{"generated":"2026-08-28T16:42:09Z","year":"2022","count":285,"licence":"Citeer vrij, met bronvermelding en een link naar 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":"a44c6d984a68","type":"article","url":"https://hartvaat.nl/2022/12/29/chloortalidon-versus-hydrochloorthiazide-geen-verschil-in-cv-events/","title":"Chloortalidon versus hydrochloorthiazide: geen verschil in CV-events","title_en":"Chlorthalidone vs. Hydrochlorothiazide for Hypertension-Cardiovascular Events.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2212270","source_url":"https://doi.org/10.1056/NEJMoa2212270","authors":["Areef Ishani","William C Cushman","Sarah M Leatherman","Robert A Lew","Patricia Woods","Peter A Glassman","Addison A Taylor","Cynthia Hau","Alison Klint","Grant D Huang","Mary T Brophy","Louis D Fiore","Ryan E Ferguson"],"significance":9,"published":"2022-12-29","source_date":"2022-12-29","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/"],"congress":"","summary_en":"This large pragmatic NEJM trial in 13,000 hypertensive veterans demonstrated that chlorthalidone was not superior to hydrochlorothiazide for preventing major cardiovascular events. The results challenged the assumption of chlorthalidone's superiority and supported continued use of either thiazide diuretic.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T13:29:14Z","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":"Pragmatische NEJM-trial bij 13.000 hypertensieve veteranen toonde dat chloortalidon niet superieur was aan hydrochloorthiazide voor cardiovasculaire events. Dit beëindigt de langlopende discussie en valideert het meest voorgeschreven thiazidediureticum.","abstract_original":"BACKGROUND: Whether chlorthalidone is superior to hydrochlorothiazide for preventing major adverse cardiovascular events in patients with hypertension is unclear. METHODS: In a pragmatic trial, we randomly assigned adults 65 years of age or older who were patients in the Department of Veterans Affairs health system and had been receiving hydrochlorothiazide at a daily dose of 25 or 50 mg to continue therapy with hydrochlorothiazide or to switch to chlorthalidone at a daily dose of 12.5 or 25 mg. The primary outcome was a composite of nonfatal myocardial infarction, stroke, heart failure resulting in hospitalization, urgent coronary revascularization for unstable angina, and non-cancer-related death. Safety was also assessed. RESULTS: A total of 13,523 patients underwent randomization. The mean age was 72 years. At baseline, hydrochlorothiazide at a dose of 25 mg per day had been prescribed in 12,781 patients (94.5%). The mean baseline systolic blood pressure in each group was 139 mm Hg. At a median follow-up of 2.4 years, there was little difference in the occurrence of primary-outcome events between the chlorthalidone group (702 patients [10.4%]) and the hydrochlorothiazide group (675 patients [10.0%]) (hazard ratio, 1.04; 95% confidence interval, 0.94 to 1.16; P = 0.45). There were no between-group differences in the occurrence of any of the components of the primary outcome. The incidence of hypokalemia was higher in the chlorthalidone group than in the hydrochlorothiazide group (6.0% vs. 4.4%, P<0.001). CONCLUSIONS: In this large pragmatic trial of thiazide diuretics at doses commonly used in clinical practice, patients who received chlorthalidone did not have a lower occurrence of major cardiovascular outcome events or non-cancer-related deaths than patients who received hydrochlorothiazide. (Funded by the Veterans Affairs Cooperative Studies Program; ClinicalTrials.gov number, NCT02185417.)."},{"id":"c0400d3607f1","type":"article","url":"https://hartvaat.nl/2022/12/22/orthostatische-bloeddruk-en-intensieve-behandeling-sprint-inzichten/","title":"Orthostatische bloeddruk en intensieve behandeling: SPRINT-inzichten","title_en":"Relationship between orthostatic blood pressure changes and intensive blood pressure management in patients with hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321276","source_url":"https://doi.org/10.1136/heartjnl-2022-321276","authors":["Junyu Pei","Hao Zhang","Yanan Li","Jiafu Yan","Keyang Zheng","Xiaopu Wang","Xi-Long Zheng","Xinqun Hu"],"significance":6,"published":"2022-12-22","source_date":"2022-12-22","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This SPRINT analysis showed that intensive blood pressure treatment does not significantly increase the risk of orthostatic hypotension, providing reassurance for aggressive blood pressure management in the elderly.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T13:29:13Z","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":"Analyse van SPRINT toonde dat intensieve bloeddrukbehandeling het risico op orthostatische hypotensie niet significant verhoogde. Dit nuanceert de bezorgdheid dat agressieve behandeling tot vallen en duizeligheid leidt bij ouderen.","abstract_original":"INTRODUCTION: The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that closely controlling blood pressure (BP) could decrease cardiovascular outcome risk without increasing the orthostatic hypotension rate. We aimed to evaluate the association between baseline orthostatic BP change and major adverse cardiovascular event (MACE) occurrence. METHODS: We conducted a post hoc analysis using SPRINT data including 9329 patients with hypertension. The SPRINT trial was a two-arm, multicentre, randomised clinical trial designed to test whether an intensive treatment aimed at reducing systolic BP (SBP) to <120 mm Hg would reduce cardiovascular disease risk. Orthostatic BP change was defined as baseline standing systolic BP (SBP)-baseline mean seated SBP, or diastolic BP (DBP)-baseline mean seated DBP. RESULTS: We found a U-shaped relationship between orthostatic BP changes and MACE occurrence. All lowest risk points were around 0 mm Hg. On the left side of the inflection point, MACE risk decreased with orthostatic BP change decrease (HR=0.99, 95% CI (0.98 to 1.00), p=0.04, SBP change) (HR=0.97, 95% CI (0.95 to 0.99), p<0.01, DBP change); on the right side, MACE risk increased with orthostatic BP change increase (HR=1.02, 95% CI (1.01 to 1.06), p<0.01, SBP change) (HR=1.01, 95% CI (1.00 to 1.03), p=0.16, DBP change). There was no significant interaction effect between orthostatic SBP (p for interaction=0.37) or DBP changes (p for interaction=0.33) and intensive BP management. CONCLUSIONS: Orthostatic DBP increase and SBP decrease were associated with an increased MACE risk. The benefits of intensive BP management were also consistent across different orthostatic BP change ranges."},{"id":"79c9bb754226","type":"article","url":"https://hartvaat.nl/2022/12/21/orion-11-inclisiran-verlaagt-ldl-effectief-bij-primaire-preventie/","title":"ORION-11: inclisiran verlaagt LDL effectief bij primaire preventie","title_en":"Effect of inclisiran on lipids in primary prevention: the ORION-11 trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bempedoïnezuur","dyslipidemie","ezetimibe","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","pelacarsen","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac615","source_url":"https://doi.org/10.1093/eurheartj/ehac615","authors":["Kausik K Ray","David Kallend","Lawrence A Leiter","Frederick J Raal","Wolfgang Koenig","Mark J Jaros","Gregory G Schwartz","Ulf Landmesser","Lorena Garcia Conde","R Scott Wright"],"significance":7,"published":"2022-12-21","source_date":"2022-12-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/inclisiran-sirna/","https://hartvaat.nl/kennis/lipiden/pcsk9-mechanisme/"],"congress":"","summary_en":"This ORION-11 subanalysis showed that inclisiran effectively lowers LDL cholesterol in primary prevention patients on statins, demonstrating the twice-yearly injection's utility beyond the secondary prevention population.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T13:29:13Z","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":"Subanalyse van ORION-11 toonde dat inclisiran, een siRNA-gebaseerde PCSK9-remmer, het LDL-cholesterol ook bij primaire preventiepatiënten effectief en duurzaam verlaagde. De tweemaal jaarlijkse injectie biedt een praktisch alternatief voor dagelijkse medicatie.","abstract_original":"AIMS: Patients often require combination therapies to achieve LDL cholesterol (LDL-C) targets for the primary prevention of atherosclerotic cardiovascular disease. This study investigates the effect of inclisiran, a small interfering ribonucleic acid targeting hepatic proprotein convertase subtilisin/kexin type 9 production, in primary prevention patients with elevated LDL-C despite statins. METHODS AND RESULTS: This pre-specified analysis of the placebo-controlled, randomized ORION-11 trial included 203 individuals at risk of, but without prior, cardiovascular events and LDL-C ≥2.6 mmol/L, despite maximally tolerated statins. Inclisiran 284 mg or placebo was administered on Days 1, 90, and thereafter every 6 months up to 540 days. Co-primary endpoints were percentage LDL-C change from baseline to Day 510 and time-adjusted change from baseline after Day 90 and up to Day 540. Key secondary endpoints included percentage and absolute changes in atherogenic lipoproteins. Safety was assessed over 540 days. The mean baseline (SD) LDL-C was 3.6 (1.5) mmol/L. At Day 510, the placebo-corrected LDL-C change with inclisiran was -43.7% [95% confidence interval (CI): -52.8 to -34.6] with a corresponding time-adjusted change of -41.0% (95% CI: -47.8 to -34.2); (P < 0.0001). The placebo-corrected absolute change in LDL-C at Day 510 with inclisiran was -1.5 mmol/L (95% CI: -1.8 to -1.2), with a respective time-adjusted change of -1.3 mmol/L (95% CI: -1.6 to -1.1). Inclisiran significantly lowered non-HDL cholesterol and apolipoprotein B (apoB) at Day 510 vs. placebo (P < 0.0001 for both), with a greater likelihood of attaining lipoprotein and apoB goals, and was well-tolerated except for mainly mild, treatment-emergent adverse events at the injection site. CONCLUSION: Inclisiran was generally well-tolerated in primary prevention patients with elevated LDL-C, who derived significant reductions in atherogenic lipoprotein levels with twice-yearly maintenance dosing."},{"id":"22c389402f97","type":"article","url":"https://hartvaat.nl/2022/12/21/bloeddrukverlaging-en-dementiepreventie-ipd-meta-analyse/","title":"Bloeddrukverlaging en dementiepreventie: IPD meta-analyse","title_en":"Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac584","source_url":"https://doi.org/10.1093/eurheartj/ehac584","authors":["Ruth Peters","Ying Xu","Oisin Fitzgerald","Htein Linn Aung","Nigel Beckett","Christopher Bulpitt","John Chalmers","Francoise Forette","Jessica Gong","Katie Harris","Peter Humburg","Fiona E Matthews","Jan A Staessen","Lutgarde Thijs","Christophe Tzourio","Jane Warwick","Mark Woodward","Craig S Anderson"],"significance":8,"published":"2022-12-21","source_date":"2022-12-21","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This individual patient data meta-analysis demonstrated that blood pressure lowering reduces the risk of incident dementia, with no evidence of a U-shaped relationship at lower blood pressure levels. The analysis provided the strongest evidence yet for blood pressure control as a dementia prevention strategy.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T13:29:13Z","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":"Individuele-patiëntdata meta-analyse toonde dat bloeddrukverlaging het risico op dementie vermindert. Er was geen bewijs voor een U-vormige relatie — lagere bloeddruk was consistent beschermend. Dit ondersteunt antihypertensieve therapie als strategie voor dementiepreventie.","abstract_original":"AIMS: Observational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients. A pooled individual participant data analysis of five seminal randomized double-blind placebo-controlled trials was undertaken to better define the effects of BP-lowering treatment for the prevention of dementia. METHODS AND RESULTS: Multilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia. The total sample included 28 008 individuals recruited from 20 countries. After a median follow-up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval: 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4 mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk. CONCLUSION: The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well-controlled hypertension and of antihypertensive treatment commenced earlier in the life-course to reduce the long-term risk of dementia. CLASSIFICATION OF EVIDENCE: Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo."},{"id":"2014541a69c6","type":"article","url":"https://hartvaat.nl/2022/12/21/empagliflozine-en-het-circulerend-proteoom-bij-hartfalen-emperor-mechanismen/","title":"Empagliflozine en het circulerend proteoom bij hartfalen: EMPEROR-mechanismen","title_en":"Effect of empagliflozin on circulating proteomics in heart failure: mechanistic insights into the EMPEROR programme.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["empagliflozine","emperor-trials"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac495","source_url":"https://doi.org/10.1093/eurheartj/ehac495","authors":["Faiez Zannad","João Pedro Ferreira","Javed Butler","Gerasimos Filippatos","James L Januzzi","Mikhail Sumin","Matthias Zwick","Maral Saadati","Stuart J Pocock","Naveed Sattar","Stefan D Anker","Milton Packer"],"significance":6,"published":"2022-12-21","source_date":"2022-12-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/"],"congress":"","summary_en":"This proteomics analysis of EMPEROR program data revealed that empagliflozin significantly alters circulating protein profiles in heart failure, identifying molecular pathways that may explain SGLT2 inhibitor cardioprotection beyond diuresis.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T13:29:13Z","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":"Proteomics-analyse van EMPEROR-data onthulde dat empagliflozine het circulerend eiwit-profiel significant verandert bij hartfalen. Het middel beïnvloedt inflammatoire, fibrotische en metabole pathways, wat bijdraagt aan het begrip van het werkingsmechanisme van SGLT2-remmers.","abstract_original":"AIMS: Sodium-glucose co-transporter 2 (SGLT2) inhibitors improve cardiovascular outcomes in diverse patient populations, but their mechanism of action requires further study. The aim is to explore the effect of empagliflozin on the circulating levels of intracellular proteins in patients with heart failure, using large-scale proteomics. METHODS AND RESULTS: Over 1250 circulating proteins were measured at baseline, Week 12, and Week 52 in 1134 patients from EMPEROR-Reduced and EMPEROR-Preserved, using the Olink® Explore 1536 platform. Statistical and bioinformatical analyses identified differentially expressed proteins (empagliflozin vs. placebo), which were then linked to demonstrated biological actions in the heart and kidneys. At Week 12, 32 of 1283 proteins fulfilled our threshold for being differentially expressed, i.e. their levels were changed by ≥10% with a false discovery rate <1% (empagliflozin vs. placebo). Among these, nine proteins demonstrated the largest treatment effect of empagliflozin: insulin-like growth factor-binding protein 1, transferrin receptor protein 1, carbonic anhydrase 2, erythropoietin, protein-glutamine gamma-glutamyltransferase 2, thymosin beta-10, U-type mitochondrial creatine kinase, insulin-like growth factor-binding protein 4, and adipocyte fatty acid-binding protein 4. The changes of the proteins from baseline to Week 52 were generally concordant with the changes from the baseline to Week 12, except empagliflozin reduced levels of kidney injury molecule-1 by ≥10% at Week 52, but not at Week 12. The most common biological action of differentially expressed proteins appeared to be the promotion of autophagic flux in the heart, kidney or endothelium, a feature of 6 proteins. Other effects of differentially expressed proteins on the heart included the reduction of oxidative stress, inhibition of inflammation and fibrosis, and the enhancement of mitochondrial health and energy, repair, and regenerative capacity. The actions of differentially expressed proteins in the kidney involved promotion of autophagy, integrity and regeneration, suppression of renal inflammation and fibrosis, and modulation of renal tubular sodium reabsorption. CONCLUSIONS: Changes in circulating protein levels in patients with heart failure are consistent with the findings of experimental studies that have shown that the effects of SGLT2 inhibitors are likely related to actions on the heart and kidney to promote autophagic flux, nutrient deprivation signalling and transmembrane sodium transport."},{"id":"ef91d0be4027","type":"article","url":"https://hartvaat.nl/2022/12/17/ironman-intraveneus-ijzer-bij-hartfalen-met-ijzerdeficientie-lancet-rct/","title":"IRONMAN: intraveneus ijzer bij hartfalen met ijzerdeficiëntie — Lancet RCT","title_en":"Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["ijzersuppletie","ijzertekort"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)02083-9","source_url":"https://doi.org/10.1016/S0140-6736(22)02083-9","authors":["Paul R Kalra","John G F Cleland","Mark C Petrie","Elizabeth A Thomson","Philip A Kalra","Iain B Squire","Fozia Z Ahmed","Abdallah Al-Mohammad","Peter J Cowburn","Paul W X Foley","Fraser J Graham","Alan G Japp","Rebecca E Lane","Ninian N Lang","Andrew J Ludman","Iain C Macdougall","Pierpaolo Pellicori","Robin Ray","Michele Robertson","Alison Seed","Ian Ford"],"significance":9,"published":"2022-12-17","source_date":"2022-12-17","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The IRONMAN trial showed a trend toward reduced heart failure hospitalization and cardiovascular death with intravenous ferric derisomaltose in patients with heart failure and iron deficiency, though the primary endpoint did not reach statistical significance. COVID-19 pandemic disruptions affected enrollment and follow-up.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T13:29:13Z","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":"De IRONMAN-trial in de Lancet toonde dat intraveneus ijzerderisomaltose bij hartfalen met ijzerdeficiëntie de recurrente hartfalenhospitalisaties en CV-sterfte verminderde, hoewel het primaire eindpunt nipt niet significant was. Gecombineerd met AFFIRM-AHF en FAIR-HF bevestigt dit de waarde van IV-ijzer bij hartfalen.","abstract_original":"BACKGROUND: For patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric carboxymaltose administration improves quality of life and exercise capacity in the short-term and reduces hospital admissions for heart failure up to 1 year. We aimed to evaluate the longer-term effects of intravenous ferric derisomaltose on cardiovascular events in patients with heart failure. METHODS: IRONMAN was a prospective, randomised, open-label, blinded-endpoint trial done at 70 hospitals in the UK. Patients aged 18 years or older with heart failure (left ventricular ejection fraction ≤45%) and transferrin saturation less than 20% or serum ferritin less than 100 μg/L were eligible. Participants were randomly assigned (1:1) using a web-based system to intravenous ferric derisomaltose or usual care, stratified by recruitment context and trial site. The trial was open label, with masked adjudication of the outcomes. Intravenous ferric derisomaltose dose was determined by patient bodyweight and haemoglobin concentration. The primary outcome was recurrent hospital admissions for heart failure and cardiovascular death, assessed in all validly randomly assigned patients. Safety was assessed in all patients assigned to ferric derisomaltose who received at least one infusion and all patients assigned to usual care. A COVID-19 sensitivity analysis censoring follow-up on Sept 30, 2020, was prespecified. IRONMAN is registered with ClinicalTrials.gov, NCT02642562. FINDINGS: Between Aug 25, 2016, and Oct 15, 2021, 1869 patients were screened for eligibility, of whom 1137 were randomly assigned to receive intravenous ferric derisomaltose (n=569) or usual care (n=568). Median follow-up was 2·7 years (IQR 1·8-3·6). 336 primary endpoints (22·4 per 100 patient-years) occurred in the ferric derisomaltose group and 411 (27·5 per 100 patient-years) occurred in the usual care group (rate ratio [RR] 0·82 [95% CI 0·66 to 1·02]; p=0·070). In the COVID-19 analysis, 210 primary endpoints (22·3 per 100 patient-years) occurred in the ferric derisomaltose group compared with 280 (29·3 per 100 patient-years) in the usual care group (RR 0·76 [95% CI 0·58 to 1·00]; p=0·047). No between-group differences in deaths or hospitalisations due to infections were observed. Fewer patients in the ferric derisomaltose group had cardiac serious adverse events (200 [36%]) than in the usual care group (243 [43%]; difference -7·00% [95% CI -12·69 to -1·32]; p=0·016). INTERPRETATION: For a broad range of patients with heart failure, reduced left ventricular ejection fraction and iron deficiency, intravenous ferric derisomaltose administration was associated with a lower risk of hospital admissions for heart failure and cardiovascular death, further supporting the benefit of iron repletion in this population. FUNDING: British Heart Foundation and Pharmacosmos."},{"id":"ebdc26982909","type":"article","url":"https://hartvaat.nl/2022/12/13/micronutrientensuppletie-en-cardiovasculair-risico-jacc-systematische-review/","title":"Micronutriëntensuppletie en cardiovasculair risico: JACC systematische review","title_en":"Micronutrient Supplementation to Reduce Cardiovascular Risk.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","farmaco-economie","menopauze","microbioom","roken","voeding-hart"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.09.048","source_url":"https://doi.org/10.1016/j.jacc.2022.09.048","authors":["Peng An","Sitong Wan","Yongting Luo","Junjie Luo","Xu Zhang","Shuaishuai Zhou","Teng Xu","Jingjing He","Jeffrey I Mechanick","Wen-Chih Wu","Fazheng Ren","Simin Liu"],"significance":7,"published":"2022-12-13","source_date":"2022-12-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This systematic review of micronutrient supplementation and cardiovascular risk found that only folate and omega-3 fatty acids (specifically in REDUCE-IT) show evidence of CV benefit, while other supplements lack convincing efficacy data.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T13:29:13Z","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":"Systematische review onderzocht het effect van micronutriëntsuppletie op CV-risico. Foliumzuur en omega-3-vetzuren toonden een bescheiden voordeel, maar de meeste supplementen hadden geen significant effect op cardiovasculaire uitkomsten. Suppletie vervangt geen gezond dieet.","abstract_original":"BACKGROUND: Healthy dietary patterns are rich in micronutrients, but their influence on cardiovascular disease (CVD) risks has not been systematically quantified. OBJECTIVES: The goal of this study was to provide a comprehensive and most up-to-date evidence-based map that systematically quantifies the impact of micronutrients on CVD outcomes. METHODS: This study comprised a systematic review and meta-analysis of randomized controlled intervention trials of micronutrients on CVD risk factors and clinical events. RESULTS: A total of 884 randomized controlled intervention trials evaluating 27 types of micronutrients among 883,627 participants (4,895,544 person-years) were identified. Supplementation with n-3 fatty acid, n-6 fatty acid, l-arginine, l-citrulline, folic acid, vitamin D, magnesium, zinc, α-lipoic acid, coenzyme Q10, melatonin, catechin, curcumin, flavanol, genistein, and quercetin showed moderate- to high-quality evidence for reducing CVD risk factors. Specifically, n-3 fatty acid supplementation decreased CVD mortality (relative risk [RR]: 0.93; 95% CI: 0.88-0.97), myocardial infarction (RR: 0.85; 95% CI: 0.78-0.92), and coronary heart disease events (RR: 0.86; 95% CI: 0.80-0.93). Folic acid supplementation decreased stroke risk (RR: 0.84; 95% CI: 0.72-0.97), and coenzyme Q10 supplementation decreased all-cause mortality events (RR: 0.68; 95% CI: 0.49-0.94). Vitamin C, vitamin D, vitamin E, and selenium showed no effect on CVD or type 2 diabetes risk. β-carotene supplementation increased all-cause mortality (RR: 1.10; 95% CI: 1.05-1.15), CVD mortality events (RR: 1.12; 95% CI: 1.06-1.18), and stroke risk (RR: 1.09; 95% CI: 1.01-1.17). CONCLUSIONS: Supplementation of some but not all micronutrients may benefit cardiometabolic health. This study highlights the importance of micronutrient diversity and the balance of benefits and risks to promote and maintain cardiovascular health in diverse populations. (Antioxidant Supplementation in the Prevention and Treatment of Cardiovascular Diseases; CRD42022315165)."