: To quantify the risk of major vascular events and investigate the response to treatment with low-dose rivaroxaban and aspirin among patients with symptomatic LE-PAD based on clinical presentation and comorbidities. DESIGN, SETTING, AND PARTICIPANTS: This is a subanalysis of a previously reported subgroup of patients with symptomatic LE-PAD who were enrolled in a large, double-blind, placebo-controlled randomized clinical trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies [COMPASS]) in 602 centers in 33 countries from March 2013 to January 2020. Data analysis was completed from May 2016 to June 2020. INTERVENTIONS: A combination of low-dose rivaroxaban and aspirin compared with aspirin alone. MAIN OUTCOMES AND MEASURES: Thirty-month incidence risk of myocardial infarction, stroke and cardiovascular death (MACE), major adverse limb events (MALE) including major vascular amputation, and bleeding. RESULTS: The COMPASS trial enrolled 4129 patients with symptomatic LE-PAD (mean [SD] age, 66.8 [8.8] years; 2932 men [71.0%]). The 30-month Kaplan-Meier incidence risk of MACE or MALE, including major amputation, was 22.6% in those with prior amputation (this outcome was observed in 54 patients), 17.6% (n = 15) in those with Fontaine III or IV symptoms, and 11.8% (n = 142) in those with previous peripheral artery revascularization, classifying these features as high-risk limb presentations. The 30-month incidence risk of MACE or MALE, including major amputation, was 14.1% (n = 118) in those with kidney dysfunction, 13.5% (n = 67) in those with heart failure, 13.4% (n = 199) in those with diabetes, and 12.8% (n = 222) in those with polyvascular disease, classifying these features as high-risk comorbidities. Among patients with either high-risk limb presentations or high-risk comorbidities, treatment with rivaroxaban and aspirin compared with aspirin alone was associated with an estimated 4.2% (95% CI, 1.9%-6.2%) absolute risk reduction for MACE or MALE, including major amputation, at 30 months. Although the estimated absolute risk increase of major bleeding was higher with rivaroxaban and aspirin in combination than aspirin alone (2.0% [95% CI, 0.5%-3.9%]) for patients with either high-risk limb presentation or high-risk comorbidity, the estimated absolute risk increase of fatal or critical organ bleeding was low in this high-risk group (0.4% [95% CI, 0.2%-1.8%]), such that the net clinical benefit was estimated to be 3.2% (95% CI, 0.6%-5.3%). CONCLUSIONS AND RELEVANCE: Patients with LE-PAD with high-risk limb presentations or high-risk comorbidities had a high incidence of major vascular events. For these patients, treatment with rivaroxaban and aspirin in combination compared with aspirin alone led to a large absolute reduction in vascular risk."},{"id":"69e933fe09ea","type":"article","url":"https://hartvaat.nl/2021/01/01/plasmatrogconcentraties-van-antihypertensiva-voor-therapietrouwbeoordeling-meta-/","title":"Plasmatrogconcentraties van antihypertensiva voor therapietrouwbeoordeling: meta-analyse","title_en":"Plasma Trough Concentrations of Antihypertensive Drugs for the Assessment of Treatment Adherence: A Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16061","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16061","authors":["Eline H Groenland","Monique E A M van Kleef","Michiel L Bots","Frank L J Visseren","Kim C M van der Elst","Wilko Spiering"],"significance":6,"published":"2021-01-01","source_date":"2021-01-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated plasma trough concentrations of antihypertensive drugs as an objective measure of medication adherence, establishing biochemical screening as a practical tool for identifying non-adherent hypertensive patients.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse naar het gebruik van plasmatrogconcentraties van antihypertensiva voor objectieve beoordeling van therapietrouw.","abstract_original":"Biochemical drug screening by liquid chromatography-tandem mass spectrometry in plasma is an accurate method for the quantification of plasma concentrations of antihypertensive medications in patients with hypertension. Trough concentrations could possibly be used as drug-specific cutoff values in the biochemical assessment of (non-)adherence. We performed a literature review and meta-analysis of pharmacokinetic studies to determine plasma trough concentrations of amlodipine, hydrochlorothiazide, and valsartan. PubMed was searched for pharmacokinetic studies up to September 2020. Eligible studies reported steady-state mean trough concentration and their variance. Pooled trough concentrations were estimated using a three-level random effects meta-analytic model. Moderator analyses were performed to explore sources of heterogeneity. One thousand three hundred eighteen potentially relevant articles were identified of which 45 were eligible for inclusion. The pooled mean trough concentration was 9.2 ng/mL (95% CI, 7.5-10.8) for amlodipine, 41.0 ng/mL (95% CI, 17.4-64.7) for hydrochlorothiazide, and 352.9 ng/mL (95% CI, 243.5-462.3) for valsartan. Substantial heterogeneity was present for all 3 pooled estimates. Moderator analyses identified dosage as a significant moderator for the pooled trough concentration of amlodipine (β1=0.9; P<0.05), mean age, and mean body weight for the mean trough concentration of hydrochlorothiazide (β1=2.2, P<0.05, respectively, β1=-4.0, P<0.05) and no significant moderators for valsartan. Plasma trough concentrations of amlodipine, hydrochlorothiazide, and valsartan, measured with liquid chromatography-tandem mass spectrometry, are highly heterogeneous over the different studies. Use of the pooled trough concentration as a cutoff in the biochemical assessment of adherence can result in inaccurate diagnosis of (non-)adherence, which may seriously harm the patient-physician relationship, and is therefore not recommended."},{"id":"dfab4e26a7e0","type":"article","url":"https://hartvaat.nl/2021/01/01/dash-dieet-verbetert-bloeddruk-en-vaatgezondheid-bij-jongeren-met-verhoogde-bloe/","title":"DASH-dieet verbetert bloeddruk en vaatgezondheid bij jongeren met verhoogde bloeddruk","title_en":"Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.120.16156","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.120.16156","authors":["Sarah C Couch","Brian E Saelens","Philip R Khoury","Katherine B Dart","Kelli Hinn","Mark M Mitsnefes","Stephen R Daniels","Elaine M Urbina"],"significance":6,"published":"2021-01-01","source_date":"2021-01-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that a DASH-focused dietary intervention improves blood pressure and vascular health in young adults with elevated blood pressure, supporting early nutritional intervention for hypertension prevention.","created":"2026-07-03T10:28:58Z","updated":"2026-07-03T13:28:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat het DASH-dieet bloeddruk en vaatgezondheid verbetert bij jongeren met verhoogde bloeddruk.","abstract_original":"This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (-2.7 mm Hg, P= 0.03, -0.3 z-score, P=0.03), flow-mediated dilation (2.5%, P=0.05), and DASH score (13.3 points, P<0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P=0.03) and DASH score (7.4 points, P=0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00585832."}]}