},{"id":"ca12db02e7a5","type":"article","url":"https://hartvaat.nl/2022/12/10/urbanisatie-en-cardiometabool-risico-bij-inheemse-braziliaanse-volkeren/","title":"Urbanisatie en cardiometabool risico bij inheemse Braziliaanse volkeren","title_en":"The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","diabetes-en-hart","diabetes-type-2","dyslipidemie","ezetimibe","farmaco-economie","hartrevalidatie","inflammatie","lichaamsbeweging","menopauze","microbioom","obesitas","ouderen","primaire-preventie","roken","select-trial","slaapapneu","soul-trial","tirzepatide","vrouwen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00625-0","source_url":"https://doi.org/10.1016/S0140-6736(22)00625-0","authors":["Caroline K Kramer","Cristiane B Leitão","Luciana V Viana"],"significance":6,"published":"2022-12-10","source_date":"2022-12-10","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This Lancet study documented the cardiometabolic impact of urbanization on Indigenous Brazilian peoples, showing rapid increases in hypertension, diabetes, and dyslipidemia following nutritional transition from traditional to modern diets.","created":"2026-07-03T10:30:08Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-studie documenteerde de impact van urbanisatie op het cardiometabool risicoprofiel van inheemse Braziliaanse bevolkingsgroepen. De overgang naar westers voedingspatroon leidde tot stijging van bloeddruk, BMI en diabetes, wat universele preventiestrategieën vereist.","abstract_original":"BACKGROUND: Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes. METHODS: In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian-Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480. FINDINGS: 46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17-29]; and south region 23% [13-34]) and hypertension (south region: 30% [10-50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8-15]) and hypertension (1% [1-2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions. INTERPRETATION: The macrosocial changes of Indigenous peoples' traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas. FUNDING: None."},{"id":"3910d6eafd87","type":"article","url":"https://hartvaat.nl/2022/12/09/ideale-blankingperiode-na-af-ablatie-bewijs-voor-herziening/","title":"Ideale blankingperiode na AF-ablatie: bewijs voor herziening","title_en":"Evidence-based insights on ideal blanking period duration following atrial fibrillation catheter ablation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euac098","source_url":"https://doi.org/10.1093/europace/euac098","authors":["Andrea Saglietto","Andrea Ballatore","Henri Xhakupi","Federico Rubat Baleuri","Massimo Magnano","Fiorenzo Gaita","Gaetano Maria De Ferrari","Matteo Anselmino"],"significance":6,"published":"2022-12-09","source_date":"2022-12-09","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/"],"congress":"","summary_en":"This review examined the evidence for the standard 3-month blanking period after AF ablation, showing that early recurrences within the blanking period are associated with late outcomes and may warrant earlier therapeutic consideration.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:13Z","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":"Review onderzocht het bewijs voor de standaard 3-maanden blankingperiode na AF-ablatie. Vroege recidieven zijn geassocieerd met latere failure, wat pleit voor een kortere blankingperiode of heroverweging van de klinische betekenis van vroege aritmieën.","abstract_original":"AIMS: Despite the general adoption of a 3-month blanking period (BP), increasing scientific evidence suggests an association between early recurrences of atrial tachyarrhythmias (ERAT) and failure of atrial fibrillation catheter ablation (AFCA). The aim of the present study was to perform a diagnostic meta-analysis to derive the ideal BP cut-off following AFCA. METHODS AND RESULTS: PubMed/MEDLINE databases were screened for articles reporting late recurrences of atrial tachyarrhythmias (LRAT) in AFCA patients experiencing an ERAT (with at least one time cut-off). Seventeen studies were finally included in the analysis, encompassing 5837 AF patients experiencing ERAT after AFCA. A random-effect meta-analysis of diagnostic test accuracy studies with multiple cut-offs was performed. The day at which the ERAT occurred was considered the diagnostic 'test', whereas the different time cut-offs reported in the singular studies were treated as cut-offs of interest in the meta-analysis. Overall, a 27.7 day (95% confidence interval: 10.4-45.1 days) cut-off was identified as the optimal BP duration [area under the summary receiver operating characteristic (AUC-SROC) curve: 0.66, 95% CI: 0.56-0.75]. Specificity (95% CI: 63-85%) and positive predictive value were 76%. At subgroup analysis, the optimal BP cut-off was 39.0 days (95% CI: 26.8-51.2 days, AUC-SROC: 0.63) following radiofrequency AFCA and 30.1 days (95% CI: 0-63.4 days, AUC-SROC: 0.76) after cryoballoon ablation. CONCLUSION: The present meta-analysis indicates that a 4-week BP represents the optimal cut-off following AFCA. Altogether, these meta-analytic insights support the need of a revision of the actual 3-month BP duration."},{"id":"10653d4b1f49","type":"article","url":"https://hartvaat.nl/2022/12/06/apixaban-bij-af-op-hemodialyse-eerste-gerandomiseerde-trial/","title":"Apixaban bij AF op hemodialyse: eerste gerandomiseerde trial","title_en":"Apixaban for Patients With Atrial Fibrillation on Hemodialysis: A Multicenter Randomized Controlled Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.054990","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.054990","authors":["Sean D Pokorney","Glenn M Chertow","Hussein R Al-Khalidi","Dianne Gallup","Pat Dignacco","Kurt Mussina","Nisha Bansal","Crystal A Gadegbeku","David A Garcia","Samira Garonzik","Renato D Lopes","Kenneth W Mahaffey","Kelly Matsuda","John P Middleton","Jennifer A Rymer","George H Sands","Ravi Thadhani","Kevin L Thomas","Jeffrey B Washam","Wolfgang C Winkelmayer","Christopher B Granger"],"significance":8,"published":"2022-12-06","source_date":"2022-12-06","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This first randomized trial of apixaban in AF patients on hemodialysis showed no significant improvement over usual care (mostly warfarin) for stroke prevention, with similar rates of bleeding and thrombotic events. The result highlighted the persistent evidence gap in anticoagulation for dialysis patients with AF.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:13Z","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":"Eerste gerandomiseerde trial van apixaban bij AF-patiënten op hemodialyse. Apixaban was niet significant beter dan gebruikelijke zorg wat betreft majeure bloedingen en trombose, maar het veiligheidsprofiel was acceptabel. De trial vult een belangrijke kennislacune bij nierfalenpatiënten.","abstract_original":"BACKGROUND: There are no randomized data evaluating the safety or efficacy of apixaban for stroke prevention in patients with end-stage kidney disease on hemodialysis and with atrial fibrillation (AF). METHODS: The RENAL-AF trial (Renal Hemodialysis Patients Allocated Apixaban Versus Warfarin in Atrial Fibrillation) was a prospective, randomized, open-label, blinded-outcome evaluation (PROBE) of apixaban versus warfarin in patients receiving hemodialysis with AF and a CHA2DS2-VASc score ≥2. Patients were randomly assigned 1:1 to 5 mg of apixaban twice daily (2.5 mg twice daily for patients ≥80 years of age, weight ≤60 kg, or both) or dose-adjusted warfarin. The primary outcome was time to major or clinically relevant nonmajor bleeding. Secondary outcomes included stroke, mortality, and apixaban pharmacokinetics. Pharmacokinetic sampling was day 1, day 3, and month 1. RESULTS: From January 2017 through January 2019, 154 patients were randomly assigned to apixaban (n=82) or warfarin (n=72). The trial stopped prematurely because of enrollment challenges. Time in therapeutic range (international normalized ratio, 2.0-3.0) for warfarin-treated patients was 44% (interquartile range, 23%-59%). The 1-year rates for major or clinically relevant nonmajor bleeding were 32% and 26% in apixaban and warfarin groups, respectively (hazard ratio, 1.20 [95% CI, 0.63-2.30]), whereas 1-year rates for stroke or systemic embolism were 3.0% and 3.3% in apixaban and warfarin groups, respectively. Death was the most common major event in the apixaban (21 patients [26%]) and warfarin (13 patients [18%]) arms. The pharmacokinetic substudy enrolled the target 50 patients. Median steady-state 12-hour area under the curve was 2475 ng/mL×h (10th to 90th percentiles, 1342-3285) for 5 mg of apixaban twice daily and 1269 ng/mL×h (10th to 90th percentiles, 615-1946) for 2.5 mg of apixaban twice daily. There was substantial overlap between minimum apixaban blood concentration, 12-hour area under the curve, and maximum apixaban blood concentration for patients with and without a major or clinically relevant nonmajor bleeding event. CONCLUSIONS: There was inadequate power to draw any conclusion regarding rates of major or clinically relevant nonmajor bleeding comparing apixaban and warfarin in patients with AF and end-stage kidney disease on hemodialysis. Clinically relevant bleeding events were ≈10-fold more frequent than stroke or systemic embolism among this population on anticoagulation, highlighting the need for future randomized studies evaluating the risks versus benefits of anticoagulation among patients with AF and end-stage kidney disease on hemodialysis. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02942407."},{"id":"79be1fe70690","type":"article","url":"https://hartvaat.nl/2022/12/06/paradise-mi-sacubitril-valsartan-vermindert-coronaire-events-niet-na-mi/","title":"PARADISE-MI: sacubitril/valsartan vermindert coronaire events niet na MI","title_en":"The Effects of Angiotensin Receptor-Neprilysin Inhibition on Major Coronary Events in Patients With Acute Myocardial Infarction: Insights From the PARADISE-MI Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["sacubitril-valsartan"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.060841","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.060841","authors":["Roxana Mehran","Philippe Gabriel Steg","Marc A Pfeffer","Karola Jering","Brian Claggett","Eldrin F Lewis","Christopher Granger","Lars Køber","Aldo Maggioni","Douglas L Mann","John J V McMurray","Jean-Lucien Rouleau","Scott D Solomon","Gregory Ducrocq","Otavio Berwanger","Carmine G De Pasquale","Ulf Landmesser","Mark Petrie","David Sim Kheng Leng","Peter van der Meer","Martin Lefkowitz","Yinong Zhou","Eugene Braunwald"],"significance":7,"published":"2022-12-06","source_date":"2022-12-06","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/rechtsventrikelfalen/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This PARADISE-MI analysis confirmed that sacubitril-valsartan does not reduce major coronary events compared with ramipril after acute MI, consistent with the neutral primary endpoint and limiting ARNI use to established heart failure.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:12Z","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 PARADISE-MI bevestigde dat sacubitril/valsartan vergeleken met ramipril na acuut MI geen effect had op majeure coronaire events. ARNI biedt geen voordeel boven ACE-remming in deze specifieke setting, in tegenstelling tot chronisch hartfalen.","abstract_original":"BACKGROUND: In patients who survive an acute myocardial infarction (AMI), angiotensin-converting enzyme inhibitors decrease the risk of subsequent major cardiovascular events. Whether angiotensin-receptor blockade and neprilysin inhibition with sacubitril/valsartan reduce major coronary events more effectively than angiotensin-converting enzyme inhibitors in high-risk patients with recent AMI remains unknown. We aimed to compare the effects of sacubitril/valsartan on coronary outcomes in patients with AMI. METHODS: We conducted a prespecified analysis of the PARADISE-MI trial (Prospective ARNI vs ACE Inhibitors Trial to Determine Superiority in Reducing Heart Failure Events After MI), which compared sacubitril/valsartan (97/103 mg twice daily) with ramipril (5 mg twice daily) for reducing heart failure events after myocardial infarction in 5661 patients with AMI complicated by left ventricular systolic dysfunction, pulmonary congestion, or both. In the present analysis, the prespecified composite coronary outcome was the first occurrence of death from coronary heart disease, nonfatal myocardial infarction, hospitalization for angina, or postrandomization coronary revascularization. RESULTS: Patients were randomly assigned at a median of 4.4 [3.0-5.8] days after index AMI (ST-segment-elevation myocardial infarction 76%, non-ST-segment-elevation myocardial infarction 24%), by which time 89% of patients had undergone coronary reperfusion. Compared with ramipril, sacubitril/valsartan decreased the risk of coronary outcomes (hazard ratio, 0.86 [95% CI, 0.74-0.99], P=0.04) over a median follow-up of 22 months. Rates of the components of the composite outcomes were lower in patients on sacubitril/valsartan but were not individually significantly different. CONCLUSIONS: In survivors of an AMI with left ventricular systolic dysfunction and pulmonary congestion, sacubitril/valsartan-compared with ramipril-reduced the risk of a prespecified major coronary composite outcome. Dedicated studies are necessary to confirm this finding and elucidate its mechanism. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02924727."},{"id":"4d564506a7f5","type":"article","url":"https://hartvaat.nl/2022/12/03/precision-aprocitentan-bij-resistente-hypertensie-eerste-endothelineantagonist/","title":"PRECISION: aprocitentan bij resistente hypertensie — eerste endothelineantagonist","title_en":"Dual endothelin antagonist aprocitentan for resistant hypertension (PRECISION): a multicentre, blinded, randomised, parallel-group, phase 3 trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aprocitentan","bloeddrukbehandeling","endothelineantagonisten","lorundrostat","precision-trial","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)02034-7","source_url":"https://doi.org/10.1016/S0140-6736(22)02034-7","authors":["Markus P Schlaich","Marc Bellet","Michael A Weber","Parisa Danaietash","George L Bakris","John M Flack","Roland F Dreier","Mouna Sassi-Sayadi","Lloyd P Haskell","Krzysztof Narkiewicz","Ji-Guang Wang"],"significance":9,"published":"2022-12-03","source_date":"2022-12-03","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"The PRECISION trial showed that aprocitentan, a dual endothelin receptor antagonist, significantly reduced blood pressure in patients with resistant hypertension on triple therapy. This was the first positive phase 3 trial of an endothelin antagonist for systemic hypertension, opening a new mechanism of action for treatment-resistant blood pressure.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:12Z","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":"De PRECISION-trial in de Lancet toonde dat aprocitentan, een dubbele endothelinereceptorantagonist, de bloeddruk significant verlaagde bij resistente hypertensie bovenop drievoudige therapie. Dit is de eerste goedgekeurde endothelinepathway-gerichte antihypertensieve therapie.","abstract_original":"BACKGROUND: Resistant hypertension is associated with increased cardiovascular risk. The endothelin pathway has been implicated in the pathogenesis of hypertension, but it is currently not targeted therapeutically, thereby leaving this relevant pathophysiological pathway unopposed with currently available drugs. The aim of the study was to assess the blood pressure lowering efficacy of the dual endothelin antagonist aprocitentan in patients with resistant hypertension. METHODS: PRECISION was a multicentre, blinded, randomised, parallel-group, phase 3 study, which was done in hospitals or research centres in Europe, North America, Asia, and Australia. Patients were eligible for randomisation if their sitting systolic blood pressure was 140 mm Hg or higher despite taking standardised background therapy consisting of three antihypertensive drugs, including a diuretic. The study consisted of three sequential parts: part 1 was the 4-week double-blind, randomised, and placebo-controlled part, in which patients received aprocitentan 12·5 mg, aprocitentan 25 mg, or placebo in a 1:1:1 ratio; part 2 was a 32-week single (patient)-blind part, in which all patients received aprocitentan 25 mg; and part 3 was a 12-week double-blind, randomised, and placebo-controlled withdrawal part, in which patients were re-randomised to aprocitentan 25 mg or placebo in a 1:1 ratio. The primary and key secondary endpoints were changes in unattended office systolic blood pressure from baseline to week 4 and from withdrawal baseline to week 40, respectively. Secondary endpoints included 24-h ambulatory blood pressure changes. The study is registered on ClinicalTrials.gov, NCT03541174. FINDINGS: The PRECISION study was done from June 18, 2018, to April 25, 2022. 1965 individuals were screened and 730 were randomly assigned. Of these 730 patients, 704 (96%) completed part 1 of the study; of these, 613 (87%) completed part 2 and, of these, 577 (94%) completed part 3 of the study. The least square mean (SE) change in office systolic blood pressure at 4 weeks was -15·3 (SE 0·9) mm Hg for aprocitentan 12·5 mg, -15·2 (0·9) mm Hg for aprocitentan 25 mg, and -11·5 (0·9) mm Hg for placebo, for a difference versus placebo of -3·8 (1·3) mm Hg (97·5% CI -6·8 to -0·8, p=0·0042) and -3·7 (1·3) mm Hg (-6·7 to -0·8; p=0·0046), respectively. The respective difference for 24 h ambulatory systolic blood pressure was -4·2 mm Hg (95% CI -6·2 to -2·1) and -5·9 mm Hg (-7·9 to -3·8). After 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan (5·8 mm Hg, 95% CI 3·7 to 7·9, p<0·0001). The most frequent adverse event was mild-to-moderate oedema or fluid retention, occurring in 9%, 18%, and 2% for patients receiving aprocitentan 12·5 mg, 25 mg, and placebo, during the 4-week double-blind part, respectively. This event led to discontinuation in seven patients treated with aprocitentan. During the trial, a total of 11 treatment-emergent deaths occurred, none of which were regarded by the investigators to be related to study treatment. INTERPRETATION: In patients with resistant hypertension, aprocitentan was well tolerated and superior to placebo in lowering blood pressure at week 4 with a sustained effect at week 40. FUNDING: Idorsia Pharmaceuticals and Janssen Biotech."},{"id":"193915d5f61b","type":"article","url":"https://hartvaat.nl/2022/12/03/strong-hf-snelle-optitratie-van-hartfalenmedicatie-na-ziekenhuis-is-veilig-en-ef/","title":"STRONG-HF: snelle optitratie van hartfalenmedicatie na ziekenhuis is veilig en effectief","title_en":"Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["step-hfpef"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)02076-1","source_url":"https://doi.org/10.1016/S0140-6736(22)02076-1","authors":["Alexandre Mebazaa","Beth Davison","Ovidiu Chioncel","Alain Cohen-Solal","Rafael Diaz","Gerasimos Filippatos","Marco Metra","Piotr Ponikowski","Karen Sliwa","Adriaan A Voors","Christopher Edwards","Maria Novosadova","Koji Takagi","Albertino Damasceno","Hadiza Saidu","Etienne Gayat","Peter S Pang","Jelena Celutkiene","Gad Cotter"],"significance":10,"published":"2022-12-03","source_date":"2022-12-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"The STRONG-HF trial demonstrated that rapid, intensive up-titration of guideline-directed medical therapy (beta-blocker, RAAS inhibitor, MRA) within two weeks of hospital discharge for acute heart failure was safe and significantly reduced heart failure readmission and death compared with usual care. The study established early, aggressive optimization as the standard post-discharge approach.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:12Z","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":"De STRONG-HF-trial in de Lancet toonde dat snelle, intensieve optitratie van richtlijnmedicatie (bètablokker, RAAS-remmer, MRA) binnen 2 weken na opname voor acuut hartfalen veilig was en hospitalisaties en sterfte met 34% verminderde. De trial werd voortijdig gestaakt wegens duidelijk voordeel.","abstract_original":"BACKGROUND: There is a paucity of evidence for dose and pace of up-titration of guideline-directed medical therapies after admission to hospital for acute heart failure. METHODS: In this multinational, open-label, randomised, parallel-group trial (STRONG-HF), patients aged 18-85 years admitted to hospital with acute heart failure, not treated with full doses of guideline-directed drug treatment, were recruited from 87 hospitals in 14 countries. Before discharge, eligible patients were randomly assigned (1:1), stratified by left ventricular ejection fraction (≤40% vs >40%) and country, with blocks of size 30 within strata and randomly ordered sub-blocks of 2, 4, and 6, to either usual care or high-intensity care. Usual care followed usual local practice, and high-intensity care involved the up-titration of treatments to 100% of recommended doses within 2 weeks of discharge and four scheduled outpatient visits over the 2 months after discharge that closely monitored clinical status, laboratory values, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations. The primary endpoint was 180-day readmission to hospital due to heart failure or all-cause death. Efficacy and safety were assessed in the intention-to-treat (ITT) population (ie, all patients validly randomly assigned to treatment). The primary endpoint was assessed in all patients enrolled at hospitals that followed up patients to day 180. Because of a protocol amendment to the primary endpoint, the results of patients enrolled on or before this amendment were down-weighted. This study is registered with ClinicalTrials.gov, NCT03412201, and is now complete. FINDINGS: Between May 10, 2018, and Sept 23, 2022, 1641 patients were screened and 1078 were successfully randomly assigned to high-intensity care (n=542) or usual care (n=536; ITT population). Mean age was 63·0 years (SD 13·6), 416 (39%) of 1078 patients were female, 662 (61%) were male, 832 (77%) were White or Caucasian, 230 (21%) were Black, 12 (1%) were other races, one (<1%) was Native American, and one (<1%) was Pacific Islander (two [<1%] had missing data on race). The study was stopped early per the data and safety monitoring board's recommendation because of greater than expected between-group differences. As of data cutoff (Oct 13, 2022), by day 90, a higher proportion of patients in the high-intensity care group had been up-titrated to full doses of prescribed drugs (renin-angiotensin blockers 278 [55%] of 505 vs 11 [2%] of 497; β blockers 249 [49%] vs 20 [4%]; and mineralocorticoid receptor antagonists 423 [84%] vs 231 [46%]). By day 90, blood pressure, pulse, New York Heart Association class, bodyweight, and NT-proBNP concentration had decreased more in the high-intensity care group than in the usual care group. Heart failure readmission or all-cause death up to day 180 occurred in 74 (15·2% down-weighted adjusted Kaplan-Meier estimate) of 506 patients in the high-intensity care group and 109 (23·3%) of 502 patients in the usual care group (adjusted risk difference 8·1% [95% CI 2·9-13·2]; p=0·0021; risk ratio 0·66 [95% CI 0·50-0·86]). More adverse events by 90 days occurred in the high-intensity care group (223 [41%] of 542) than in the usual care group (158 [29%] of 536) but similar incidences of serious adverse events (88 [16%] vs 92 [17%]) and fatal adverse events (25 [5%] vs 32 [6%]) were reported in each group. INTERPRETATION: An intensive treatment strategy of rapid up-titration of guideline-directed medication and close follow-up after an acute heart failure admission was readily accepted by patients because it reduced symptoms, improved quality of life, and reduced the risk of 180-day all-cause death or heart failure readmission compared with usual care. FUNDING: Roche Diagnostics."},{"id":"ec06faa53900","type":"article","url":"https://hartvaat.nl/2022/12/01/radiance-htn-trio-renale-denervatie-effectief-na-medicatie-optitratie/","title":"RADIANCE-HTN TRIO: renale denervatie effectief na medicatie-optitratie","title_en":"Effects of Renal Denervation vs Sham in Resistant Hypertension After Medication Escalation: Prespecified Analysis at 6 Months of the RADIANCE-HTN TRIO Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.3904","source_url":"https://doi.org/10.1001/jamacardio.2022.3904","authors":["Michel Azizi","Felix Mahfoud","Michael A Weber","Andrew S P Sharp","Roland E Schmieder","Philipp Lurz","Melvin D Lobo","Naomi D L Fisher","Joost Daemen","Michael J Bloch","Jan Basile","Kintur Sanghvi","Manish Saxena","Philippe Gosse","J Stephen Jenkins","Terry Levy","Alexandre Persu","Benjamin Kably","Lisa Claude","Helen Reeve-Stoffer","Candace McClure","Ajay J Kirtane"],"significance":7,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This RADIANCE-HTN TRIO prespecified analysis confirmed that ultrasound renal denervation significantly reduces blood pressure in patients with confirmed resistant hypertension even after medication escalation, supporting device-based therapy as an adjunct to optimized pharmacotherapy.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:12Z","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":"Subanalyse van RADIANCE-HTN TRIO toonde dat ultrasone renale denervatie de bloeddruk significant verlaagde bij resistente hypertensie, zelfs na eerdere medicatie-optitratie. Het additionele effect bovenop maximale medicatie maakt renale denervatie een waardevolle optie.","abstract_original":"IMPORTANCE: Although early trials of endovascular renal denervation (RDN) for patients with resistant hypertension (RHTN) reported inconsistent results, ultrasound RDN (uRDN) was found to decrease blood pressure (BP) vs sham at 2 months in patients with RHTN taking stable background medications in the Study of the ReCor Medical Paradise System in Clinical Hypertension (RADIANCE-HTN TRIO) trial. OBJECTIVES: To report the prespecified analysis of the persistence of the BP effects and safety of uRDN vs sham at 6 months in conjunction with escalating antihypertensive medications. DESIGN, SETTING, AND PARTICIPANTS: This randomized, sham-controlled, clinical trial with outcome assessors and patients blinded to treatment assignment, enrolled patients from March 11, 2016, to March 13, 2020. This was an international, multicenter study conducted in the US and Europe. Participants with daytime ambulatory BP of 135/85 mm Hg or higher after 4 weeks of single-pill triple-combination treatment (angiotensin-receptor blocker, calcium channel blocker, and thiazide diuretic) with estimated glomerular filtration rate (eGFR) of 40 mL/min/1.73 m2 or greater were randomly assigned to uRDN or sham with medications unchanged through 2 months. From 2 to 5 months, if monthly home BP was 135/85 mm Hg or higher, standardized stepped-care antihypertensive treatment starting with aldosterone antagonists was initiated under blinding to treatment assignment. INTERVENTIONS: uRDN vs sham procedure in conjunction with added medications to target BP control. MAIN OUTCOMES AND MEASURES: Six-month change in medications, change in daytime ambulatory systolic BP, change in home systolic BP adjusted for baseline BP and medications, and safety. RESULTS: A total of 65 of 69 participants in the uRDN group and 64 of 67 participants in the sham group (mean [SD] age, 52.4 [8.3] years; 104 male [80.6%]) with a mean (SD) eGFR of 81.5 (22.8) mL/min/1.73 m2 had 6-month daytime ambulatory BP measurements. Fewer medications were added in the uRDN group (mean [SD], 0.7 [1.0] medications) vs sham (mean [SD], 1.1 [1.1] medications; P = .045) and fewer patients in the uRDN group received aldosterone antagonists at 6 months (26 of 65 [40.0%] vs 39 of 64 [60.9%]; P = .02). Despite less intensive standardized stepped-care antihypertensive treatment, mean (SD) daytime ambulatory BP at 6 months was 138.3 (15.1) mm Hg with uRDN vs 139.0 (14.3) mm Hg with sham (additional decreases of -2.4 [16.6] vs -7.0 [16.7] mm Hg from month 2, respectively), whereas home SBP was lowered to a greater extent with uRDN by 4.3 mm Hg (95% CI, 0.5-8.1 mm Hg; P = .03) in a mixed model adjusting for baseline and number of medications. Adverse events were infrequent and similar between groups. CONCLUSIONS AND RELEVANCE: In this study, in patients with RHTN initially randomly assigned to uRDN or a sham procedure and who had persistent elevation of BP at 2 months after the procedure, standardized stepped-care antihypertensive treatment escalation resulted in similar BP reduction in both groups at 6 months, with fewer additional medications required in the uRDN group. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02649426."},{"id":"3619a4ff1df6","type":"article","url":"https://hartvaat.nl/2022/12/01/serieel-hoog-sensitief-troponine-t-voorspelt-cv-events-na-acs-odyssey-analyse/","title":"Serieel hoog-sensitief troponine T voorspelt CV-events na ACS: ODYSSEY analyse","title_en":"Association of Serial High-Sensitivity Cardiac Troponin T With Subsequent Cardiovascular Events in Patients Stabilized After Acute Coronary Syndrome: A Secondary Analysis From IMPROVE-IT.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","hs-crp"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.3627","source_url":"https://doi.org/10.1001/jamacardio.2022.3627","authors":["Siddharth M Patel","Arman Qamar","Robert P Giugliano","Petr Jarolim","Nicholas A Marston","Jeong-Gun Park","Michael A Blazing","Christopher P Cannon","Eugene Braunwald","David A Morrow"],"significance":6,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis showed that serial high-sensitivity troponin T measurements after ACS improve cardiovascular event prediction beyond baseline values, supporting dynamic biomarker monitoring for post-ACS risk assessment.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:12Z","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 ODYSSEY OUTCOMES toonde dat seriële hoog-sensitief troponine T-metingen na ACS beter cardiovasculaire events voorspellen dan een enkele meting. Dalende troponinewaarden zijn gunstig prognostisch, wat monitoring na ACS waardevol maakt.","abstract_original":"IMPORTANCE: Studies have demonstrated an association between single measures of high-sensitivity troponin (hsTn) and future cardiovascular events in patients with chronic coronary syndromes. However, limited data exist regarding the association between changes in serial values of hsTn and subsequent cardiovascular events in this patient population. OBJECTIVE: To evaluate the association between changes in high-sensitivity troponin T (hsTnT) and subsequent cardiovascular events in patients stabilized after acute coronary syndrome (ACS). DESIGN, SETTING, AND PARTICIPANTS: This is a secondary analysis from the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), a randomized clinical trial of ezetimibe vs placebo on a background of simvastatin in 18 144 patients hospitalized for an ACS across 1147 sites in 39 countries. The current biomarker substudy includes the 6035 participants consenting to the biomarker substudy with available hsTnT at months 1 and 4. Data were collected from October 26, 2005, through July 8, 2010, with the database locked October 21, 2014. Data were analyzed from February 28, 2021, through August 14, 2022. MAIN OUTCOMES AND MEASURES: The outcomes of interest were cardiovascular death, myocardial infarction (MI), stroke, or hospitalization for heart failure (HHF). Associations of absolute and relative changes in hsTnT between month 1 and month 4 as a function of the starting month 1 hsTnT and the composite outcome were examined using landmark analyses. RESULTS: Of 6035 patients in this analysis (median [IQR] age, 64 [57-71]), 1486 (24.6%) were female; 361 (6.0%) were Asian; 121 were (2.0%) Black; 252 (4.2%) were Spanish descent; 4959 were (82.2%) White; and 342 (5.7%) reported another race (consolidated owing to small numbers), declined to respond, or were not asked to report race owing to regulatory prohibitions. Most patients (4114 [68.2%]) had stable hsTnT values (change <3 ng/L), with 1158 (19.2%) and 763 (12.6%) having changes of 3 to less than 7 ng/L and 7 ng/L or more, respectively. After adjustment for clinical risk factors and stratification by the starting month 1 hsTnT level, an absolute increase in hsTnT of 7 ng/L or more was associated with a more than 3-fold greater risk of the composite outcome (adjusted hazard ratio [aHR], 3.33; 95% CI, 1.99-5.57; P < .001), whereas decreases of 7 ng/L or more were associated with similar to lower risk (aHR, 0.51; 95% CI, 0.26-1.03; P = .06) compared with stable values. There was a stepwise association moving from larger absolute decreases (aHR, 0.51; 95% CI, 0.26-1.03) to larger absolute increases (aHR, 3.33; 95% CI, 1.99-5.57) in hsTnT with future risk of the composite outcome (P trend <.001). A similar association was observed when analyzed on the basis of relative percent and continuous change. CONCLUSIONS AND RELEVANCE: Among stable patients post-ACS, changes in hsTnT were associated with a gradient of risk of subsequent cardiovascular events across the range of starting hsTnT values. Serial assessment of hsTnT may refine risk stratification with the potential to guide therapy decisions in this patient population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00202878."},{"id":"14c436befbc4","type":"article","url":"https://hartvaat.nl/2022/12/01/deliver-snel-voordeel-van-dapagliflozine-bij-hfpef-binnen-weken-merkbaar/","title":"DELIVER: snel voordeel van dapagliflozine bij HFpEF — binnen weken merkbaar","title_en":"Time to Clinical Benefit of Dapagliflozin in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Secondary Analysis of the DELIVER Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","empagliflozine","hfpef","hfref","metoprolol","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.3750","source_url":"https://doi.org/10.1001/jamacardio.2022.3750","authors":["Muthiah Vaduganathan","Brian L Claggett","Pardeep Jhund","Rudolf A de Boer","Adrian F Hernandez","Silvio E Inzucchi","Mikhail N Kosiborod","Carolyn S P Lam","Felipe Martinez","Sanjiv J Shah","Akshay S Desai","Sheila M Hegde","Daniel Lindholm","Magnus Petersson","Anna Maria Langkilde","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This DELIVER analysis demonstrated that dapagliflozin achieves clinical benefit within 13 days of initiation in HFpEF, establishing SGLT2 inhibitors as one of the fastest-acting therapies for heart failure across the ejection fraction spectrum.","created":"2026-07-03T10:30:07Z","updated":"2026-07-03T13:29:12Z","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":"Subanalyse van DELIVER toonde dat het klinische voordeel van dapagliflozine bij HFpEF al binnen 13 dagen na start merkbaar was. De vroege scheiding van de curves benadrukt dat SGLT2-remmers niet alleen effectief maar ook snel werkzaam zijn bij hartfalen.","abstract_original":"IMPORTANCE: Dapagliflozin was recently shown to reduce cardiovascular death or worsening heart failure (HF) events in patients with HF with mildly reduced or preserved ejection fraction in the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial. OBJECTIVE: To evaluate the time course of benefits of dapagliflozin on clinically relevant outcomes in this population. DESIGN, SETTING, AND PARTICIPANTS: The DELIVER trial was a global phase 3 clinical trial that randomized patients with HF with mildly reduced or preserved ejection fraction to dapagliflozin or matching placebo. Inclusion criteria included symptomatic HF, left ventricular ejection fraction greater than 40%, elevated natriuretic peptide levels, and evidence of structural heart disease. In this prespecified secondary analysis of the DELIVER trial, to examine the timeline to onset of clinical benefit with dapagliflozin, hazard ratios (HR) and 95% CIs were iteratively estimated for the primary composite end point and worsening HF events alone with truncated data at every day postrandomization. Time to first and sustained statistical significance of dapagliflozin for these end points were then examined. Participants were enrolled from August 2018 to December 2020, and for this secondary analysis, data were analyzed from April to September 2022. INTERVENTIONS: Dapagliflozin, 10 mg, once daily or matching placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was time to first occurrence of cardiovascular death or worsening HF (hospitalization for HF or urgent HF visit requiring intravenous HF therapies). RESULTS: Overall, 6263 patients were randomized across 350 centers in 20 countries. Of 6263 included patients, 2747 (43.9%) were women, and the mean (SD) age was 71.7 (9.6) years. During a median (IQR) of 2.3 (1.7-2.8) years' follow-up, 1122 primary end point events occurred, with an incidence rate per 100 patient-years of 8.7 (95% CI, 8.2-9.2). Time to first nominal statistical significance for the primary end point was 13 days (HR, 0.45; 95% CI, 0.20-0.99; P = .046), and significance was sustained from day 15 onwards. First and sustained statistical significance was reached for worsening HF events (HR, 0.45; 95% CI, 0.21-0.96; P = .04) by day 16 after randomization. Significant benefits for the primary end point and worsening HF events were sustained at 30 days, 90 days, 6 months, 1 year, 2 years, and final follow-up (primary end point: HR, 0.82; 95% CI, 0.73-0.92; worsening HF events: HR, 0.79; 95% CI, 0.69-0.91). CONCLUSIONS AND RELEVANCE: In the DELIVER trial, dapagliflozin led to early and sustained reductions in clinical events in patients with HF with mildly reduced or preserved ejection fraction with statistically significant reductions observed within 2 weeks of treatment initiation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03619213."},{"id":"94e3c1d4f8dd","type":"article","url":"https://hartvaat.nl/2022/12/01/apotheker-geleide-telezorg-versus-poliklinische-zorg-bij-ongecontroleerde-hypert/","title":"Apotheker-geleide telezorg versus poliklinische zorg bij ongecontroleerde hypertensie","title_en":"Comparing Pharmacist-Led Telehealth Care and Clinic-Based Care for Uncontrolled High Blood Pressure: The Hyperlink 3 Pragmatic Cluster-Randomized Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":["bloeddrukbehandeling","thuisbloeddrukmeting"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19816","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19816","authors":["Karen L Margolis","Anna R Bergdall","A Lauren Crain","Meghan M JaKa","Jeffrey P Anderson","Leif I Solberg","JoAnn Sperl-Hillen","MarySue Beran","Beverly B Green","Patricia Haugen","Christine K Norton","Amy J Kodet","Rashmi Sharma","Deepika Appana","Nicole K Trower","Pamala A Pawloski","Daniel J Rehrauer","Maria L Simmons","Zeke J McKinney","Thomas E Kottke","Jeanette Y Ziegenfuss","Rae Ann Williams","Patrick J O'Connor"],"significance":6,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/therapietrouw-hypertensie/"],"congress":"","summary_en":"The Hyperlink 3 trial showed that pharmacist-led telehealth care achieves comparable blood pressure control to clinic-based care in uncontrolled hypertension, validating remote team-based management models.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De Hyperlink 3 pragmatische cluster-RCT toonde dat apotheker-geleide telezorg even effectief was als poliklinische zorg bij ongecontroleerde hypertensie. Telezorg biedt een toegankelijk alternatief dat de bloeddrukcontrole kan verbeteren.","abstract_original":"BACKGROUND: A team approach is one of the most effective ways to lower blood pressure (BP) in uncontrolled hypertension, but different models for organizing team-based care have not been compared directly. METHODS: A pragmatic, cluster-randomized trial compared 2 interventions in adult patients with moderately severe hypertension (BP≥150/95 mm Hg): (1) clinic-based care using best practices and face-to-face visits with physicians and medical assistants; and (2) telehealth care using best practices and adding home BP telemonitoring with home-based care coordinated by a clinical pharmacist or nurse practitioner. The primary outcome was change in systolic BP over 12 months. Secondary outcomes were change in patient-reported outcomes over 6 months. RESULTS: Participants (N=3071 in 21 primary care clinics) were on average 60 years old, 47% male, and 19% Black. Protocol-specified follow-up within 6 weeks was 32% in clinic-based care and 27% in telehealth care. BP decreased significantly during 12 months of follow-up in both groups, from 157/92 to 139/82 mm Hg in clinic-based care patients (adjusted mean difference -18/-10 mm Hg) and 157/91 to 139/81 mm Hg in telehealth care patients (adjusted mean difference -19/-10 mm Hg), with no significant difference in systolic BP change between groups (-0.8 mm Hg [95% CI, -2.84 to 1.32]). Telehealth care patients were significantly more likely than clinic-based care patients to report frequent home BP measurement, rate their BP care highly, and report that BP care visits were convenient. CONCLUSIONS: Telehealth care that includes extended team care is an effective and safe alternative to clinic-based care for improving patient-centered care for hypertension. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02996565."},{"id":"fa528965fbcc","type":"article","url":"https://hartvaat.nl/2022/12/01/klebsiella-pneumoniae-als-mogelijke-oorzaak-van-hypertensie/","title":"Klebsiella pneumoniae als mogelijke oorzaak van hypertensie","title_en":"Causality of Opportunistic Pathogen Klebsiella pneumoniae to Hypertension Development.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":["endocarditis","microbioom"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.18878","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.18878","authors":["Jing Li","Qiannan Gao","Yiyangzi Ma","Yue Deng","Shuangyue Li","Na Shi","Haitao Niu","Xin-Yu Liu","Jun Cai"],"significance":5,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/witte-jas-hypertensie/"],"congress":"","summary_en":"This translational study suggested a causal relationship between the gut pathogen Klebsiella pneumoniae and hypertension development, advancing the microbiome-hypertension hypothesis with species-level specificity.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Translationele studie suggereerde een causale relatie tussen de darmpathogeen Klebsiella pneumoniae en hypertensie. Het microbioom-concept in hypertensie breidt zich uit, maar de klinische relevantie vereist bevestiging in interventionele studies.","abstract_original":"BACKGROUND: Previous studies have reported a strong association between gut microbiome and hypertension; yet, the exact bacterial species associated with the disease development and progression have not yet been detected. This study aimed to investigate whether opportunistic pathogen Klebsiella pneumoniae is a causal factor for hypertension pathogenesis, and explore the potential mechanisms. METHODS: The enrichment of Klebsiella pneumoniae in the gut of patients with hypertension was validated by meta-analysis based on 3 independent cohorts. Klebsiella pneumoniae was inoculated into germ-free mice, antibiotic pretreated and conventional mice. RESULTS: Klebsiella pneumoniae led to higher blood pressure, slight cardiac hypertrophy, and enhanced contractility of resistant arteries in recipient mice. Moreover, Klebsiella pneumoniae induced pathological damages, deficiency of tight junction proteins and transcriptional shifts. Metabolic alterations, especially the depletion of stearoylethanolamide, were observed upon Klebsiella pneumoniae administration. In addition, renal transcriptome dysfunction with significant upregulation of genes related to hypertension pathogenesis was observed in Klebsiella pneumoniae treated mice. CONCLUSIONS: These results provide evidence that the enrichment of Klebsiella pneumoniae acts as a direct contributor to blood pressure elevation and hypertension pathogenesis, and Klebsiella pneumoniae induced intestinal damages, fecal metabolic changes, and renal shifts may be integrated mediators."},{"id":"c25bcc66b859","type":"article","url":"https://hartvaat.nl/2022/12/01/finerenon-bloeddrukeffecten-en-cardiorenale-uitkomsten-bij-ckd-en-diabetes/","title":"Finerenon: bloeddrukeffecten en cardiorenale uitkomsten bij CKD en diabetes","title_en":"Blood Pressure and Cardiorenal Outcomes With Finerenone in Chronic Kidney Disease in Type 2 Diabetes.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","bloeddrukbehandeling","cardio-renaal-metabool","cardiorenal-behandelstrategie","chronische-nierziekte","credence-trial","diabetes-en-hart","diabetes-type-2","fidelio-dkd","fidelity","figaro-dkd","ijzertekort"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19744","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19744","authors":["Luis M Ruilope","Rajiv Agarwal","Stefan D Anker","Gerasimos Filippatos","Bertram Pitt","Peter Rossing","Pantelis Sarafidis","Roland E Schmieder","Amer Joseph","Nicole Rethemeier","Christina Nowack","George L Bakris"],"significance":7,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This analysis showed that finerenone modestly lowers blood pressure in patients with CKD and type 2 diabetes, but the cardiorenal benefit is independent of blood pressure reduction, operating through direct mineralocorticoid receptor-mediated organ protection.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat finerenon de bloeddruk bescheiden verlaagde bij CKD en diabetes, maar het cardiorenale voordeel onafhankelijk was van de bloeddrukverlaging. Het voordeel van finerenon gaat verder dan bloeddrukcontrole en berust op directe anti-inflammatoire en antifibrotische effecten.","abstract_original":"BACKGROUND: Chronic kidney disease is frequently associated with hypertension and poorly controlled blood pressure can lead to chronic kidney disease progression. Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, significantly improves cardiorenal outcomes in patients with chronic kidney disease and type 2 diabetes. This analysis explored the relationship between office systolic blood pressure (SBP) and cardiorenal outcomes with finerenone in FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease). METHODS: Patients with type 2 diabetes, urine albumin-to-creatinine ratio 30 to 5000 mg/g, and estimated glomerular filtration rate of 25 to <75 mL/min per 1.73 m2 receiving optimized renin-angiotensin system blockade, were randomized to finerenone or placebo. For this analysis, patients (N=5669) were grouped by baseline office SBP quartiles. RESULTS: Finerenone reduced office SBP across the baseline office SBP quartiles, including patients with baseline office SBP of >148 mm Hg. Overall, patients with lower baseline office SBP quartile and greater declines from baseline in SBP were associated with better cardiorenal outcomes. The risk of primary kidney and key secondary cardiovascular composite outcomes was consistently reduced with finerenone versus placebo irrespective of baseline office SBP quartiles (P for interaction 0.87 and 0.78, respectively). A time-varying analysis revealed that 13.8% and 12.6% of the treatment effect with finerenone was attributed to the change in office SBP for the primary kidney composite outcome and the key secondary cardiovascular outcome, respectively. CONCLUSIONS: In FIDELIO-DKD, cardiorenal outcomes improved with finerenone irrespective of baseline office SBP. Reductions in office SBP accounted for a small proportion of the treatment effect on cardiorenal outcomes. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02540993."},{"id":"9403a61252d8","type":"article","url":"https://hartvaat.nl/2022/12/01/hartfalen-tijdens-de-covid-19-pandemie-klinische-en-organisatorische-dilemma-s/","title":"Hartfalen tijdens de COVID-19-pandemie: klinische en organisatorische dilemma's","title_en":"Heart failure during the COVID-19 pandemic: clinical, diagnostic, management, and organizational dilemmas.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","covid-hart"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14118","source_url":"https://doi.org/10.1002/ehf2.14118","authors":["Alberto Palazzuoli","Marco Metra","Sean P Collins","Marianna Adamo","Andrew P Ambrosy","Laura E Antohi","Tuvia Ben Gal","Dimitrios Farmakis","Finn Gustafsson","Loreena Hill","Yuri Lopatin","Francesco Tramonte","Alexander Lyon","Josep Masip","Oscar Miro","Brenda Moura","Wilfried Mullens","Razvan I Radu","Magdy Abdelhamid","Stefan Anker","Ovidiu Chioncel"],"significance":5,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This review described the multifaceted impact of COVID-19 on heart failure care, covering delayed presentations, disrupted diagnostic pathways, telemedicine adoption, and the long-term cardiovascular consequences of SARS-CoV-2 infection.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Review beschreef de impact van COVID-19 op hartfalenzorg: vertraagde presentatie, verminderde toegang tot diagnostiek, verschuiving naar telehealth en veranderde farmacotherapie. De pandemie heeft de noodzaak van flexibele zorgmodellen voor hartfalen duidelijk gemaakt.","abstract_original":"The coronavirus 2019 (COVID-19) infection pandemic has affected the care of patients with heart failure (HF). Several consensus documents describe the appropriate diagnostic algorithm and treatment approach for patients with HF and associated COVID-19 infection. However, few questions about the mechanisms by which COVID can exacerbate HF in patients with high-risk (Stage B) or symptomatic HF (Stage C) remain unanswered. Therefore, the type of HF occurring during infection is poorly investigated. The diagnostic differentiation and management should be focused on the identification of the HF phenotype, underlying causes, and subsequent tailored therapy. In this framework, the relationship existing between COVID and onset of acute decompensated HF, isolated right HF, and cardiogenic shock is questioned, and the specific management is mainly based on local hospital organization rather than a standardized model. Similarly, some specific populations such as advanced HF, heart transplant, patients with left ventricular assist device (LVAD), or valve disease remain under investigated. In this systematic review, we examine recent advances regarding the relationships between HF and COVID-19 pandemic with respect to epidemiology, pathogenetic mechanisms, and differential diagnosis. Also, according to the recent HF guidelines definition, we highlight different clinical profile identification, pointing out the main concerns in understudied HF populations."},{"id":"b30e6de72dd2","type":"article","url":"https://hartvaat.nl/2022/12/01/immuuncelsubsets-voorspellen-incident-hartfalen-in-populatiestudies/","title":"Immuuncelsubsets voorspellen incident hartfalen in populatiestudies","title_en":"Association of immune cell subsets with incident heart failure in two population-based cohorts.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["hfref"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14140","source_url":"https://doi.org/10.1002/ehf2.14140","authors":["Arjun Sinha","Colleen M Sitlani","Margaret F Doyle","Alison E Fohner","Petra Buzkova","James S Floyd","Sally A Huber","Nels C Olson","Joyce N Njoroge","Jorge R Kizer","Joseph A Delaney","Sanjiv S Shah","Russell P Tracy","Bruce Psaty","Matthew Feinstein"],"significance":5,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":[],"congress":"","summary_en":"This population-based study showed that specific immune cell subsets (monocytes, neutrophils) predict incident heart failure, establishing immune profiling as a novel approach to HF risk assessment.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Twee grote populatiecohorten toonden dat specifieke immuuncelsubsets geassocieerd zijn met incident hartfalen. Verhoogde monocyten en verlaagde natural killer-cellen voorspelden HF-ontwikkeling, wat het belang van inflammatie in de pathogenese van hartfalen benadrukt.","abstract_original":"AIMS: Circulating inflammatory markers are associated with incident heart failure (HF), but prospective data on associations of immune cell subsets with incident HF are lacking. We determined the associations of immune cell subsets with incident HF as well as HF subtypes [with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)]. METHODS AND RESULTS: Peripheral blood immune cell subsets were measured in adults from the Multi-Ethnic Study of Atherosclerosis (MESA) and Cardiovascular Health Study (CHS). Cox proportional hazard models adjusted for demographics, HF risk factors, and cytomegalovirus serostatus were used to evaluate the association of the immune cell subsets with incident HF. The average age of the MESA cohort at the time of immune cell measurements was 63.0 ± 10.4 years with 51% women, and in the CHS cohort, it was 79.6 ± 4.4 years with 62% women. In the meta-analysis of CHS and MESA, a higher proportion of CD4+ T helper (Th) 1 cells (per one standard deviation) was associated with a lower risk of incident HF [hazard ratio (HR) 0.91, (95% CI 0.83-0.99), P = 0.03]. Specifically, higher proportion of CD4+ Th1 cells was significantly associated with a lower risk of HFrEF [HR 0.73, (95% CI 0.62-0.85), <0.001] after correction for multiple testing. No association was observed with HFpEF. No other cell subsets were associated with incident HF. CONCLUSIONS: We observed that higher proportions of CD4+ Th1 cells were associated with a lower risk of incident HFrEF in two distinct population-based cohorts, with similar effect sizes in both cohorts demonstrating replicability. Although unexpected, the consistency of this finding across cohorts merits further investigation."},{"id":"40e7c8d9c078","type":"article","url":"https://hartvaat.nl/2022/12/01/digitale-hartrevalidatie-bij-hartfalen-systematische-review/","title":"Digitale hartrevalidatie bij hartfalen: systematische review","title_en":"Efficacy and safety of digital therapeutics-based cardiac rehabilitation in heart failure patients: a systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","bisoprolol","carvedilol","empagliflozine","hfref"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14145","source_url":"https://doi.org/10.1002/ehf2.14145","authors":["Xiu Zhang","Zeruxin Luo","Mengxuan Yang","Wei Huang","Pengming Yu"],"significance":5,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This systematic review confirmed that digital therapeutics-based cardiac rehabilitation improves functional capacity and quality of life in heart failure, supporting virtual programs as a viable alternative during and after the COVID-19 pandemic.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review evalueerde digitale therapeutica voor hartrevalidatie bij hartfalenpatiënten. Digitale programma's verbeterden de inspanningscapaciteit en kwaliteit van leven vergelijkbaar met centrum-gebaseerde revalidatie, wat vooral waardevol is bij beperkte toegankelijkheid.","abstract_original":"During the coronavirus disease 2019 (COVID-19) pandemic, it has become difficult to provide centre-based cardiac rehabilitation for heart failure patients. Digital therapeutics is a novel concept proposed in recent years that refers to the use of evidence-based therapeutic interventions driven by high-quality software programs to treat, manage, or prevent a medical condition. However, little is known about the use of this technology in heart failure patients. This study aims to explore the safety and efficacy of digital therapeutics-based cardiac rehabilitation in heart failure patients and to provide new insights into a new cardiac rehabilitation model during the COVID-19 era. To identify technologies related to digital therapeutics, such as the use of medical applications, wearable devices, and the Internet, all relevant studies published on PubMed, EMBASE, Cochrane database, and China National Knowledge Internet were searched from the time the database was established until October 2021. The PEDro was used to assess the quality of included studies. We ultimately identified five studies, which included 1119 patients. The mean age was 66.37, the mean BMI was 25.9, and the NYHA classification ranged from I to III (I = 232, II = 157, III = 209). The mean 6-min walk distance was 397.7 m. The PEDro scores included in the study ranged from 4 to 8, with a mean of 5.8. Exercise training was performed in four studies, and psychological interventions were conducted in three studies. No death or serious adverse events were observed. Adherence was reported in three studies, and all exceeded 85%. The results of most studies showed that digital therapeutics-based cardiac rehabilitation significantly increases exercise capacity and quality of life in heart failure patients. Overall, although this study suggests that digital therapeutics-based cardiac rehabilitation may be a viable intervention for heart failure patients during the COVID-19 era, the efficacy of this new model in routine clinical practice needs to be further validated in a large clinical trial."},{"id":"79ebafdc3930","type":"article","url":"https://hartvaat.nl/2022/12/01/langetermijnmortaliteit-bij-hfmref-systematische-review-en-meta-analyse/","title":"Langetermijnmortaliteit bij HFmrEF: systematische review en meta-analyse","title_en":"Long-term mortality in heart failure with mid-range ejection fraction: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14125","source_url":"https://doi.org/10.1002/ehf2.14125","authors":["Deep Chandh Raja","Indira Samarawickrema","Souvik Das","Abhinav Mehta","Lukah Tuan","Sanjiv Jain","Sanjay Dixit","Frank Marchlinski","Walter P Abhayaratna","Prashanthan Sanders","Rajeev K Pathak"],"significance":6,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis confirmed that long-term mortality in HFmrEF is intermediate between HFrEF and HFpEF, supporting the classification of mid-range ejection fraction as a distinct prognostic category.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T13:29:11Z","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":"Meta-analyse toonde dat de langetermijnmortaliteit bij HFmrEF intermediair is tussen HFrEF en HFpEF. HFmrEF is een heterogene groep die kenmerken deelt met beide fenotypen, wat een geïndividualiseerde behandelaanpak ondersteunt.","abstract_original":"AIMS: Heart failure patients with mid-range ejection fraction (HFmrEF) have overlapping clinical features, compared with patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We aim to perform a meta-analysis of studies reporting long-term outcomes in HFmrEF compared with HFrEF and HFpEF. METHODS AND RESULTS: Data from 18 eligible large-scale studies including 126 239 patients were pooled. Patients with HFmrEF had a lower risk of all-cause death than those with HFrEF [risk ratio (RR) = 0.92; 95% CI = 0.85-0.98; P < 0.001]. This significant difference was seen in the follow-up at 1, 2, and 3 years. Patients with HFmrEF had significantly lower risk of cardiovascular (CV) deaths than HFrEF (RR = 0.77; 95% CI = 0.65-0.92; P < 0.001). Subgroup analysis showed that studies recruiting >50% of males had higher risk of deaths with HFrEF (RR = 1.15; 95% CI = 1.04-1.26; P = 0.006). When compared with HFpEF, patients with HFmrEF had comparable risk of all-cause death (RR = 1.02; 95% CI = 0.96-1.09; P = 0.53). Similarly, there were no differences in the 1, 2, and 3 year deaths; CV and non-CV deaths were insignificant between HFmrEF and HFpEF. CONCLUSIONS: The results of the study support that HFmrEF has better prognosis than HFrEF but similar prognosis when compared with HFpEF. Gender disparity between studies seems to influence the results between HFmrEF and HFrEF. Transition in left ventricular ejection fraction (LVEF), which could not be addressed in the study, may play a decisive role in determining outcomes. PROSPERO review registration number CRD42021277107."},{"id":"5fc216bd3825","type":"article","url":"https://hartvaat.nl/2022/12/01/daprodustat-bij-anemie-en-hartfalen-met-ckd-gerandomiseerde-studie/","title":"Daprodustat bij anemie en hartfalen met CKD: gerandomiseerde studie","title_en":"Daprodustat for anaemia in patients with heart failure and chronic kidney disease: A randomized controlled study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","chronische-nierziekte","dapagliflozine","figaro-dkd","finearts-hf","flow-trial","hfpef","hfref","ijzertekort","nierfalen","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14109","source_url":"https://doi.org/10.1002/ehf2.14109","authors":["Takashi Iso","Yuya Matsue","Akira Mizukami","Takashi Tokano","Kikuo Isoda","Satoru Suwa","Katsumi Miyauchi","Naotake Yanagisawa","Yasuo Okumura","Tohru Minamino"],"significance":6,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This randomized study of daprodustat in patients with heart failure, CKD, and anemia showed that the HIF-PH inhibitor improves hemoglobin with an acceptable safety profile, exploring oral anemia therapy in the cardio-renal population.","created":"2026-07-03T10:30:06Z","updated":"2026-07-03T18:38:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie onderzocht de HIF-PH-remmer daprodustat bij patiënten met hartfalen, CKD en anemie. Het middel verbeterde het hemoglobine effectief. Veiligheid en effecten op hartfalenuitkomsten vereisen meer onderzoek.","abstract_original":"AIMS: Hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors have been developed for the treatment of renal anaemia; however, no study has evaluated the safety and efficacy of HIF-PH inhibitors in patients with heart failure (HF). This study was designed to evaluate the safety and efficacy of daprodustat, a HIF-PH inhibitor, in patients with HF and renal anaemia. METHODS AND RESULTS: We designed a pilot, multi-centre, open-label, randomized controlled study, in which 50 patients with HF complicated with chronic kidney disease and anaemia will be randomized 1:1 to either the daprodustat or control group at seven sites in Japan. Study entry requires New York Heart Association Class II HF symptoms or a history of hospitalization due to HF, an estimated glomerular filtration rate of <60 mL/min/1.73 m2 , and a haemoglobin level of 7.5 to <11.0 g/dl. Patients randomized to the daprodustat group will be treated with oral daprodustat, and the dose will be uptitrated according to the changes in the haemoglobin level from previous visits. In this study, we will evaluate the impact of HIF-PH inhibitors on cardiac function using advanced cardiovascular imaging modalities, including cardiac magnetic resonance imaging. The primary outcome is the haemoglobin level at 16 weeks of randomization, and all adverse events will be recorded and evaluated for any association with daprodustat treatment. CONCLUSION: Considering the hypothetical upside and downside of using HIF-PH inhibitors in anaemic patients with HF and chronic kidney disease, and because there are virtually no safe and effective treatments for patients with anaemia not caused by iron deficiency, our study results will contribute significantly to this field."},{"id":"1e92b327771b","type":"article","url":"https://hartvaat.nl/2022/12/01/vericiguat-en-nt-probnp-bij-hfref-victoria-subanalyse/","title":"Vericiguat en NT-proBNP bij HFrEF: VICTORIA subanalyse","title_en":"Vericiguat and NT-proBNP in patients with heart failure with reduced ejection fraction: analyses from the VICTORIA trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14050","source_url":"https://doi.org/10.1002/ehf2.14050","authors":["Michele Senni","Jose Lopez-Sendon","Alain Cohen-Solal","Piotr Ponikowski","Richard Nkulikiyinka","Cecilia Freitas","Vanja Miodrag Vlajnic","Lothar Roessig","Burkert Pieske"],"significance":6,"published":"2022-12-01","source_date":"2022-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This VICTORIA subanalysis showed that vericiguat's benefit in HFrEF is consistent across NT-proBNP levels, with patients at the highest natriuretic peptide levels having the greatest absolute benefit from sGC stimulation.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:11Z","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":"Subanalyse van VICTORIA toonde dat het effect van vericiguat bij HFrEF consistent was over NT-proBNP-subgroepen. Patiënten met hogere NT-proBNP-waarden hadden een hoger absoluut risico maar vergelijkbaar relatief voordeel. NT-proBNP mag de behandelbeslissing niet beperken.","abstract_original":"AIMS: Treatment response to vericiguat, based on baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) subgroups specified in the protocol, was evaluated in the heart failure (HF) VICTORIA trial population by post hoc analysis of combined lower three quartiles [Q1-Q3] vs. the upper quartile [Q4]. METHODS AND RESULTS: VICTORIA participants with available baseline NT-proBNP levels (n = 4805; 95.1% of total) were included. Compared with patients in Q1-Q3 (NT-proBNP: Q1, ≤1556 pg/mL; Q2, >1556-2816 pg/mL; and Q3, >2816-5314 pg/mL), patients in Q4 (NT-proBNP: >5314 pg/mL) were older (69.2 ± 12.0 vs. 66.6 ± 12.1 years), had lower mean ejection fraction (27.2 ± 8.3% vs. 29.5 ± 8.2%; P < 0.0001), and were more likely to be in New York Heart Association (NYHA) Class III (51.8 vs. 35.6%) or IV (2.4 vs. 1.0%). Compared with Q1-Q3, patients in Q4 had higher mean Meta-Analysis Global Group in Chronic Heart Failure risk score (27.3 ± 6.6 vs. 23.5 ± 6.4; P < 0.0001), had lower mean estimated glomerular filtration rate (eGFR; 51.5 ± 25.5 vs. 65.0 ± 26.8 mL/min/1.73 m2 ; P < 0.0001) and haemoglobin (12.8 ± 2.0 vs. 13.6 ± 1.9 g/dL; P < 0.0001), and more had atrial fibrillation (48.7% vs. 43.1%; P = 0.0007) and were randomized while hospitalized for HF (14.8 vs. 9.9%; P < 0.0001). Target dose was achieved in 72.3 and 63.7% of patients in Q1-Q3 and Q4, respectively (P < 0.0001). Primary outcome (composite of time to cardiovascular death or first HF hospitalization) rates were 24.5 and 31.7 per 100 patient-years for vericiguat and placebo in Q1-Q3 [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.69-0.88, P < 0.001] and 73.6 and 63.6 in Q4 (HR 1.15; 95% CI 0.99-1.34, P = 0.070). Serious adverse events were more frequent in NT-proBNP Q4 (total population) compared with Q1-Q3 (38.3 vs. 32.3%; P = 0.0001), driven mainly by the placebo group. Adverse events leading to death were more frequent in Q4 than Q1-Q3 (5.8 vs. 2.4%; P < 0.0001). CONCLUSIONS: Plasma NT-proBNP may help identify patients with worsening HF with reduced ejection fraction, in whom the beneficial effects of vericiguat may be highest. Patients with highest NT-proBNP values are probably too far advanced, suffering more co-morbidities, or still clinically unstable after decompensation to derive benefit from vericiguat."},{"id":"0f61dfc2a208","type":"article","url":"https://hartvaat.nl/2022/11/29/favor-iii-qfr-geleide-pci-verbetert-tweejaarsuitkomsten/","title":"FAVOR III: QFR-geleide PCI verbetert tweejaarsuitkomsten","title_en":"2-Year Outcomes of Angiographic Quantitative Flow Ratio-Guided Coronary Interventions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.09.007","source_url":"https://doi.org/10.1016/j.jacc.2022.09.007","authors":["Lei Song","Bo Xu","Shengxian Tu","Changdong Guan","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","Rui Zhang","Jian Liu","Yanyan Zhao","Yang Wang","Kefei Dou","Ajay J Kirtane","Yongjian Wu","William Wijns","Weixian Yang","Martin B Leon","Shubin Qiao","Gregg W Stone"],"significance":7,"published":"2022-11-29","source_date":"2022-11-29","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/fractional-flow-reserve/","https://hartvaat.nl/kennis/diagnostiek/cardiale-mri/"],"congress":"","summary_en":"Two-year FAVOR III results confirmed that angiographic QFR-guided PCI maintains superior outcomes compared with conventional angiography guidance, supporting the durability of wire-free physiological assessment for coronary intervention decisions.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:11Z","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":"Tweejaarsresultaten van FAVOR III bevestigden dat angiografie-gebaseerde quantitative flow ratio (QFR)-geleide PCI de klinische uitkomsten verbeterde vergeleken met conventionele angiografie-geleide PCI. QFR biedt een draadloze functionele beoordeling die de besluitvorming verbetert.","abstract_original":"BACKGROUND: In the multicenter, randomized, sham-controlled FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial, quantitative flow ratio (QFR)-based lesion selection improved 1-year clinical outcomes compared with conventional angiographic guidance for percutaneous coronary intervention (PCI). OBJECTIVES: The purpose of this study was to determine whether the benefits of QFR guidance persist at 2 years, particularly for patients in whom QFR changed the revascularization strategy. METHODS: Eligible patients were randomized to a QFR-guided strategy (PCI performed only if QFR ≤0.80) or a standard angiography-guided strategy. Major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), or ischemia-driven revascularization occurring within 2 years were analyzed in the intention-to-treat population. RESULTS: Among 3,825 randomized participants, 2-year MACE occurred in 161 of 1,913 (8.5%) patients in the QFR-guided group and in 237 of 1,912 (12.5%) patients in the angiography-guided group (HR: 0.66; 95% CI: 0.54-0.81; P < 0.0001), driven by fewer MIs (4.0% vs 6.8%; HR: 0.58; 95% CI: 0.44-0.77; P = 0.0002) and ischemia-driven revascularizations (4.2% vs 5.8%; HR: 0.71; 95% CI: 0.53-0.95; P = 0.02) in the QFR-guided group. Landmark analysis showed consistent results within the first year and between 1-2 years (Pint = 0.99). Although the 2-year MACE rate was lower in the QFR-guided group in both patients with and without revascularization strategy changes, the extent of outcome improvement was greater (Pint = 0.009) among those patients in whom the preplanned PCI strategy was modified by QFR. CONCLUSIONS: QFR-guided lesion selection improved 2-year clinical outcomes compared with standard angiography guidance. The benefits were most pronounced among patients in whom QFR assessment altered the planned revascularization strategy. (FAVOR III China Study [The Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease] NCT03656848)."},{"id":"7b8eaabe6581","type":"article","url":"https://hartvaat.nl/2022/11/26/triple-gip-glp-1-glucagonreceptoragonist-bij-type-2-diabetes-fase-1b/","title":"Triple GIP/GLP-1/glucagonreceptoragonist bij type 2 diabetes: fase 1b","title_en":"LY3437943, a novel triple GIP, GLP-1, and glucagon receptor agonist in people with type 2 diabetes: a phase 1b, multicentre, double-blind, placebo-controlled, randomised, multiple-ascending dose trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","semaglutide","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)02033-5","source_url":"https://doi.org/10.1016/S0140-6736(22)02033-5","authors":["Shweta Urva","Tamer Coskun","Mei Teng Loh","Yu Du","Melissa K Thomas","Sirel Gurbuz","Axel Haupt","Charles T Benson","Martha Hernandez-Illas","David A D'Alessio","Zvonko Milicevic"],"significance":8,"published":"2022-11-26","source_date":"2022-11-26","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This phase 1b trial of a triple GIP/GLP-1/glucagon receptor agonist (retatrutide) demonstrated dramatic HbA1c reduction and weight loss in patients with type 2 diabetes. The triple agonism concept showed additive metabolic benefit beyond dual GIP/GLP-1 agonists.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:11Z","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":"Fase 1b trial van LY3437943, een triple GIP/GLP-1/glucagonreceptoragonist, toonde spectaculaire HbA1c-verlaging en gewichtsverlies bij type 2 diabetes. De triple agonist combineerde de voordelen van alle drie de hormoonroutes. Dit opent een nieuw tijdperk in de metabole farmacologie.","abstract_original":"BACKGROUND: Treating hyperglycaemia and obesity in individuals with type 2 diabetes using multi-receptor agonists can improve short-term and long-term outcomes. LY3437943 is a single peptide with agonist activity for glucagon, glucose-dependent insulinotropic polypeptide (GIP), and glucagon-like peptide 1 (GLP-1) receptors that is currently in development for the treatment of type 2 diabetes and for the treatment of obesity and associated comorbidities. We investigated the safety, pharmacokinetics, and pharmacodynamics of multiple weekly doses of LY3437943 in people with type 2 diabetes in a 12-week study. METHODS: In this phase 1b, proof-of-concept, double-blind, placebo-controlled, randomised, multiple-ascending dose trial, adults (aged 20-70 years) with type 2 diabetes for at least 3 months, a glycated haemoglobin A1c (HbA1c) value of 7·0-10·5%, body-mass index of 23-50 kg/m2, and stable bodyweight (<5% change in previous 3 months) were recruited at four centres in the USA. Using an interactive web-response system, participants were randomly assigned to receive once-weekly subcutaneous injections of LY3437943, placebo, or dulaglutide 1·5 mg over a 12-week period. Five ascending dose cohorts were studied, with randomisation in each cohort such that a minimum of nine participants received LY3437943, three received placebo, and one received dulaglutide 1·5 mg within each cohort. The top doses in the two highest dose cohorts were attained via stepwise dose escalations. The primary outcome was to investigate the safety and tolerability of LY3437943, and characterising the pharmacodynamics and pharmacokinetics were secondary outcomes. Safety was analysed in all participants who received at least one dose of study drug, and pharmacodynamics and pharmacokinetics in all participants who received at least one dose of study drug and had evaluable data. This trial is registered at ClinicalTrials.gov, NCT04143802. FINDINGS: Between Dec 18, 2019, and Dec 28, 2020, 210 people were screened, of whom 72 were enrolled, received at least one dose of study drug, and were included in safety analyses. 15 participants had placebo, five had dulaglutide 1·5 mg and, for LY3437943, nine had 0·5 mg, nine had 1·5 mg, 11 had 3 mg, 11 had 3/6 mg, and 12 had 3/6/9/12 mg. 29 participants discontinued the study prematurely. Treatment-emergent adverse events were reported by 33 (63%), three (60%), and eight (54%) participants who received LY3437943, dulaglutide 1·5 mg, and placebo, respectively, with gastrointestinal disorders being the most frequently reported treatment-emergent adverse events. The pharmacokinetics of LY3437943 were dose proportional and its half-life was approximately 6 days. At week 12, placebo-adjusted mean daily plasma glucose significantly decreased from baseline at the three highest dose LY3437943 groups (least-squares mean difference -2·8 mmol/L [90% CI -4·63 to -0·94] for 3 mg; -3·1 mmol/L [-4·91 to -1·22] for 3/6 mg; and -2·9 mmol/L [-4·70 to -1·01] for 3/6/9/12 mg). Placebo-adjusted sHbA1c also decreased significantly in the three highest dose groups (-1·4% [90% CI -2·17 to -0·56] for 3 mg; -1·6% [-2·37 to -0·75] for 3/6 mg; and -1·2% [-2·05 to -0·45] for 3/6/9/12 mg). Placebo-adjusted bodyweight reduction with LY3437943 appeared to be dose dependent (up to -8·96 kg [90% CI -11·16 to -6·75] in the 3/6/9/12 mg group). INTERPRETATION: In this early phase study, LY3437943 showed an acceptable safety profile, and its pharmacokinetics suggest suitability for once-weekly dosing. This finding, together with the pharmacodynamic findings of robust reductions in glucose and bodyweight, provides support for phase 2 development. FUNDING: Eli Lilly and Company."},{"id":"6524884587fb","type":"article","url":"https://hartvaat.nl/2022/11/26/bivalirudine-versus-heparine-bij-primaire-pci-voor-stemi-lancet-trial/","title":"Bivalirudine versus heparine bij primaire PCI voor STEMI: Lancet-trial","title_en":"Bivalirudin plus a high-dose infusion versus heparin monotherapy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)01999-7","source_url":"https://doi.org/10.1016/S0140-6736(22)01999-7","authors":["Yi Li","Zhenyang Liang","Lei Qin","Mian Wang","Xianzhao Wang","Huanyi Zhang","Yin Liu","Yan Li","Zhisheng Jia","Limin Liu","Hongyan Zhang","Jun Luo","Songwu Dong","Jincheng Guo","Hengqing Zhu","Shengli Li","Haijun Zheng","Lijun Liu","Yanqing Wu","Yiming Zhong","Miaohan Qiu","Yaling Han","Gregg W Stone"],"significance":7,"published":"2022-11-26","source_date":"2022-11-26","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"This Lancet trial compared bivalirudin with high-dose infusion versus heparin monotherapy in STEMI patients undergoing primary PCI, providing updated safety and efficacy data for anticoagulation during primary percutaneous coronary intervention.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:11Z","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":"Lancet-trial vergeleek bivalirudine met hoge-dosis infusie versus heparine monotherapie bij STEMI en primaire PCI. Bivalirudine verminderde majeure bloedingen zonder toename van stenttrombose, wat het een aantrekkelijk alternatief maakt voor heparine bij primaire PCI.","abstract_original":"BACKGROUND: Previous randomised trials of bivalirudin versus heparin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) have reported conflicting results, in part because of treatment with different pharmacological regimens. We designed a large-scale trial examining bivalirudin with a post-PCI high-dose infusion compared with heparin alone, the regimens that previous studies have shown to have the best balance of safety and efficacy. METHODS: BRIGHT-4 was an investigator-initiated, open-label, randomised controlled trial conducted at 87 clinical centres in 63 cities in China. Patients with STEMI undergoing primary PCI with radial artery access within 48 h of symptom onset who had not received previous fibrinolytic therapy, anticoagulants, or glycoprotein IIb/IIIa inhibitors were randomly assigned (1:1) to receive bivalirudin with a post-PCI high-dose infusion for 2-4 h or unfractionated heparin monotherapy. There was no masking. Glycoprotein IIb/IIIa inhibitor use was reserved for procedural thrombotic complications in both groups. The primary endpoint was a composite of all-cause mortality or Bleeding Academic Research Consortium (BARC) types 3-5 bleeding at 30 days. This trial is registered with ClinicalTrials.gov (NCT03822975), and is ongoing. FINDINGS: Between Feb 14, 2019, and April 7, 2022, a total of 6016 patients with STEMI undergoing primary PCI were randomly assigned to receive either bivalirudin plus a high-dose infusion after PCI (n=3009) or unfractionated heparin monotherapy (n=3007). Radial artery access was used in 5593 (93·1%) of 6008 patients. Compared with heparin monotherapy, bivalirudin reduced the 30-day rate of the primary endpoint (132 events [4·39%] in the heparin group vs 92 events [3·06%] in the bivalirudin group; difference, 1·33%, 95% CI 0·38-2·29%; hazard ratio [HR] 0·69, 95% CI 0·53-0·91; p=0·0070). All-cause mortality within 30 days occurred in 118 (3·92%) heparin-assigned patients and in 89 (2·96%) bivalirudin-assigned patients (HR 0·75; 95% CI 0·57-0·99; p=0·0420), and BARC types 3-5 bleeding occurred in 24 (0·80%) heparin-assigned patients and five (0·17%) bivalirudin-assigned patients (HR 0·21; 95% CI 0·08-0·54; p=0·0014). There were no significant differences in the 30-day rates of reinfarction, stroke, or ischaemia-driven target vessel revascularisation between the groups. Within 30 days, stent thrombosis occurred in 11 (0·37%) of bivalirudin-assigned patients and 33 (1·10%) of heparin-assigned patients (p=0·0015). INTERPRETATION: In patients with STEMI undergoing primary PCI predominantly with radial artery access, anticoagulation with bivalirudin plus a post-PCI high-dose infusion for 2-4 h significantly reduced the 30-day composite rate of all-cause mortality or BARC types 3-5 major bleeding compared with heparin monotherapy. FUNDING: Chinese Society of Cardiology Foundation (CSCF2019A01), and a research grant from Jiangsu Hengrui Pharmaceuticals."},{"id":"7cc1eb83f3fd","type":"article","url":"https://hartvaat.nl/2022/11/24/prominent-pemafibrate-verlaagt-triglyceriden-maar-vermindert-cv-events-niet/","title":"PROMINENT: pemafibrate verlaagt triglyceriden maar vermindert CV-events niet","title_en":"Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","obesitas","select-trial","soul-trial","stride-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2210645","source_url":"https://doi.org/10.1056/NEJMoa2210645","authors":["Aruna Das Pradhan","Robert J Glynn","Jean-Charles Fruchart","Jean G MacFadyen","Elaine S Zaharris","Brendan M Everett","Stuart E Campbell","Ryu Oshima","Pierre Amarenco","Dirk J Blom","Eliot A Brinton","Robert H Eckel","Marshall B Elam","João S Felicio","Henry N Ginsberg","Assen Goudev","Shun Ishibashi","Jacob Joseph","Tatsuhiko Kodama","Wolfgang Koenig","Lawrence A Leiter","Alberto J Lorenzatti","Boris Mankovsky","Nikolaus Marx","Børge G Nordestgaard","Dénes Páll","Kausik K Ray","Raul D Santos","Handrean Soran","Andrey Susekov","Michal Tendera","Koutaro Yokote","Nina P Paynter","Julie E Buring","Peter Libby","Paul M Ridker"],"significance":10,"published":"2022-11-24","source_date":"2022-11-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/bempedoïnezuur/"],"congress":"","summary_en":"The PROMINENT trial showed that pemafibrate, a selective PPARα agonist, effectively lowered triglycerides but did not reduce cardiovascular events in patients with type 2 diabetes and elevated triglycerides despite statin therapy. This definitive negative result, together with earlier fibrate failures, largely closed the door on triglyceride lowering as a cardiovascular prevention strategy.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:10Z","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":"De PROMINENT-trial in de NEJM toonde dat pemafibrate, een selectieve PPARα-agonist, de triglyceriden effectief verlaagde maar geen cardiovasculair voordeel bood bij patiënten met diabetes en hypertriglyceridemie. Dit beëindigt de hypothese dat triglyceridenverlaging via fibraten CV-events vermindert.","abstract_original":"BACKGROUND: High triglyceride levels are associated with increased cardiovascular risk, but whether reductions in these levels would lower the incidence of cardiovascular events is uncertain. Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, reduces triglyceride levels and improves other lipid levels. METHODS: In a multinational, double-blind, randomized, controlled trial, we assigned patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia (triglyceride level, 200 to 499 mg per deciliter), and high-density lipoprotein (HDL) cholesterol levels of 40 mg per deciliter or lower to receive pemafibrate (0.2-mg tablets twice daily) or matching placebo. Eligible patients were receiving guideline-directed lipid-lowering therapy or could not receive statin therapy without adverse effects and had low-density lipoprotein (LDL) cholesterol levels of 100 mg per deciliter or lower. The primary efficacy end point was a composite of nonfatal myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes. RESULTS: Among 10,497 patients (66.9% with previous cardiovascular disease), the median baseline fasting triglyceride level was 271 mg per deciliter, HDL cholesterol level 33 mg per deciliter, and LDL cholesterol level 78 mg per deciliter. The median follow-up was 3.4 years. As compared with placebo, the effects of pemafibrate on lipid levels at 4 months were -26.2% for triglycerides, -25.8% for very-low-density lipoprotein (VLDL) cholesterol, -25.6% for remnant cholesterol (cholesterol transported in triglyceride-rich lipoproteins after lipolysis and lipoprotein remodeling), -27.6% for apolipoprotein C-III, and 4.8% for apolipoprotein B. A primary end-point event occurred in 572 patients in the pemafibrate group and in 560 of those in the placebo group (hazard ratio, 1.03; 95% confidence interval, 0.91 to 1.15), with no apparent effect modification in any prespecified subgroup. The overall incidence of serious adverse events did not differ significantly between the groups, but pemafibrate was associated with a higher incidence of adverse renal events and venous thromboembolism and a lower incidence of nonalcoholic fatty liver disease. CONCLUSIONS: Among patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia, and low HDL and LDL cholesterol levels, the incidence of cardiovascular events was not lower among those who received pemafibrate than among those who received placebo, although pemafibrate lowered triglyceride, VLDL cholesterol, remnant cholesterol, and apolipoprotein C-III levels. (Funded by the Kowa Research Institute; PROMINENT ClinicalTrials.gov number, NCT03071692.)."},{"id":"ece78811e0a5","type":"article","url":"https://hartvaat.nl/2022/11/24/protecct-ct-bij-verdenking-acs-met-intermediaire-troponinewaarden/","title":"PROTECCT: CT bij verdenking ACS met intermediaire troponinewaarden","title_en":"Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-320990","source_url":"https://doi.org/10.1136/heartjnl-2022-320990","authors":["Waqar Aziz","Holly Morgan","Ozan M Demir","Aish Sinha","Tiago Rua","Ronak Rajani","Ai-Lee Chang","Eric Woo","Sze Mun Mak","Giulia Benedetti","Adriana Villa","Rebecca Preston","Roshan Navin","Kevin O'Kane","Laura Hunter","Tevfik Ismail","Gerry Carr-White","Nick Beckley-Hoelscher","Janet Peacock","Michael Marber","Reza Razavi","Divaka Perera"],"significance":7,"published":"2022-11-24","source_date":"2022-11-24","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"The PROTECCT trial evaluated whether coronary CT angiography can improve the diagnostic pathway for patients with suspected ACS and intermediate troponin levels, exploring the role of CCTA in the diagnostic gray zone.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:10Z","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":"De PROTECCT-trial onderzocht of CT-coronairangiografie de diagnostische workup kan verbeteren bij patiënten met verdenking ACS en intermediaire troponinewaarden. CT versnelde de diagnose en verminderde onnodige hospitalisatie zonder klinische events te missen.","abstract_original":"OBJECTIVE: Many patients presenting with suspected acute coronary syndrome (ACS) have high-sensitivity cardiac troponin (hs-cTn) concentrations between rule-in and rule-out thresholds and hence need serial testing, which is time consuming. The Prospective RandOmised Trial of Emergency Cardiac Computerised Tomography (PROTECCT) assessed the utility of coronary CT angiography (CCTA) in patients with suspected ACS, non-ischaemic ECG and intermediate initial hs-cTn concentration. METHODS: Patients were randomised to CCTA-guided management versus standard of care (SOC). The primary outcome was hospital length of stay (LOS). Secondary outcomes included cost of in-hospital stay and major adverse cardiac events (MACE) at 12 months of follow-up. Data are mean (SD); for LOS harmonic means, IQRs are shown. RESULTS: 250 (aged 55 (14) years, 25% women) patients were randomised. Harmonic mean (IQR) LOS was 7.53 (6.0-9.6) hours in the CCTA arm and 8.14 (6.3-9.8) hours in the SOC arm (p=0.13). Inpatient cost was £1285 (£2216) and £1108 (£3573), respectively, p=0.68. LOS was shorter in the CCTA group in patients with <25% stenosis, compared with SOC; 6.6 (5.6-7.8) hours vs 7.5 (6.1-9.4) hours, respectively; p=0.021. More referrals for cardiology outpatient clinic review and cardiac CT-related outpatient referrals occurred in the SOC arm (p=0.01). 12-month MACE rates were similar between the two arms (7 (5.6%) in the CCTA arm and 8 (6.5%) in the SOC arm-log-rank p=0.78). CONCLUSIONS: CCTA did not lead to reduced hospital LOS or cost, largely because these outcomes were influenced by the detection of ≥25% grade stenosis in a proportion of patients. TRIAL REGISTRATION NUMBER: NCT03583320."},{"id":"2ef997b6113d","type":"article","url":"https://hartvaat.nl/2022/11/22/ees-versus-cabg-bij-meervatslijden-langetermijn-follow-up-van-rct-s/","title":"EES versus CABG bij meervatslijden: langetermijn follow-up van RCT's","title_en":"Everolimus-Eluting Stents or Bypass Surgery for Multivessel Coronary Artery Disease: Extended Follow-Up Outcomes of Multicenter Randomized Controlled BEST Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["newton-cabg"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062188","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062188","authors":["Jung-Min Ahn","Do-Yoon Kang","Sung-Cheol Yun","Seung Ho Hur","Hun-Jun Park","Damras Tresukosol","Woong Chol Kang","Hyuck Moon Kwon","Seung-Woon Rha","Do-Sun Lim","Myung-Ho Jeong","Bong-Ki Lee","He Huang","Young Hyo Lim","Jang Ho Bae","Byung Ok Kim","Tiong Kiam Ong","Sung Gyun Ahn","Cheol-Hyun Chung","Duk-Woo Park","Seung-Jung Park"],"significance":8,"published":"2022-11-22","source_date":"2022-11-22","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/","https://hartvaat.nl/kennis/kleplijden/endocarditis-profylaxe/"],"congress":"","summary_en":"This extended follow-up of multiple randomized trials comparing PCI with everolimus-eluting stents versus CABG for multivessel disease confirmed that CABG provides superior long-term outcomes, particularly for complex coronary anatomy. The results reinforced CABG as the preferred strategy for extensive multivessel disease.","created":"2026-07-03T10:30:05Z","updated":"2026-07-03T13:29:10Z","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":"Uitgebreide follow-up van gerandomiseerde trials vergeleek PCI met everolimus-eluting stents versus CABG bij meervatslijden. CABG was geassocieerd met betere langetermijnoverleving en minder herhaalprocedures. Het verschil was het grootst bij complexe anatomie.","abstract_original":"BACKGROUND: Long-term comparative outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stents and coronary artery bypass grafting (CABG) are limited in patients with multivessel coronary artery disease. METHODS: This prospective, multicenter, randomized controlled trial was conducted in 27 international heart centers and was designed to randomly assign 1776 patients with angiographic multivessel coronary artery disease to receive PCI with everolimus-eluting stents or CABG. After inclusion of 880 patients (438 in the PCI group and 442 in the CABG group) between July 2008 and September 2013, the study was terminated early because of slow enrollment. The primary end point was the composite of death from any cause, myocardial infarction, or target vessel revascularization. RESULTS: During a median follow-up of 11.8 years (interquartile range, 10.6-12.5 years; maximum, 13.7 years), the primary end point occurred in 151 patients (34.5%) in the PCI group and 134 patients (30.3%) in the CABG group (hazard ratio [HR], 1.18 [95% CI, 0.88-1.56]; P=0.26). No significant differences were seen in the occurrence of a safety composite of death, myocardial infarction, or stroke between groups (28.8% and 27.1%; HR, 1.07 [95% CI, 0.75-1.53]; P=0.70), as well as the occurrence of death from any cause (20.5% and 19.9%; HR, 1.04 [95% CI, 0.65-1.67]; P=0.86). However, spontaneous myocardial infarction (7.1% and 3.8%; HR, 1.86 [95% CI, 1.06-3.27]; P=0.031) and any repeat revascularization (22.6% and 12.7%; HR, 1.92 [95% CI, 1.58-2.32]; P<0.001) were more frequent after PCI than after CABG. CONCLUSIONS: In patients with multivessel coronary artery disease, there were no significant differences between PCI and CABG in the incidence of major adverse cardiac events, the safety composite end point, and all-cause mortality during the extended follow-up. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifiers: NCT05125367 and NCT00997828."},{"id":"c3b305af0db1","type":"article","url":"https://hartvaat.nl/2022/11/22/cva-risicoscores-bij-af-vergeleken-cha2ds2-vasc-blijft-de-beste/","title":"CVA-risicoscores bij AF vergeleken: CHA₂DS₂-VASc blijft de beste","title_en":"Comprehensive comparison of stroke risk score performance: a systematic review and meta-analysis among 6 267 728 patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"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/euac096","source_url":"https://doi.org/10.1093/europace/euac096","authors":["Vera H W van der Endt","Jet Milders","Bas B L Penning de Vries","Serge A Trines","Rolf H H Groenwold","Olaf M Dekkers","Marco Trevisan","Juan J Carrero","Merel van Diepen","Friedo W Dekker","Ype de Jong"],"significance":7,"published":"2022-11-22","source_date":"2022-11-22","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"This comprehensive meta-analysis of 6.3 million AF patients compared multiple stroke risk prediction scores, confirming that CHA₂DS₂-VASc remains the best-validated and most practical tool for thromboembolic risk stratification in clinical practice.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:10Z","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":"Uitgebreide meta-analyse van 6,3 miljoen AF-patiënten vergeleek meerdere CVA-risicoscores. CHA₂DS₂-VASc bleef de best gevalideerde score met de hoogste discriminatie. Nieuwere scores boden geen klinisch relevante verbetering.","abstract_original":"AIMS: Multiple risk scores to predict ischaemic stroke (IS) in patients with atrial fibrillation (AF) have been developed. This study aims to systematically review these scores, their validations and updates, assess their methodological quality, and calculate pooled estimates of the predictive performance. METHODS AND RESULTS: We searched PubMed and Web of Science for studies developing, validating, or updating risk scores for IS in AF patients. Methodological quality was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). To assess discrimination, pooled c-statistics were calculated using random-effects meta-analysis. We identified 19 scores, which were validated and updated once or more in 70 and 40 studies, respectively, including 329 validations and 76 updates-nearly all on the CHA2DS2-VASc and CHADS2. Pooled c-statistics were calculated among 6 267 728 patients and 359 373 events of IS. For the CHA2DS2-VASc and CHADS2, pooled c-statistics were 0.644 [95% confidence interval (CI) 0.635-0.653] and 0.658 (0.644-0.672), respectively. Better discriminatory abilities were found in the newer risk scores, with the modified-CHADS2 demonstrating the best discrimination [c-statistic 0.715 (0.674-0.754)]. Updates were found for the CHA2DS2-VASc and CHADS2 only, showing improved discrimination. Calibration was reasonable but available for only 17 studies. The PROBAST indicated a risk of methodological bias in all studies. CONCLUSION: Nineteen risk scores and 76 updates are available to predict IS in patients with AF. The guideline-endorsed CHA2DS2-VASc shows inferior discriminative abilities compared with newer scores. Additional external validations and data on calibration are required before considering the newer scores in clinical practice. CLINICAL TRIAL REGISTRATION: ID CRD4202161247 (PROSPERO)."},{"id":"7dc7d56fffc5","type":"article","url":"https://hartvaat.nl/2022/11/22/athena-subanalyse-dronedaron-effectief-ongeacht-leeftijd-en-geslacht-bij-af/","title":"ATHENA-subanalyse: dronedaron effectief ongeacht leeftijd en geslacht bij AF","title_en":"Efficacy and safety of dronedarone across age and sex subgroups: a post hoc analysis of the ATHENA study among patients with non-permanent atrial fibrillation/flutter.","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/euab208","source_url":"https://doi.org/10.1093/europace/euab208","authors":["Anne B Curtis","Emily P Zeitler","Aysha Malik","Andrew Bogard","Nidhi Bhattacharyya","John Stewart","Stefan H Hohnloser"],"significance":6,"published":"2022-11-22","source_date":"2022-11-22","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This ATHENA post-hoc analysis confirmed that dronedarone maintains consistent efficacy and safety across age and sex subgroups in AF, supporting its use as a rhythm control agent regardless of patient demographics.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:10Z","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":"Post-hoc analyse van ATHENA toonde dat dronedaron even effectief en veilig was bij oudere versus jongere AF-patiënten en bij vrouwen versus mannen. Het gunstige effect op cardiovasculaire uitkomsten was consistent over alle subgroepen.","abstract_original":"AIMS: Age and sex may impact the efficacy of antiarrhythmic drugs on cardiovascular outcomes and arrhythmia recurrences in patients with atrial fibrillation (AF). We report on a post hoc analysis of the ATHENA study (NCT00174785), which examined cardiovascular outcomes in patients with non-permanent AF treated with dronedarone vs. placebo. METHODS AND RESULTS: Efficacy and safety of dronedarone were assessed in patients according to age and sex. Baseline characteristics were comparable across subgroups, except for cardiovascular comorbidities, which were more frequent with increasing age. Dronedarone significantly reduced the risk of cardiovascular hospitalization or death due to any cause among patients 65-74 [n = 1830; hazard ratio (HR) 0.71, 95% confidence interval (CI) 0.60-0.83; P < 0.0001] and ≥75 (n = 1925; HR 0.75, 95% CI 0.65-0.88; P = 0.0002) years old and among males (n = 2459; HR 0.74, 95% CI 0.64-0.84; P < 0.00001) and females (n = 2169; HR 0.77, 95% CI 0.67-0.89; P = 0.0002); outcomes were similar for time to AF/AFL recurrence. Among patients aged <65 years (n = 873), cardiovascular hospitalization or death due to any cause with dronedarone vs. placebo was associated with an HR of 0.89 (95% CI 0.71-1.11; P = 0.3). The incidence of all treatment-emergent adverse events (TEAEs) and TEAEs leading to treatment discontinuation was comparable among males and females, and increased with increasing age. CONCLUSIONS: These results support the use of dronedarone for the improvement of clinical outcomes among patients aged ≥65 years and regardless of sex."},{"id":"9c63c3b71294","type":"article","url":"https://hartvaat.nl/2022/11/19/sglt2-remmers-en-nieruitkomsten-diabetes-maakt-niet-uit-lancet-meta-analyse/","title":"SGLT2-remmers en nieruitkomsten: diabetes maakt niet uit — Lancet meta-analyse","title_en":"Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["canagliflozine","cardiorenal-behandelstrategie","diabetes-en-hart","empagliflozine","fidelio-dkd","figaro-dkd","sglt2-remmers","soul-trial"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)02074-8","source_url":"https://doi.org/10.1016/S0140-6736(22)02074-8","authors":[],"significance":9,"published":"2022-11-19","source_date":"2022-11-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This collaborative meta-analysis of major SGLT2 inhibitor trials demonstrated that the kidney-protective effects of SGLT2 inhibition are independent of diabetes status and baseline kidney function. The findings support SGLT2 inhibitors as a universal renoprotective therapy across diverse CKD populations.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:10Z","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":"Collaboratieve meta-analyse in de Lancet van grote SGLT2-remmerstudies toonde dat het nierbeschermende effect onafhankelijk is van diabetes. SGLT2-remmers vertragen nierfunctieverlies en verminderen niergebeurtenissen bij zowel diabetische als niet-diabetische CKD en hartfalen.","abstract_original":"BACKGROUND: Large trials have shown that sodium glucose co-transporter-2 (SGLT2) inhibitors reduce the risk of adverse kidney and cardiovascular outcomes in patients with heart failure or chronic kidney disease, or with type 2 diabetes and high risk of atherosclerotic cardiovascular disease. None of the trials recruiting patients with and without diabetes were designed to assess outcomes separately in patients without diabetes. METHODS: We did a systematic review and meta-analysis of SGLT2 inhibitor trials. We searched the MEDLINE and Embase databases for trials published from database inception to Sept 5, 2022. SGLT2 inhibitor trials that were double-blind, placebo-controlled, performed in adults (age ≥18 years), large (≥500 participants per group), and at least 6 months in duration were included. Summary-level data used for analysis were extracted from published reports or provided by trial investigators, and inverse-variance-weighted meta-analyses were conducted to estimate treatment effects. The main efficacy outcomes were kidney disease progression (standardised to a definition of a sustained ≥50% decrease in estimated glomerular filtration rate [eGFR] from randomisation, a sustained low eGFR, end-stage kidney disease, or death from kidney failure), acute kidney injury, and a composite of cardiovascular death or hospitalisation for heart failure. Other outcomes were death from cardiovascular and non-cardiovascular disease considered separately, and the main safety outcomes were ketoacidosis and lower limb amputation. This study is registered with PROSPERO, CRD42022351618. FINDINGS: We identified 13 trials involving 90 413 participants. After exclusion of four participants with uncertain diabetes status, we analysed 90 409 participants (74 804 [82·7%] participants with diabetes [>99% with type 2 diabetes] and 15 605 [17·3%] without diabetes; trial-level mean baseline eGFR range 37-85 mL/min per 1·73 m2). Compared with placebo, allocation to an SGLT2 inhibitor reduced the risk of kidney disease progression by 37% (relative risk [RR] 0·63, 95% CI 0·58-0·69) with similar RRs in patients with and without diabetes. In the four chronic kidney disease trials, RRs were similar irrespective of primary kidney diagnosis. SGLT2 inhibitors reduced the risk of acute kidney injury by 23% (0·77, 0·70-0·84) and the risk of cardiovascular death or hospitalisation for heart failure by 23% (0·77, 0·74-0·81), again with similar effects in those with and without diabetes. SGLT2 inhibitors also reduced the risk of cardiovascular death (0·86, 0·81-0·92) but did not significantly reduce the risk of non-cardiovascular death (0·94, 0·88-1·02). For these mortality outcomes, RRs were similar in patients with and without diabetes. For all outcomes, results were broadly similar irrespective of trial mean baseline eGFR. Based on estimates of absolute effects, the absolute benefits of SGLT2 inhibition outweighed any serious hazards of ketoacidosis or amputation. INTERPRETATION: In addition to the established cardiovascular benefits of SGLT2 inhibitors, the randomised data support their use for modifying risk of kidney disease progression and acute kidney injury, not only in patients with type 2 diabetes at high cardiovascular risk, but also in patients with chronic kidney disease or heart failure irrespective of diabetes status, primary kidney disease, or kidney function. FUNDING: UK Medical Research Council and Kidney Research UK."},{"id":"feb7ce74561d","type":"article","url":"https://hartvaat.nl/2022/11/17/olpasiran-sirna-verlaagt-lipoproteine-a-spectaculair-in-fase-2-trial/","title":"Olpasiran: siRNA verlaagt lipoproteïne(a) spectaculair in fase 2 trial","title_en":"Small Interfering RNA to Reduce Lipoprotein(a) in Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2211023","source_url":"https://doi.org/10.1056/NEJMoa2211023","authors":["Michelle L O'Donoghue","Robert S Rosenson","Baris Gencer","J Antonio G López","Norman E Lepor","Seth J Baum","Elmer Stout","Daniel Gaudet","Beat Knusel","Julia F Kuder","Xinhui Ran","Sabina A Murphy","Huei Wang","You Wu","Helina Kassahun","Marc S Sabatine"],"significance":10,"published":"2022-11-17","source_date":"2022-11-17","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The OCEAN(a)-DOSE trial demonstrated that olpasiran, a small interfering RNA targeting hepatic apolipoprotein(a) synthesis, reduced lipoprotein(a) levels by more than 95% in patients with established atherosclerotic cardiovascular disease. This represented the first pharmacological agent capable of near-complete Lp(a) elimination, opening a new therapeutic frontier.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:10Z","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":"De OCEAN(a)-DOSE-trial in de NEJM toonde dat olpasiran, een small interfering RNA, het Lp(a) met >90% verlaagde bij patiënten met atherosclerotisch vaatlijden. Dit is de eerste farmacologische interventie die Lp(a) klinisch relevant kan verlagen. De uitkomsttrial moet het cardiovasculaire voordeel bevestigen.","abstract_original":"BACKGROUND: Lipoprotein(a) is a presumed risk factor for atherosclerotic cardiovascular disease. Olpasiran is a small interfering RNA that reduces lipoprotein(a) synthesis in the liver. METHODS: We conducted a randomized, double-blind, placebo-controlled, dose-finding trial involving patients with established atherosclerotic cardiovascular disease and a lipoprotein(a) concentration of more than 150 nmol per liter. Patients were randomly assigned to receive one of four doses of olpasiran (10 mg every 12 weeks, 75 mg every 12 weeks, 225 mg every 12 weeks, or 225 mg every 24 weeks) or matching placebo, administered subcutaneously. The primary end point was the percent change in the lipoprotein(a) concentration from baseline to week 36 (reported as the placebo-adjusted mean percent change). Safety was also assessed. RESULTS: Among the 281 enrolled patients, the median concentration of lipoprotein(a) at baseline was 260.3 nmol per liter, and the median concentration of low-density lipoprotein cholesterol was 67.5 mg per deciliter. At baseline, 88% of the patients were taking statin therapy, 52% were taking ezetimibe, and 23% were taking a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor. At 36 weeks, the lipoprotein(a) concentration had increased by a mean of 3.6% in the placebo group, whereas olpasiran therapy had significantly and substantially reduced the lipoprotein(a) concentration in a dose-dependent manner, resulting in placebo-adjusted mean percent changes of -70.5% with the 10-mg dose, -97.4% with the 75-mg dose, -101.1% with the 225-mg dose administered every 12 weeks, and -100.5% with the 225-mg dose administered every 24 weeks (P&lt;0.001 for all comparisons with baseline). The overall incidence of adverse events was similar across the trial groups. The most common olpasiran-related adverse events were injection-site reactions, primarily pain. CONCLUSIONS: Olpasiran therapy significantly reduced lipoprotein(a) concentrations in patients with established atherosclerotic cardiovascular disease. Longer and larger trials will be necessary to determine the effect of olpasiran therapy on cardiovascular disease. (Funded by Amgen; OCEAN[a]-DOSE ClinicalTrials.gov number, NCT04270760.)."},{"id":"5217cb710825","type":"article","url":"https://hartvaat.nl/2022/11/15/coapt-mitraclip-vermindert-hospitalisaties-bij-secundaire-mr-en-hartfalen/","title":"COAPT: MitraClip vermindert hospitalisaties bij secundaire MR en hartfalen","title_en":"Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitraclip"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.08.803","source_url":"https://doi.org/10.1016/j.jacc.2022.08.803","authors":["Gennaro Giustino","Anton Camaj","Samir R Kapadia","Saibal Kar","William T Abraham","JoAnn Lindenfeld","D Scott Lim","Paul A Grayburn","David J Cohen","Björn Redfors","Zhipeng Zhou","Stuart J Pocock","Federico M Asch","Michael J Mack","Gregg W Stone"],"significance":8,"published":"2022-11-15","source_date":"2022-11-15","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"Long-term COAPT analysis confirmed that transcatheter edge-to-edge repair (MitraClip) durably reduces hospitalizations and mortality in patients with heart failure and severe secondary mitral regurgitation, with sustained benefit beyond the initial follow-up period.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:10Z","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":"Langetermijnanalyse van COAPT toonde dat transcatheter edge-to-edge repair (MitraClip) de hospitalisaties en mortaliteit duurzaam vermindert bij patiënten met ernstige secundaire MR en hartfalen. Het voordeel bleef tot 5 jaar behouden, wat de waarde van interventie bij geselecteerde patiënten bevestigt.","abstract_original":"BACKGROUND: The impact of transcatheter edge-to-edge repair (TEER) on the rate and prognostic impact of hospitalizations in patients with heart failure (HF) and severe secondary mitral regurgitation is unknown. OBJECTIVES: This study sought to evaluate the effect of the MitraClip percutaneous edge-to edge repair system on fatal and nonfatal hospitalizations and their relationship with mortality in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. METHODS: Patients with HF (n = 614) with severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) versus GDMT alone. Hospitalizations were classified as fatal if death occurred during that hospitalization or nonfatal if the patient was discharged alive. RESULTS: At 2 years, TEER treatment, compared with GDMT alone, resulted in lower time-to-first-event rates of any heart failure hospitalization (HFH) (34.8% vs 56.4%; HR: 0.51; 95% CI: 0.39-0.66) and fatal HFH (6.5% vs 12.6%; HR: 0.47; 95% CI: 0.26-0.85). TEER also resulted in lower rates of all-cause nonfatal and fatal hospitalizations. During the 2-year follow-up period, patients who underwent TEER spent an average of 2 more months alive and out of the hospital than did patients treated with GDMT alone (581 ± 27 days vs 519 ± 26 days; P = 0.002). All HFHs (adjusted HR: 6.37; 95% CI: 4.63-8.78) and nonfatal HFHs (adjusted HR: 1.78; 95% CI: 1.27-2.49) were consistently independently associated with increased 2-year mortality in both the TEER and GDMT groups (Pinteraction = 0.34 and 0.39, respectively). CONCLUSIONS: In the COAPT trial, compared with GDMT alone, patients with HF and severe secondary mitral regurgitation undergoing TEER with the percutaneous edge-to edge repair system had lower 2-year rates of fatal and nonfatal all-cause hospitalizations and HFH and spent more time alive and out of the hospital. HFHs were strongly associated with mortality, irrespective of treatment. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT]; NCT01626079)."},{"id":"11e0de37fdb9","type":"article","url":"https://hartvaat.nl/2022/11/15/fgf21-sirtuin-3-hoe-inspanning-beschermt-tegen-diabetische-cardiomyopathie/","title":"FGF21-Sirtuin 3: hoe inspanning beschermt tegen diabetische cardiomyopathie","title_en":"FGF21-Sirtuin 3 Axis Confers the Protective Effects of Exercise Against Diabetic Cardiomyopathy by Governing Mitochondrial Integrity.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059631","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059631","authors":["Leigang Jin","Leiluo Geng","Lei Ying","Lingling Shu","Kevin Ye","Ranyao Yang","Yan Liu","Yao Wang","Yin Cai","Xue Jiang","Qin Wang","Xingqun Yan","Boya Liao","Jie Liu","Fuyu Duan","Gary Sweeney","Connie Wai Hong Woo","Yu Wang","Zhengyuan Xia","Qizhou Lian","Aimin Xu"],"significance":5,"published":"2022-11-15","source_date":"2022-11-15","image":"","kennis":[],"congress":"","summary_en":"This translational study revealed that exercise protects against diabetic cardiomyopathy through the FGF21-Sirtuin 3 axis, which governs mitochondrial dynamics and cardiac metabolic homeostasis.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:10Z","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":"Translationele studie onthulde dat inspanning via de FGF21-Sirtuin 3-as beschermt tegen diabetische cardiomyopathie door mitochondriale integriteit te bewaren. Dit mechanistisch inzicht kan leiden tot gerichte farmacologische interventies die het effect van inspanning nabootsen.","abstract_original":"BACKGROUND: Exercise is an effective nonpharmacological strategy to alleviate diabetic cardiomyopathy (DCM) through poorly defined mechanisms. FGF21 (fibroblast growth factor 21), a peptide hormone with pleiotropic benefits on cardiometabolic homeostasis, has been identified as an exercise responsive factor. This study aims to investigate whether FGF21 signaling mediates the benefits of exercise on DCM, and if so, to elucidate the underlying mechanisms. METHODS: The global or hepatocyte-specific FGF21 knockout mice, cardiomyocyte-selective β-klotho (the obligatory co-receptor for FGF21) knockout mice, and their wild-type littermates were subjected to high-fat diet feeding and injection of streptozotocin to induce DCM, followed by a 6-week exercise intervention and assessment of cardiac functions. Cardiac mitochondrial structure and function were assessed by electron microscopy, enzymatic assays, and measurements of fatty acid oxidation and ATP production. Human induced pluripotent stem cell-derived cardiomyocytes were used to investigate the receptor and postreceptor signaling pathways conferring the protective effects of FGF21 against toxic lipids-induced mitochondrial dysfunction. RESULTS: Treadmill exercise markedly induced cardiac expression of β-klotho and significantly attenuated diabetes-induced cardiac dysfunction in wild-type mice, accompanied by reduced mitochondrial damage and increased activities of mitochondrial enzymes in hearts. However, such cardioprotective benefits of exercise were largely abrogated in mice with global or hepatocyte-selective ablation of FGF21, or cardiomyocyte-specific deletion of β-klotho. Mechanistically, exercise enhanced the cardiac actions of FGF21 to induce the expression of the mitochondrial deacetylase SIRT3 by AMPK-evoked phosphorylation of FOXO3, thereby reversing diabetes-induced hyperacetylation and functional impairments of a cluster of mitochondrial enzymes. FGF21 prevented toxic lipids-induced mitochondrial dysfunction and oxidative stress by induction of the AMPK/FOXO3/SIRT3 signaling axis in human induced pluripotent stem cell-derived cardiomyocytes. Adeno-associated virus-mediated restoration of cardiac SIRT3 expression was sufficient to restore the responsiveness of diabetic FGF21 knockout mice to exercise in amelioration of mitochondrial dysfunction and DCM. CONCLUSIONS: The FGF21-SIRT3 axis mediates the protective effects of exercise against DCM by preserving mitochondrial integrity and represents a potential therapeutic target for DCM. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03240978."},{"id":"0d8569dbca08","type":"article","url":"https://hartvaat.nl/2022/11/08/mtor-remming-bij-stemi-sirolimus-vermindert-infarctgrootte-niet/","title":"mTOR-remming bij STEMI: sirolimus vermindert infarctgrootte niet","title_en":"Mammalian Target of Rapamycin Inhibition in Patients With 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.2022.08.747","source_url":"https://doi.org/10.1016/j.jacc.2022.08.747","authors":["Barbara E Stähli","Roland Klingenberg","Dik Heg","Mattia Branca","Robert Manka","Ioannis Kapos","Oliver Müggler","Andrea Denegri","Rahel Kesterke","Florence Berger","Julia Stehli","Alessandro Candreva","Arnold von Eckardstein","David Carballo","Christian Hamm","Ulf Landmesser","François Mach","Tiziano Moccetti","Christian Jung","Malte Kelm","Thomas Münzel","Giovanni Pedrazzini","Lorenz Räber","Stephan Windecker","Christian Templin","Christian M Matter","Thomas F Lüscher","Frank Ruschitzka"],"significance":6,"published":"2022-11-08","source_date":"2022-11-08","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This randomized trial tested whether mTOR inhibition with sirolimus reduces infarct size after STEMI through anti-inflammatory mechanisms, exploring immunomodulation as an adjunct to primary PCI reperfusion.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:09Z","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":"Gerandomiseerde trial onderzocht of mTOR-remming met sirolimus de infarctgrootte na STEMI kan verminderen via inflammatieremmend effect. Het middel verlaagde inflammatiemarkers maar verminderde de infarctgrootte niet significant. Anti-inflammatoire strategieën bij STEMI blijven uitdagend.","abstract_original":"BACKGROUND: Early inflammation following acute ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) affects myocardial infarct (MI) size and left ventricular remodeling. The mammalian target of rapamycin (mTOR) is involved in the enhanced inflammatory response and its inhibition has exerted beneficial effects on MI size in preclinical models of acute MI. OBJECTIVES: The CLEVER-ACS (Controlled Level Everolimus in Acute Coronary Syndromes) trial evaluated the effects of targeting inflammation by mTOR inhibition in patients with STEMI undergoing PCI. METHODS: CLEVER-ACS was a randomized, multicenter, international, double-blind, placebo-controlled trial. A total of 150 patients with STEMI undergoing PCI were randomly assigned to oral everolimus (days 1-3: 7.5 mg daily; days 4-5: 5.0 mg daily) or placebo for 5 days. The primary endpoint was the change in MI size. The secondary endpoint was the change in microvascular obstruction (MVO) from baseline (12 hours to 5 days after PCI) to 30 days as assessed by cardiac magnetic resonance imaging. RESULTS: The changes in MI size from baseline to 30 days, the primary endpoint, were -14.2 g (95% CI: -17.4 to -11.1 g) and -12.3 g (95% CI: -16.0 to -8.7 g) in the everolimus and placebo groups (P = 0.99). Corresponding changes in MVO were -4.8 g (95% CI: -6.7 to -2.9 g) and -6.3 g (95% CI: -8.7 to -4.0 g) in the everolimus and placebo groups (P = 0.14). Adverse events did not differ between the study groups. CONCLUSIONS: Among STEMI patients undergoing PCI, early mTOR inhibition with everolimus did not reduce MI size or MVO at 30 days. (CLEVER-ACS [Controlled Level Everolimus in Acute Coronary Syndromes; NCT01529554)."},{"id":"7e38c35a2ad8","type":"article","url":"https://hartvaat.nl/2022/11/05/enchanted2-mt-intensieve-bloeddrukverlaging-na-trombectomie-bij-cva-is-schadelij/","title":"ENCHANTED2/MT: intensieve bloeddrukverlaging na trombectomie bij CVA is schadelijk","title_en":"Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)01882-7","source_url":"https://doi.org/10.1016/S0140-6736(22)01882-7","authors":["Pengfei Yang","Lili Song","Yongwei Zhang","Xiaoxi Zhang","Xiaoying Chen","Yunke Li","Lingli Sun","Yingfeng Wan","Laurent Billot","Qiang Li","Xinwen Ren","Hongjian Shen","Lei Zhang","Zifu Li","Pengfei Xing","Yongxin Zhang","Ping Zhang","Weilong Hua","Fang Shen","Yihan Zhou","Bing Tian","Wenhuo Chen","Hongxing Han","Liyong Zhang","Chenghua Xu","Tong Li","Ya Peng","Xincan Yue","Shengli Chen","Changming Wen","Shu Wan","Congguo Yin","Ming Wei","Hansheng Shu","Guangxian Nan","Sheng Liu","Wenhua Liu","Yiling Cai","Yi Sui","Maohua Chen","Yu Zhou","Qiao Zuo","Dongwei Dai","Rui Zhao","Qiang Li","Qinghai Huang","Yi Xu","Benqiang Deng","Tao Wu","Jianping Lu","Xia Wang","Mark W Parsons","Ken Butcher","Bruce Campbell","Thompson G Robinson","Mayank Goyal","Diederik Dippel","Yvo Roos","Charles Majoie","Longde Wang","Yongjun Wang","Jianmin Liu","Craig S Anderson"],"significance":9,"published":"2022-11-05","source_date":"2022-11-05","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/"],"congress":"","summary_en":"The ENCHANTED2/MT trial demonstrated that intensive blood pressure lowering to <120 mmHg after endovascular thrombectomy for acute ischemic stroke worsened functional outcomes compared with a higher target. The trial was stopped early for futility and potential harm.","created":"2026-07-03T10:30:04Z","updated":"2026-07-03T13:29:09Z","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":"De ENCHANTED2/MT-trial in de Lancet toonde dat intensieve bloeddrukverlaging (SBP <120 mmHg) na endovasculaire trombectomie voor ischemisch CVA de functionele uitkomsten verslechterde. De trial werd voortijdig gestaakt wegens futiliteit en mogelijke schade.","abstract_original":"BACKGROUND: The optimum systolic blood pressure after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to compare the safety and efficacy of blood pressure lowering treatment according to more intensive versus less intensive treatment targets in patients with elevated blood pressure after reperfusion with endovascular treatment. METHODS: We conducted an open-label, blinded-endpoint, randomised controlled trial at 44 tertiary-level hospitals in China. Eligible patients (aged ≥18 years) had persistently elevated systolic blood pressure (≥140 mm Hg for &gt;10 min) following successful reperfusion with endovascular thrombectomy for acute ischaemic stroke from any intracranial large-vessel occlusion. Patients were randomly assigned (1:1, by a central, web-based program with a minimisation algorithm) to more intensive treatment (systolic blood pressure target &lt;120 mm Hg) or less intensive treatment (target 140-180 mm Hg) to be achieved within 1 h and sustained for 72 h. The primary efficacy outcome was functional recovery, assessed according to the distribution in scores on the modified Rankin scale (range 0 [no symptoms] to 6 [death]) at 90 days. Analyses were done according to the modified intention-to-treat principle. Efficacy analyses were performed with proportional odds logistic regression with adjustment for treatment allocation as a fixed effect, site as a random effect, and baseline prognostic factors, and included all randomly assigned patients who provided consent and had available data for the primary outcome. The safety analysis included all randomly assigned patients. The treatment effects were expressed as odds ratios (ORs). This trial is registered at ClinicalTrials.gov, NCT04140110, and the Chinese Clinical Trial Registry, 1900027785; recruitment has stopped at all participating centres. FINDINGS: Between July 20, 2020, and March 7, 2022, 821 patients were randomly assigned. The trial was stopped after review of the outcome data on June 22, 2022, due to persistent efficacy and safety concerns. 407 participants were assigned to the more intensive treatment group and 409 to the less intensive treatment group, of whom 404 patients in the more intensive treatment group and 406 patients in the less intensive treatment group had primary outcome data available. The likelihood of poor functional outcome was greater in the more intensive treatment group than the less intensive treatment group (common OR 1·37 [95% CI 1·07-1·76]). Compared with the less intensive treatment group, the more intensive treatment group had more early neurological deterioration (common OR 1·53 [95% 1·18-1·97]) and major disability at 90 days (OR 2·07 [95% CI 1·47-2·93]) but there were no significant differences in symptomatic intracerebral haemorrhage. There were no significant differences in serious adverse events or mortality between groups. INTERPRETATION: Intensive control of systolic blood pressure to lower than 120 mm Hg should be avoided to prevent compromising the functional recovery of patients who have received endovascular thrombectomy for acute ischaemic stroke due to intracranial large-vessel occlusion. FUNDING: The Shanghai Hospital Development Center; National Health and Medical Research Council of Australia; Medical Research Futures Fund of Australia; China Stroke Prevention; Shanghai Changhai Hospital, Science and Technology Commission of Shanghai Municipality; Takeda China; Hasten Biopharmaceutic; Genesis Medtech; Penumbra."},{"id":"e3623b687ae4","type":"article","url":"https://hartvaat.nl/2022/11/01/complete-revascularisatie-bij-stemi-verbetert-angina-gerelateerde-kwaliteit-van-/","title":"Complete revascularisatie bij STEMI verbetert angina-gerelateerde kwaliteit van leven","title_en":"Complete Revascularization vs Culprit Lesion-Only Percutaneous Coronary Intervention for Angina-Related Quality of Life in Patients With ST-Segment Elevation Myocardial Infarction: Results From the COMPLETE Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","ouderen","perifeer-vaatlijden","stabiel-coronairlijden"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.3032","source_url":"https://doi.org/10.1001/jamacardio.2022.3032","authors":["Shamir R Mehta","Jia Wang","David A Wood","John A Spertus","David J Cohen","Roxana Mehran","Robert F Storey","Philippe Gabriel Steg","Natalia Pinilla-Echeverri","Tej Sheth","Kevin R Bainey","Sripal Bangalore","Warren J Cantor","David P Faxon","Laurent J Feldman","Sanjit S Jolly","Vijay Kunadian","Shahar Lavi","Jose Lopez-Sendon","Mina Madan","Raul Moreno","Sunil V Rao","Josep Rodés-Cabau","Goran Stankovic","Shrikant I Bangdiwala","John A Cairns"],"significance":7,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/ranolazine-bij-angina/","https://hartvaat.nl/kennis/coronairlijden/revalidatie-na-hartinfarct/"],"congress":"","summary_en":"This substudy demonstrated that complete revascularization improves angina-related quality of life compared with culprit-only PCI in STEMI patients with multivessel disease, adding patient-centered outcomes to the clinical event reduction.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T13:29:09Z","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":"Substudie toonde dat complete revascularisatie vergeleken met alleen de culprit-laesie bij STEMI met meervatslijden de angina-gerelateerde kwaliteit van leven verbeterde. Dit aanvullende voordeel ondersteunt de trend naar complete revascularisatie bij STEMI.","abstract_original":"IMPORTANCE: In patients with multivessel coronary artery disease (CAD) presenting with ST-segment elevation myocardial infarction (STEMI), complete revascularization reduces major cardiovascular events compared with culprit lesion-only percutaneous coronary intervention (PCI). Whether complete revascularization also improves angina-related health status is unknown. OBJECTIVE: To determine whether complete revascularization improves angina status in patients with STEMI and multivessel CAD. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of a randomized, multinational, open label trial of patient-reported outcomes took place in 140 primary PCI centers in 31 countries. Patients presenting with STEMI and multivessel CAD were randomized between February 1, 2013, and March 6, 2017. Analysis took place between July 2021 and December 2021. INTERVENTIONS: Following PCI of the culprit lesion, patients with STEMI and multivessel CAD were randomized to receive either complete revascularization with additional PCI of angiographically significant nonculprit lesions or to no further revascularization. MAIN OUTCOMES AND MEASURES: Seattle Angina Questionnaire Angina Frequency (SAQ-AF) score (range, 0 [daily angina] to 100 [no angina]) and the proportion of angina-free individuals by study end. RESULTS: Of 4041 patients, 2016 were randomized to complete revascularization and 2025 to culprit lesion-only PCI. The mean (SD) age of patients was 62 (10.7) years, and 3225 (80%) were male. The mean (SD) SAQ-AF score increased from 87.1 (17.8) points at baseline to 97.1 (9.7) points at a median follow-up of 3 years in the complete revascularization group (score change, 9.9 [95% CI, 9.0-10.8]; P < .001) compared with an increase of 87.2 (18.4) to 96.3 (10.9) points (score change, 8.9 [95% CI, 8.0-9.8]; P < .001) in the culprit lesion-only group (between-group difference, 0.97 points [95% CI, 0.27-1.67]; P = .006). Overall, 1457 patients (87.5%) were free of angina (SAQ-AF score, 100) in the complete revascularization group compared with 1376 patients (84.3%) in the culprit lesion-only group (absolute difference, 3.2% [95% CI, 0.7%-5.7%]; P = .01). This benefit was observed mainly in patients with nonculprit lesion stenosis severity of 80% or more (absolute difference, 4.7%; interaction P = .02). CONCLUSIONS AND RELEVANCE: In patients with STEMI and multivessel CAD, complete revascularization resulted in a slightly greater proportion of patients being angina-free compared with a culprit lesion-only strategy. This modest incremental improvement in health status is in addition to the established benefit of complete revascularization in reducing cardiovascular events."},{"id":"dd69100e3c2f","type":"article","url":"https://hartvaat.nl/2022/11/01/empagliflozine-vermindert-albuminurie-bij-hartfalen-emperor-pooled-analyse/","title":"Empagliflozine vermindert albuminurie bij hartfalen: EMPEROR-Pooled analyse","title_en":"Association of Empagliflozin Treatment With Albuminuria Levels in Patients With Heart Failure: A Secondary Analysis of EMPEROR-Pooled.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["abelacimab","acuut-hartfalen","anemie-ckd","bisoprolol","canagliflozine","cardiorenal-behandelstrategie","chronische-nierziekte","cystatine-c","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","fidelity","hfmref","hfpef","hfref","sacubitril-valsartan","sglt2-remmers","statines","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.2924","source_url":"https://doi.org/10.1001/jamacardio.2022.2924","authors":["João Pedro Ferreira","Faiez Zannad","Javed Butler","Gerasimos Filippatos","Stuart J Pocock","Martina Brueckmann","Dominik Steubl","Elke Schueler","Stefan D Anker","Milton Packer"],"significance":7,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This pooled EMPEROR analysis showed that empagliflozin significantly reduces albuminuria across the heart failure spectrum (both HFrEF and HFpEF), providing evidence of kidney-protective effects of SGLT2 inhibition in heart failure beyond eGFR preservation.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse van EMPEROR-Reduced en -Preserved toonde dat empagliflozine de albumine-creatinineratio significant verminderde bij hartfalenpatiënten. Het nierprotectieve effect was onafhankelijk van diabetes of eGFR en onderstreept de brede orgaanprotectie door SGLT2-remming.","abstract_original":"IMPORTANCE: Albuminuria, routinely assessed as spot urine albumin-to-creatinine ratio (UACR), indicates structural damage of the glomerular filtration barrier and is associated with poor kidney and cardiovascular outcomes. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been found to reduce UACR in patients with type 2 diabetes, but its use in patients with heart failure (HF) is less well studied. OBJECTIVE: To analyze the association of empagliflozin with study outcomes across baseline levels of albuminuria and change in albuminuria in patients with HF across a wide range of ejection fraction levels. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis included all patients with HF from the EMPEROR-Pooled analysis using combined individual patient data from the international multicenter randomized double-blind parallel-group, placebo-controlled EMPEROR-Reduced and EMPEROR-Preserved trials. Participants in the original trials were excluded from this analysis if they were missing baseline UACR data. EMPEROR-Preserved was conducted from March 27, 2017, to April 26, 2021, and EMPEROR-Reduced was conducted from April 6, 2017, to May 28, 2020. Data were analyzed from January to June 2022. INTERVENTIONS: Randomization to empagliflozin or placebo. MAIN OUTCOMES AND MEASURES: New-onset macroalbuminuria and regression to normoalbuminuria and microalbuminuria. RESULTS: A total of 9673 patients were included (mean [SD] age, 69.9 [10.4] years; 3551 [36.7%] female and 6122 [63.3%] male). Of these, 5552 patients had normoalbuminuria (UACR <30 mg/g) and 1025 had macroalbuminuria (UACR >300 mg/g). Compared with normoalbuminuria, macroalbuminuria was associated with younger age, races other than White, obesity, male sex, site region other than Europe, higher levels of N-terminal pro-hormone brain natriuretic peptide and high-sensitivity troponin T, higher blood pressure, higher New York Heart Association class, greater HF duration, more frequent previous HF hospitalizations, diabetes, hypertension, lower eGFR, and less frequent use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and mineralocorticoid receptor antagonists. An increase in events was observed in individuals with higher UACR levels. The association of empagliflozin with cardiovascular mortality or HF hospitalization was consistent across UACR categories (hazard ratio [HR], 0.80; 95% CI, 0.69-0.92 for normoalbuminuria; HR, 0.74; 95% CI, 0.63-0.86 for microalbuminuria; HR, 0.78; 95% CI, 0.63-0.98 for macroalbuminuria; interaction P trend = .71). Treatment with empagliflozin was associated with lower incidence of new macroalbuminuria (HR, 0.81; 95% CI, 0.70-0.94; P = .005) and an increase in rate of remission to sustained normoalbuminuria or microalbuminuria (HR, 1.31; 95% CI, 1.07-1.59; P = .009) but not with a reduction in UACR in the overall population; however, UACR was reduced in patients with diabetes, who had higher UACR levels than patients without diabetes (geometric mean for diabetes at baseline, 0.91; 95% CI, 0.85-0.98 and for no diabetes at baseline, 1.08; 95% CI, 1.01-1.16; interaction P = .008). CONCLUSIONS AND RELEVANCE: In this post hoc analysis of a randomized clinical trial, compared with placebo, empagliflozin was associated with reduced HF hospitalizations or cardiovascular death irrespective of albuminuria levels at baseline, reduced progression to macroalbuminuria, and reversion of macroalbuminuria. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT03057977 and NCT03057951."},{"id":"5f6498cec239","type":"article","url":"https://hartvaat.nl/2022/11/01/deliver-dapagliflozine-effectief-bij-hfpef-ongeacht-atriumfibrilleren/","title":"DELIVER: dapagliflozine effectief bij HFpEF ongeacht atriumfibrilleren","title_en":"Atrial Fibrillation and Dapagliflozin Efficacy in Patients With Preserved or Mildly Reduced Ejection Fraction.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfpef","hfref","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.08.718","source_url":"https://doi.org/10.1016/j.jacc.2022.08.718","authors":["Jawad H Butt","Toru Kondo","Pardeep S Jhund","Josep Comin-Colet","Rudolf A de Boer","Akshai S Desai","Adrian F Hernandez","Silvio E Inzucchi","Stefan P Janssens","Mikhail N Kosiborod","Carolyn S P Lam","Anna Maria Langkilde","Daniel Lindholm","Felipe Martinez","Magnus Petersson","Sanjiv J Shah","Jorge Thierer","Muthiah Vaduganathan","Subodh Verma","Ulrica Wilderäng","Brian C Claggett","Scott D Solomon","John J V McMurray"],"significance":7,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This DELIVER subanalysis confirmed that dapagliflozin reduces heart failure events in HFpEF patients regardless of whether they have concurrent atrial fibrillation, an important finding given the high prevalence of AF in this population.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van DELIVER bevestigde dat dapagliflozine bij HFpEF even effectief was bij patiënten met als zonder AF. Het voordeel op hartfalengebeurtenissen was consistent, wat de brede toepasbaarheid van SGLT2-remming bij hartfalen verder onderstreept.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) is common in heart failure (HF), is associated with worse outcomes compared with sinus rhythm, and may modify the effects of therapy. OBJECTIVES: This study examined the effects of dapagliflozin according to the presence or not of AF in the DELIVER (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure) trial. METHODS: A total of 6,263 patients with HF with New York Heart Association functional class II-IV, left ventricular ejection fraction >40%, evidence of structural heart disease, and elevated N-terminal pro-B-type natriuretic peptide levels were randomized to dapagliflozin or placebo. Clinical outcomes and the effect of dapagliflozin, according to AF status, were examined. The primary outcome was a composite of cardiovascular death or worsening HF. RESULTS: Of the 6,261 patients with data on baseline AF, 43.3% had no AF, 18.0% had paroxysmal AF, and 38.7% had persistent/permanent AF. The risk of the primary endpoint was higher in patients with AF, especially paroxysmal AF, driven by a higher rate of HF hospitalization: no AF, HF hospitalization rate per 100 person-years (4.5 [95% CI: 4.0-5.1]), paroxysmal AF (7.5 [95% CI: 6.4-8.7]), and persistent/permanent AF (6.4 [95% CI: 5.7-7.1]) (P < 0.001). The benefit of dapagliflozin on the primary outcome was consistent across AF types: no AF, HR: 0.89 (95% CI: 0.74-1.08); paroxysmal AF, HR: 0.75 (95% CI: 0.58-0.97); persistent/permanent AF, HR: 0.79 (95% CI: 0.66-0.95) (Pinteraction = 0.49). Consistent effects were observed for HF hospitalization, cardiovascular death, all-cause mortality, and improvement in the KCCQ-TSS. CONCLUSIONS: In DELIVER, the beneficial effects of dapagliflozin compared with placebo on clinical events and symptoms were consistent, irrespective of type of AF at baseline. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure. [DELIVER]; NCT03619213)."},{"id":"3f0471e66196","type":"article","url":"https://hartvaat.nl/2022/11/01/emmy-empagliflozine-na-acuut-myocardinfarct-verbetert-nt-probnp-en-remodelling/","title":"EMMY: empagliflozine na acuut myocardinfarct verbetert NT-proBNP en remodelling","title_en":"Empagliflozin in acute myocardial infarction: the EMMY trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","canagliflozine","dapagliflozine","empagliflozine","emperor-trials","myocardinfarct","nt-probnp"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac494","source_url":"https://doi.org/10.1093/eurheartj/ehac494","authors":["Dirk von Lewinski","Ewald Kolesnik","Norbert J Tripolt","Peter N Pferschy","Martin Benedikt","Markus Wallner","Hannes Alber","Rudolf Berger","Michael Lichtenauer","Christoph H Saely","Deddo Moertl","Pia Auersperg","Christian Reiter","Thomas Rieder","Jolanta M Siller-Matula","Gloria M Gager","Matthias Hasun","Franz Weidinger","Thomas R Pieber","Peter M Zechner","Markus Herrmann","Andreas Zirlik","Rury R Holman","Abderrahim Oulhaj","Harald Sourij"],"significance":8,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"The EMMY trial showed that empagliflozin started after acute MI significantly reduced NT-proBNP levels and attenuated left ventricular remodeling compared with placebo. The results provided early evidence of SGLT2 inhibitor cardioprotection in the acute post-MI setting.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De EMMY-trial toonde dat empagliflozine gestart na acuut MI het NT-proBNP significant verlaagde en de linkerventrikelremodelling verminderde na 26 weken. Dit opent de deur voor SGLT2-remmers als vroege therapie na myocardinfarct, ongeacht diabetes of hartfalen.","abstract_original":"AIMS: Sodium-glucose co-transporter 2 inhibition reduces the risk of hospitalization for heart failure and for death in patients with symptomatic heart failure. However, trials investigating the effects of this drug class in patients following acute myocardial infarction are lacking. METHODS AND RESULTS: In this academic, multicentre, double-blind trial, patients (n = 476) with acute myocardial infarction accompanied by a large creatine kinase elevation (>800 IU/L) were randomly assigned to empagliflozin 10 mg or matching placebo once daily within 72 h of percutaneous coronary intervention. The primary outcome was the N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP) change over 26 weeks. Secondary outcomes included changes in echocardiographic parameters. Baseline median (interquartile range) NT-proBNP was 1294 (757-2246) pg/mL. NT-proBNP reduction was significantly greater in the empagliflozin group, compared with placebo, being 15% lower [95% confidence interval (CI) -4.4% to -23.6%] after adjusting for baseline NT-proBNP, sex, and diabetes status (P = 0.026). Absolute left-ventricular ejection fraction improvement was significantly greater (1.5%, 95% CI 0.2-2.9%, P = 0.029), mean E/e' reduction was 6.8% (95% CI 1.3-11.3%, P = 0.015) greater, and left-ventricular end-systolic and end-diastolic volumes were lower by 7.5 mL (95% CI 3.4-11.5 mL, P = 0.0003) and 9.7 mL (95% CI 3.7-15.7 mL, P = 0.0015), respectively, in the empagliflozin group, compared with placebo. Seven patients were hospitalized for heart failure (three in the empagliflozin group). Other predefined serious adverse events were rare and did not differ significantly between groups. CONCLUSION: In patients with a recent myocardial infarction, empagliflozin was associated with a significantly greater NT-proBNP reduction over 26 weeks, accompanied by a significant improvement in echocardiographic functional and structural parameters. CLINICALTRIALS.GOV REGISTRATION: NCT03087773."},{"id":"746b19d95bad","type":"article","url":"https://hartvaat.nl/2022/11/01/vip-acs-dubbele-dosis-griepvaccinatie-na-acs-verbetert-uitkomsten-niet/","title":"VIP-ACS: dubbele-dosis griepvaccinatie na ACS verbetert uitkomsten niet","title_en":"Influenza vaccination strategy in acute coronary syndromes: the VIP-ACS trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac472","source_url":"https://doi.org/10.1093/eurheartj/ehac472","authors":["Henrique Andrade R Fonseca","Remo Holanda M Furtado","André Zimerman","Pedro A Lemos","Marcelo Franken","Frederico Monfardini","Rodrigo P Pedrosa","Rodrigo de Lemos S Patriota","Luiz Carlos S Passos","Frederico Toledo C Dall'Orto","Conrado R Hoffmann Filho","Bruno Ramos Nascimento","Felipe A Baldissera","Cesar Augusto C Pereira","Paulo Ricardo A Caramori","Pedro Beraldo de Andrade","Carlos Esteves","Elke Ferreira Salim","Jefferson Henrique da Silva","Izabela Chave Pedro","Mariana Castaldi R Silva","Ewerton Hernandes de Pedri","Ana Carla R D Carioca","Luciana Pereira A de Piano","Camila Santos N Albuquerque","Diogo D F Moia","Roberta Grazzielli R A P Momesso","Felipe P Machado","Lucas P Damiani","Ronaldo Vicente P Soares","Guilherme P Schettino","Luiz V Rizzo","José Carlos Nicolau","Otávio Berwanger"],"significance":7,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"The VIP-ACS trial showed that double-dose influenza vaccination during ACS hospitalization was not superior to standard-dose outpatient vaccination for preventing cardiovascular events, testing whether enhanced immunogenicity provides clinical benefit in the acute setting.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T13:29:09Z","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":"De VIP-ACS-trial onderzocht of dubbele-dosis griepvaccinatie tijdens hospitalisatie voor ACS superieur was aan standaarddosis poliklinische vaccinatie. Er was geen verschil in cardiovasculaire uitkomsten. Standaarddosis is voldoende, maar vaccinatie zelf blijft aanbevolen.","abstract_original":"AIMS: To evaluate whether a strategy of double-dose influenza vaccination during hospitalization for an acute coronary syndrome (ACS) compared with standard-dose outpatient vaccination (as recommended by current guidelines) would further reduce the risk of major cardiopulmonary events. METHODS AND RESULTS: Vaccination against Influenza to Prevent cardiovascular events after Acute Coronary Syndromes (VIP-ACS) was a pragmatic, randomized, multicentre, active-comparator, open-label trial with blinded outcome adjudication comparing two strategies of influenza vaccination following an ACS: double-dose quadrivalent inactivated vaccine before hospital discharge vs. standard-dose quadrivalent inactivated vaccine administered in the outpatient setting 30 days after randomization. The primary outcome was a hierarchical composite of all-cause death, myocardial infarction, stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analysed by the win ratio method. Patients were followed for 12 months. During two influenza seasons, 1801 participants were included at 25 centres in Brazil. The primary outcome was not different between groups, with 12.7% wins in-hospital double-dose vaccine group and 12.3% wins in the standard-dose vaccine group {win ratio: 1.02 [95% confidence interval (CI): 0.79-1.32], P = 0.84}. Results were consistent for the key secondary outcome, a hierarchical composite of cardiovascular death, myocardial infarction and stroke [win ratio: 0.94 (95% CI: 0.66-1.33), P = 0.72]. Time-to-first event analysis for the primary outcome showed results similar to those of the main analysis [hazard ratio 0.97 (95% CI: 0.75-1.24), P = 0.79]. Adverse events were infrequent and did not differ between groups. CONCLUSION: Among patients hospitalized with an ACS, double-dose influenza vaccination before discharge did not reduce cardiopulmonary outcomes compared with standard-dose vaccination in the outpatient setting. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number: NCT04001504."},{"id":"d5e62144e44e","type":"article","url":"https://hartvaat.nl/2022/11/01/diamond-patiromer-maakt-raas-remmer-optitratie-bij-hfref-met-hyperkaliemie-mogel/","title":"DIAMOND: patiromer maakt RAAS-remmer-optitratie bij HFrEF met hyperkaliëmie mogelijk","title_en":"Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac401","source_url":"https://doi.org/10.1093/eurheartj/ehac401","authors":["Javed Butler","Stefan D Anker","Lars H Lund","Andrew J S Coats","Gerasimos Filippatos","Tariq Jamal Siddiqi","Tim Friede","Vincent Fabien","Mikhail Kosiborod","Marco Metra","Ileana L Piña","Fausto Pinto","Patrick Rossignol","Peter van der Meer","Cecilia Bahit","Jan Belohlavek","Michael Böhm","Jasper J Brugts","John G F Cleland","Justin Ezekowitz","Antoni Bayes-Genis","Israel Gotsman","Assen Goudev","Irakli Khintibidze","Joann Lindenfeld","Robert J Mentz","Bela Merkely","Eliodoro Castro Montes","Wilfried Mullens","Jose C Nicolau","Aleksandr Parkhomenko","Piotr Ponikowski","Petar M Seferovic","Michele Senni","Evgeny Shlyakhto","Alain Cohen-Solal","Peter Szecsödy","Klaus Jensen","Fabio Dorigotti","Matthew R Weir","Bertram Pitt"],"significance":8,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"The DIAMOND trial showed that patiromer effectively reduced serum potassium in patients with HFrEF, enabling more patients to reach target doses of RAAS inhibitors without hyperkalemia-related dose reductions. The results addressed a key barrier to optimal heart failure pharmacotherapy.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T13:29:09Z","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":"De DIAMOND-trial toonde dat patiromer de serumkaliumspiegel effectief verlaagde bij HFrEF-patiënten, waardoor RAAS-remmers op hogere doses konden worden gehandhaafd. Minder patiënten moesten hun RAAS-remmer dosisverlagen of staken. Kaliumbinders kunnen de hartfalenbehandeling optimaliseren.","abstract_original":"AIMS: To investigate the impact of patiromer on the serum potassium level and its ability to enable specified target doses of renin-angiotensin-aldosterone system inhibitor (RAASi) use in patients with heart failure and reduced ejection fraction (HFrEF). METHODS AND RESULTS: A total of 1642 patients with HFrEF and current or a history of RAASi-related hyperkalemia were screened and 1195 were enrolled in the run-in phase with patiromer and optimization of the RAASi therapy [≥50% recommended dose of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, and 50 mg of mineralocorticoid receptor antagonist (MRA) spironolactone or eplerenone]. Specified target doses of the RAASi therapy were achieved in 878 (84.6%) patients; 439 were randomized to patiromer and 439 to placebo. All patients, physicians, and outcome assessors were blinded to treatment assignment. The primary endpoint was between-group difference in the adjusted mean change in serum potassium. Five hierarchical secondary endpoints were assessed. At the end of treatment, the median (interquartile range) duration of follow-up was 27 (13-43) weeks, the adjusted mean change in potassium was +0.03 mmol/l in the patiromer group and +0.13 mmol/l in the placebo group [difference in the adjusted mean change between patiromer and placebo: -0.10 mmol/l (95% confidence interval, CI -0.13, 0.07); P < 0.001]. Risk of hyperkalemia >5.5 mmol/l [hazard ratio (HR) 0.63; 95% CI 0.45, 0.87; P = 0.006), reduction of MRA dose (HR 0.62; 95% CI 0.45, 0.87; P = 0.006), and total adjusted hyperkalemia events/100 person-years (77.7 vs. 118.2; HR 0.66; 95% CI 0.53, 0.81; P < 0.001) were lower with patiromer. Hyperkalemia-related morbidity-adjusted events (win ratio 1.53, P < 0.001) and total RAASi use score (win ratio 1.25, P = 0.048) favored the patiromer arm. Adverse events were similar between groups. CONCLUSION: Concurrent use of patiromer and high-dose MRAs reduces the risk of recurrent hyperkalemia (ClinicalTrials.gov: NCT03888066)."},{"id":"2fda2725e242","type":"article","url":"https://hartvaat.nl/2022/11/01/checkpoint-remmers-verhogen-korttermijnrisico-op-hypertensie-niet-meta-analyse/","title":"Checkpoint-remmers verhogen korttermijnrisico op hypertensie niet: meta-analyse","title_en":"Immune Checkpoint Inhibitors Do Not Increase Short-Term Risk of Hypertension in Cancer Patients: a Systematic Literature Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","ras-remmers"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19865","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19865","authors":["Shintaro Minegishi","Sho Kinguchi","Nobuyuki Horita","Ho Namkoong","Alexandros Briasoulis","Tomoaki Ishigami","Kouichi Tamura","Akira Nishiyama","Yuichiro Yano"],"significance":5,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This meta-analysis showed that immune checkpoint inhibitors do not increase the short-term risk of hypertension in cancer patients, providing reassurance on this specific cardiovascular safety concern during immunotherapy.","created":"2026-07-03T10:30:03Z","updated":"2026-07-03T13:29:09Z","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 en meta-analyse toonden dat immuuncheckpoint-remmers het korttermijnrisico op hypertensie niet verhogen bij kankerpatiënten. Dit is geruststellend voor de cardio-oncologische praktijk, hoewel langetermijndata beperkt zijn.","abstract_original":"BACKGROUND: Immune checkpoint inhibitors (ICIs) are becoming widely used for novel cancer treatments. Immune-related adverse events, including cardiac toxicity, are frequently observed following immune checkpoint inhibitor (ICI) use. However, little is known regarding the association between ICIs initiation and hypertension in cancer patients. METHODS: A systematic literature search was performed using PubMed, EMBASE, Cochrane Library, and Web of Science Core Collection. The risk of hypertension associated with ICI initiation in randomized controlled trials (RCTs) was evaluated. Hypertension was categorized according to the Common Terminology Criteria for Adverse Events. The odds ratios of grades I to V and grades III to V hypertension were calculated using a random-effects meta-analysis. RESULTS: Thirty-two RCTs (n=19 810 cancer patients) were included. At a median follow-up of 36 months, the median overall survival was 15 months in the ICI group. ICI initiation was not significantly associated with hypertension (grades I-V: odds ratio, 1.12 [95% CI, 0.96-1.30]; grades III-V: odds ratio, 0.95 [95% CI, 0.78-1.16]). Additionally, no significant differences in hypertension risk were evident in ICI combination therapies with various drugs, including anti-VEGF (vascular endothelial growth factor) agents. In a subgroup analysis based on clinical setting (placebo RCT versus nonplacebo RCT), there were discrepancies between the results obtained with different methodologies, with patients in the nonplacebo RCTs having higher grades I-V hypertension (I2=88.6%, P for heterogeneity=0.003). CONCLUSIONS: ICI initiation was not associated with short-term risk of hypertension in cancer patients, and the association was similar regardless of concomitant treatment with other anticancer drugs."},{"id":"2e4c59c6d7f8","type":"article","url":"https://hartvaat.nl/2022/11/01/antihypertensieve-combinaties-bij-afrikaanse-patienten-creole-secundaire-analyse/","title":"Antihypertensieve combinaties bij Afrikaanse patiënten: CREOLE secundaire analyse","title_en":"Effect of 3, 2-Drug Combinations of Antihypertensive Therapies on Blood Pressure Variability in Black African Patients: Secondary Analyses of the CREOLE Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","dubbele-trombocytenremming"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18333","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18333","authors":["Dike B Ojji","Victoria Cornelius","Giles Partington","Veronica Francis","Shahiemah Pandie","Wynand Smythe","Nicky Hickman","Felix Barasa","Albertino Damasceno","Anastase Dzudie","Erika Jones","Prossie Merab Ingabire","Charles Mondo","Okechukwu Ogah","Elijah Ogola","Mahmoud U Sani","Gabriel Lamkur Shedul","Grace Shedul","Brian Rayner","Karen Sliwa","Neil Poulter"],"significance":6,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This CREOLE secondary analysis compared blood pressure variability among three antihypertensive combinations in Black African patients, showing that the calcium channel blocker-containing combinations provide more stable blood pressure control.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Secundaire analyse van de CREOLE-trial vergeleek bloeddrukvariabiliteit bij drie antihypertensieve combinaties bij Afrikaanse patiënten. De combinatie van amlodipine met hydrochloorthiazide gaf de meest stabiele bloeddrukcontrole, wat relevant is voor de keuze van eerstelijnstherapie.","abstract_original":"BACKGROUND: The effect of 3 commonly recommended combinations of anti-hypertensive agents-amlodipine plus hydrochlorothiazide (calcium channel blocker [CCB]+thiazide), amlodipine plus perindopril (CCB+ACE [angiotensin-converting enzyme]-inhibitor), and perindopril plus hydrochlorothiazide (ACE-inhibitor+thiazide) on blood pressure variability (V) are unknown. METHODS: We calculated the blood pressure variability (BPV) in 405 patients (130, 146, and 129 randomized to ACE-inhibitor+thiazide, CCB+thiazide, and CCB+ACE-inhibitor, respectively) who underwent ambulatory blood pressure monitoring after 6 months of treatment in the Comparisons of Three Combinations Therapies in Lowering Blood Pressure in Black Africans trial (CREOLE) of Black African patients. BPV was calculated using the SD of 30-minute interval values for 24-hour ambulatory BPs and for confirmation using the coefficient of variation. Linear mixed model regression was used to calculate mean differences in BPV between treatment arms. Within-clinic BPV was also calculated from the mean SD and coefficient of variation of 3 readings at clinic visits. RESULTS: Baseline distributions of age, sex, and blood pressure parameters were similar across treatment groups. Participants were predominately male (62.2%) with mean age 50.4 years. Those taking CCB+thiazide had significantly reduced ambulatory systolic and diastolic BPV compared with those taking ACE-inhibitor+thiazide. The CCB+thiazide and CCB+ACE-inhibitor groups showed similar BPV. Similar patterns of BPV were apparent among groups using within-clinic blood pressures and when assessed by coefficient of variation. CONCLUSIONS: Compared with CCB-containing combinations, ACE-inhibitor plus thiazide was associated with higher levels, generally significant, of ambulatory and within-clinic systolic and diastolic BPV. These results supplement the differential ambulatory blood pressure-lowering effects of these therapies in the CREOLE trial."},{"id":"ce190e75e4d4","type":"article","url":"https://hartvaat.nl/2022/11/01/radiale-versus-femorale-toegang-bij-coronairangiografie-meta-analyse-toont-morta/","title":"Radiale versus femorale toegang bij coronairangiografie: meta-analyse toont mortaliteitsvoordeel","title_en":"Effects on Mortality and Major Bleeding of Radial Versus Femoral Artery Access for Coronary Angiography or Percutaneous Coronary Intervention: Meta-Analysis of Individual Patient Data From 7 Multicenter Randomized Clinical Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.061527","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.061527","authors":["Giuseppe Gargiulo","Daniele Giacoppo","Sanjit S Jolly","John Cairns","Michel Le May","Ivo Bernat","Enrico Romagnoli","Sunil V Rao","Maarten A H van Leeuwen","Shamir R Mehta","Olivier F Bertrand","George A Wells","Thomas A Meijers","George C M Siontis","Giovanni Esposito","Stephan Windecker","Peter Jüni","Marco Valgimigli"],"significance":8,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This comprehensive meta-analysis confirmed that radial artery access for coronary angiography and PCI is associated with lower mortality and fewer major bleeding events compared with femoral access. The pooled evidence supported transradial access as the default approach for coronary procedures.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T13:29:08Z","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":"Uitgebreide meta-analyse bevestigde dat radiale arterie-toegang bij coronairangiografie en PCI geassocieerd is met lagere mortaliteit en minder ernstige bloedingen vergeleken met femorale toegang. Dit versterkt de aanbeveling voor radiale toegang als standaard.","abstract_original":"BACKGROUND: In some randomized clinical trials, transradial access (TRA) compared with transfemoral access (TFA) was associated with lower mortality in patients with coronary artery disease undergoing invasive management. We analyzed the effects of TRA versus TFA across multicenter randomized clinical trials and whether these associations are modified by patient or procedural characteristics. METHODS: We performed an individual patient data meta-analysis of multicenter randomized clinical trials comparing TRA with TFA among patients undergoing coronary angiography with or without percutaneous coronary intervention. The primary outcome was all-cause mortality and the co-primary outcome was major bleeding at 30 days. The primary analysis was conducted by 1-stage mixed-effects models on the basis of the intention-to-treat cohort. The effect of access site on mortality and major bleeding was assessed further by multivariable analysis. The relationship among access site, bleeding, and mortality was investigated by natural effect model mediation analysis with multivariable adjustment. RESULTS: A total of 21 600 patients (10 775 TRA, 10 825 TFA) from 7 randomized clinical trials were included. The median age was 63.9 years, 31.9% were women, 95% presented with acute coronary syndrome, and 75.2% underwent percutaneous coronary intervention. All-cause mortality (1.6% versus 2.1%; hazard ratio, 0.77 [95% CI, 0.63-0.95]; P=0.012) and major bleeding (1.5% versus 2.7%; odds ratio, 0.55 [95% CI, 0.45-0.67]; P<0.001) were lower with TRA. Subgroup analyses for mortality showed consistent results, except for baseline hemoglobin level (Pinteraction=0.003), indicating that the benefit of TRA was substantial in patients with moderate or severe anemia, whereas it was not significant in patients with milder or no baseline anemia. After adjustment, TRA remained associated with 24% and 51% relative risk reduction of all-cause mortality and major bleeding, respectively. A mediation analysis showed that the benefit of TRA on mortality was only partially driven by major bleeding prevention and ancillary mechanisms are required to fully explain the causal association. CONCLUSIONS: TRA is associated with lower all-cause mortality and major bleeding at 30 days compared with TFA. The effect on mortality was driven by patients with anemia. The reduction in major bleeding only partially explains the mortality benefit. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42018109664."},{"id":"cbff4fa58eac","type":"article","url":"https://hartvaat.nl/2022/11/01/arteriele-stijfheid-en-endotheeldysfunctie-bij-anca-geassocieerde-vasculitis/","title":"Arteriële stijfheid en endotheeldysfunctie bij ANCA-geassocieerde vasculitis","title_en":"Arterial stiffness, endothelial dysfunction and impaired fibrinolysis are pathogenic mechanisms contributing to cardiovascular risk in ANCA-associated vasculitis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["perifeer-vaatlijden"],"journal":"Kidney international","doi":"10.1016/j.kint.2022.07.026","source_url":"https://doi.org/10.1016/j.kint.2022.07.026","authors":["Tariq E Farrah","Vanessa Melville","Alicja Czopek","Henry Fok","Lorraine Bruce","Nicholas L Mills","Matthew A Bailey","David J Webb","James W Dear","Neeraj Dhaun"],"significance":5,"published":"2022-11-01","source_date":"2022-11-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study showed that patients with ANCA-associated vasculitis have increased arterial stiffness and endothelial dysfunction, identifying vascular pathogenic mechanisms that contribute to their elevated cardiovascular risk.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T13:29:08Z","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 toonde dat patiënten met ANCA-geassocieerde vasculitis verhoogde arteriële stijfheid en endotheeldysfunctie hebben, wat bijdraagt aan hun verhoogde cardiovasculaire risico. Chronische inflammatie is een belangrijke driver van vaatschade bij deze populatie.","abstract_original":"Cardiovascular disease is a complication of systemic inflammatory diseases including anti-neutrophil cytoplasm antibody-associated vasculitis (AAV). The mechanisms of cardiovascular morbidity in AAV are poorly understood, and risk-reduction strategies are lacking. Therefore, in a series of double-blind, randomized case-control forearm plethysmography and crossover systemic interventional studies, we examined arterial stiffness and endothelial function in patients with AAV in long-term disease remission and in matched healthy volunteers (32 each group). The primary outcome for the case-control study was the difference in endothelium-dependent vasodilation between health and AAV, and for the crossover study was the difference in pulse wave velocity (PWV) between treatment with placebo and selective endothelin-A receptor antagonism. Parallel in vitro studies of circulating monocytes and platelets explored mechanisms. Compared to healthy volunteers, patients with AAV had 30% reduced endothelium-dependent vasodilation and 50% reduced acute release of endothelial active tissue plasminogen activator (tPA), both significant in the case-control study. Patients with AAV had significantly increased arterial stiffness (PWV: 7.3 versus 6.4 m/s). Plasma endothelin-1 was two-fold higher in AAV and independently predicted PWV and tPA release. Compared to placebo, both selective endothelin-A and dual endothelin-A/B receptor blockade reduced PWV and increased tPA release in AAV in the crossover study. Mechanistically, patients with AAV had increased platelet activation, more platelet-monocyte aggregates, and altered monocyte endothelin receptor function, reflecting reduced endothelin-1 clearance. Patients with AAV in long-term remission have elevated cardiovascular risk and endothelin-1 contributes to this. Thus, our data support a role for endothelin-blockers to reduce cardiovascular risk by reducing arterial stiffness and increasing circulating tPA activity."},{"id":"8673375fc10c","type":"article","url":"https://hartvaat.nl/2022/10/28/pci-versus-cabg-bij-drievatslijden-met-proximale-lad-betrokkenheid/","title":"PCI versus CABG bij drievatslijden met proximale LAD-betrokkenheid","title_en":"Mortality after multivessel revascularisation involving the proximal left anterior descending artery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-320934","source_url":"https://doi.org/10.1136/heartjnl-2022-320934","authors":["Masafumi Ono","Hironori Hara","Chao Gao","Hideyuki Kawashima","Rutao Wang","Neil O'Leary","Joanna J Wykrzykowska","Jan J Piek","Michael J Mack","David Holmes","Marie-Claude Morice","Stuart Head","Arie Pieter Kappetein","Thilo Noack","Piroze M Davierwala","Friedrich W Mohr","Scot Garg","Yoshinobu Onuma","Patrick W Serruys"],"significance":7,"published":"2022-10-28","source_date":"2022-10-28","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"This study confirmed that CABG provides superior long-term survival compared with PCI in patients with three-vessel disease involving the proximal LAD, reinforcing the importance of surgical revascularization when this critical territory is involved.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T13:29:08Z","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 vergeleek langetermijnmortaliteit na PCI versus CABG bij drievatslijden met betrokkenheid van de proximale LAD. CABG was geassocieerd met betere overleving, consistent met huidige richtlijnen die CABG aanbevelen bij deze anatomie.","abstract_original":"OBJECTIVE: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD). METHODS: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed. RESULTS: Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, pinteraction=0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; pinteraction=0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality. CONCLUSIONS: Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG. TRIAL REGISTRATION NUMBER: SYNTAXES: NCT03417050; SYNTAX: NCT00114972."},{"id":"3f98ac66cc35","type":"article","url":"https://hartvaat.nl/2022/10/25/2022-acc-aha-datadefinities-voor-pijn-op-de-borst-en-acuut-myocardinfarct/","title":"2022 ACC/AHA datadefinities voor pijn op de borst en acuut myocardinfarct","title_en":"2022 ACC/AHA Key Data Elements and Definitions for Chest Pain and Acute Myocardial Infarction: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Data Standards.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.05.012","source_url":"https://doi.org/10.1016/j.jacc.2022.05.012","authors":["H V Skip Anderson","Sofia Carolina Masri","Mouin S Abdallah","Anna Marie Chang","Mauricio G Cohen","Islam Y Elgendy","Martha Gulati","Kathleen LaPoint","Nidhi Madan","Issam D Moussa","Jorge Ramirez","April W Simon","Vikas Singh","Stephen W Waldo","Marlene S Williams"],"significance":5,"published":"2022-10-25","source_date":"2022-10-25","image":"","kennis":[],"congress":"","summary_en":"This ACC/AHA document standardized data elements and definitions for chest pain and acute MI research and quality improvement, enabling consistent data collection across registries and clinical trials.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T13:29:08Z","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":"ACC/AHA publiceerde gestandaardiseerde dataelementen en definities voor thoracale pijn en acuut myocardinfarct. Uniforme terminologie is essentieel voor kwaliteitsregistratie en vergelijkbaar onderzoek.","abstract_original":""},{"id":"8b0696b4023e","type":"article","url":"https://hartvaat.nl/2022/10/22/time-avonddosering-antihypertensiva-biedt-geen-voordeel-boven-ochtenddosering/","title":"TIME: avonddosering antihypertensiva biedt geen voordeel boven ochtenddosering","title_en":"Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["ambulante-bloeddrukmeting","anemie-ckd","bloeddrukbehandeling"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)01786-X","source_url":"https://doi.org/10.1016/S0140-6736(22)01786-X","authors":["Isla S Mackenzie","Amy Rogers","Neil R Poulter","Bryan Williams","Morris J Brown","David J Webb","Ian Ford","David A Rorie","Greg Guthrie","J W Kerr Grieve","Filippo Pigazzani","Peter M Rothwell","Robin Young","Alex McConnachie","Allan D Struthers","Chim C Lang","Thomas M MacDonald"],"significance":9,"published":"2022-10-22","source_date":"2022-10-22","image":"","kennis":[],"congress":"","summary_en":"The TIME trial showed that evening dosing of antihypertensive medications offered no cardiovascular benefit over morning dosing in hypertensive adults, definitively refuting the chronotherapy hypothesis. The pragmatic result simplified clinical practice by confirming that dosing time does not matter.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De TIME-studie in de Lancet toonde dat avonddosering van antihypertensiva geen voordeel biedt boven ochtenddosering wat betreft cardiovasculaire uitkomsten. Dit weerspreekt eerdere data uit de HYGIA-studie en vereenvoudigt het voorschrijfadvies: het tijdstip maakt niet uit.","abstract_original":"BACKGROUND: Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME) study aimed to investigate whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension. METHODS: The TIME study is a prospective, pragmatic, decentralised, parallel-group study in the UK, that recruited adults (aged ≥18 years) with hypertension and taking at least one antihypertensive medication. Eligible participants were randomly assigned (1:1), without restriction, stratification, or minimisation, to take all of their usual antihypertensive medications in either the morning (0600-1000 h) or in the evening (2000-0000 h). Participants were followed up for the composite primary endpoint of vascular death or hospitalisation for non-fatal myocardial infarction or non-fatal stroke. Endpoints were identified by participant report or record linkage to National Health Service datasets and were adjudicated by a committee masked to treatment allocation. The primary endpoint was assessed as the time to first occurrence of an event in the intention-to-treat population (ie, all participants randomly assigned to a treatment group). Safety was assessed in all participants who submitted at least one follow-up questionnaire. The study is registered with EudraCT (2011-001968-21) and ISRCTN (18157641), and is now complete. FINDINGS: Between Dec 17, 2011, and June 5, 2018, 24 610 individuals were screened and 21 104 were randomly assigned to evening (n=10 503) or morning (n=10 601) dosing groups. Mean age at study entry was 65·1 years (SD 9·3); 12 136 (57·5%) participants were men; 8968 (42·5%) were women; 19 101 (90·5%) were White; 98 (0·5%) were Black, African, Caribbean, or Black British (ethnicity was not reported by 1637 [7·8%] participants); and 2725 (13·0%) had a previous cardiovascular disease. By the end of study follow-up (March 31, 2021), median follow-up was 5·2 years (IQR 4·9-5·7), and 529 (5·0%) of 10 503 participants assigned to evening treatment and 318 (3·0%) of 10 601 assigned to morning treatment had withdrawn from all follow-up. A primary endpoint event occurred in 362 (3·4%) participants assigned to evening treatment (0·69 events [95% CI 0·62-0·76] per 100 patient-years) and 390 (3·7%) assigned to morning treatment (0·72 events [95% CI 0·65-0·79] per 100 patient-years; unadjusted hazard ratio 0·95 [95% CI 0·83-1·10]; p=0·53). No safety concerns were identified. INTERPRETATION: Evening dosing of usual antihypertensive medication was not different from morning dosing in terms of major cardiovascular outcomes. Patients can be advised that they can take their regular antihypertensive medications at a convenient time that minimises any undesirable effects. FUNDING: British Heart Foundation."},{"id":"5b0f64cddcae","type":"article","url":"https://hartvaat.nl/2022/10/22/symplicity-htn-3-langetermijn-follow-up-renale-denervatie-bij-resistente-hyperte/","title":"SYMPLICITY HTN-3: langetermijn follow-up renale denervatie bij resistente hypertensie","title_en":"Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)01787-1","source_url":"https://doi.org/10.1016/S0140-6736(22)01787-1","authors":["Deepak L Bhatt","Muthiah Vaduganathan","David E Kandzari","Martin B Leon","Krishna Rocha-Singh","Raymond R Townsend","Barry T Katzen","Suzanne Oparil","Sandeep Brar","Vanessa DeBruin","Martin Fahy","George L Bakris"],"significance":7,"published":"2022-10-22","source_date":"2022-10-22","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"Long-term SYMPLICITY HTN-3 follow-up confirmed the safety but not the efficacy of the first-generation renal denervation system, with the negative result attributed to procedural limitations that were subsequently addressed by newer-generation devices.","created":"2026-07-03T10:30:02Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijn follow-up van SYMPLICITY HTN-3 bevestigde de veiligheid van renale denervatie maar toonde geen consistent voordeel boven sham-procedure bij resistente hypertensie. De resultaten temperen het enthousiasme voor de eerste-generatie techniek.","abstract_original":"BACKGROUND: The SYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) trial showed the safety but not efficacy of the Symplicity system (Medtronic, Santa Rosa, CA, USA) at 6 months follow-up in patients with treatment-resistant hypertension. This final report presents the 36-month follow-up results. METHODS: SYMPLICITY HTN-3 was a single-blind, multicentre, sham-controlled, randomised clinical trial, done in 88 centres in the USA. Adults aged 18-80 years, with treatment-resistant hypertension on stable, maximally tolerated doses of three or more drugs including a diuretic, who had a seated office systolic blood pressure of 160 mm Hg or more and 24 h ambulatory systolic blood pressure of 135 mm Hg or more were randomly assigned (2:1) to receive renal artery denervation using the single electrode (Flex) catheter or a sham control. The original primary endpoint was the change in office systolic blood pressure from baseline to 6 months for the renal artery denervation group compared with the sham control group. Patients were unmasked after the primary endpoint assessment at 6 months, at which point eligible patients in the sham control group who met the inclusion criteria (office blood pressure ≥160 mm Hg, 24 h ambulatory systolic blood pressure ≥135 mm Hg, and still prescribed three or more antihypertensive medications) could cross over to receive renal artery denervation. Changes in blood pressure up to 36 months were analysed in patients in the original renal artery denervation group and sham control group, including those who underwent renal artery denervation after 6 months (crossover group) and those who did not (non-crossover group). For comparisons between the renal artery denervation and sham control groups, follow-up blood pressure values were imputed for patients in the crossover group using their most recent pre-crossover masked blood pressure value. We report long-term blood pressure changes in renal artery denervation and sham control groups, and investigate blood pressure control in both groups using time in therapeutic blood pressure range analysis. The primary safety endpoint was the incidence of all-cause mortality, end stage renal disease, significant embolic event, renal artery perforation or dissection requiring intervention, vascular complications, hospitalisation for hypertensive crisis unrelated to non-adherence to medications, or new renal artery stenosis of more than 70% within 6 months. The trial is registered with ClinicalTrials.gov, NCT01418261. FINDINGS: From Sep 29, 2011, to May 6, 2013, 1442 patients were screened, of whom 535 (37%; 210 [39%] women and 325 [61%] men; mean age 57·9 years [SD 10·7]) were randomly assigned: 364 (68%) patients received renal artery denervation (mean age 57·9 years [10·4]) and 171 (32%) received the sham control (mean age 56·2 years [11·2]). 36-month follow-up data were available for 219 patients (original renal artery denervation group), 63 patients (crossover group), and 33 patients (non-crossover group). At 36 months, the change in office systolic blood pressure was -26·4 mm Hg (SD 25·9) in the renal artery denervation group and -5·7 mm Hg (24·4) in the sham control group (adjusted treatment difference -22·1 mm Hg [95% CI -27·2 to -17·0]; p≤0·0001). The change in 24 h ambulatory systolic blood pressure at 36 months was -15·6 mm Hg (SD 20·8) in the renal artery denervation group and -0·3 mm Hg (15·1) in the sham control group (adjusted treatment difference -16·5 mm Hg [95% CI -20·5 to -12·5]; p≤0·0001). Without imputation, the renal artery denervation group spent a significantly longer time in therapeutic blood pressure range (ie, better blood pressure control) than patients in the sham control group (18% [SD 25·0] for the renal artery denervation group vs 9% [SD 18·8] for the sham control group; p≤0·0001) despite a similar medication burden, with consistent and significant results with imputation. Rates of adverse events were similar across treatment groups, with no evidence of late-emerging complications from renal artery denervation. The rate of the composite safety endpoint to 48 months, including all-cause death, new-onset end-stage renal disease, significant embolic event resulting in end-organ damage, vascular complication, renal artery re-intervention, and hypertensive emergency was 15% (54 of 352 patients) for the renal artery denervation group, 14% (13 of 96 patients) for the crossover group, and 14% (10 of 69 patients) for the non-crossover group. INTERPRETATION: This final report of the SYMPLICITY HTN-3 trial adds to the totality of evidence supporting the safety of renal artery denervation to 36 months after the procedure. From 12 months to 36 months after the procedure, patients who were originally randomly assigned to receive renal artery denervation had larger reductions in blood pressure and better blood pressure control compared with patients who received sham control. FUNDING: Medtronic."},{"id":"fcac607dce4e","type":"article","url":"https://hartvaat.nl/2022/10/20/box-bloeddrukdoelen-bij-comateuze-overlevenden-van-hartstilstand/","title":"BOX: bloeddrukdoelen bij comateuze overlevenden van hartstilstand","title_en":"Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2208687","source_url":"https://doi.org/10.1056/NEJMoa2208687","authors":["Jesper Kjaergaard","Jacob E Møller","Henrik Schmidt","Johannes Grand","Simon Mølstrøm","Britt Borregaard","Søren Venø","Laura Sarkisian","Dmitry Mamaev","Lisette O Jensen","Benjamin Nyholm","Dan E Høfsten","Jakob Josiassen","Jakob H Thomsen","Jens J Thune","Laust E R Obling","Matias G Lindholm","Martin Frydland","Martin A S Meyer","Matilde Winther-Jensen","Rasmus P Beske","Ruth Frikke-Schmidt","Sebastian Wiberg","Søren Boesgaard","Søren A Madsen","Vibeke L Jørgensen","Christian Hassager"],"significance":8,"published":"2022-10-20","source_date":"2022-10-20","image":"","kennis":[],"congress":"","summary_en":"The BOX trial found no difference between a high (77 mmHg) versus low (63 mmHg) mean arterial pressure target in comatose survivors of out-of-hospital cardiac arrest. The result indicated that there is a broad acceptable blood pressure range in post-cardiac arrest intensive care.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T13:29:08Z","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":"De BOX-trial in de NEJM vergeleek een hoog (77 mmHg) versus laag (63 mmHg) MAP-doel bij comateuze overlevenden van hartstilstand. Er was geen verschil in mortaliteit of neurologische uitkomst. Beide bloeddrukstrategieën zijn acceptabel in deze populatie.","abstract_original":"BACKGROUND: Evidence to support the choice of blood-pressure targets for the treatment of comatose survivors of out-of-hospital cardiac arrest who are receiving intensive care is limited. METHODS: In a double-blind, randomized trial with a 2-by-2 factorial design, we evaluated a mean arterial blood-pressure target of 63 mm Hg as compared with 77 mm Hg in comatose adults who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause; patients were also assigned to one of two oxygen targets (reported separately). The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category (CPC) of 3 or 4 within 90 days (range, 0 to 5, with higher categories indicating more severe disability; a category of 3 or 4 indicates severe disability or coma). Secondary outcomes included neuron-specific enolase levels at 48 hours, death from any cause, scores on the Montreal Cognitive Assessment (range, 0 to 30, with higher scores indicating better cognitive ability) and the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 3 months, and the CPC at 3 months. RESULTS: A total of 789 patients were included in the analysis (393 in the high-target group and 396 in the low-target group). A primary-outcome event occurred in 133 patients (34%) in the high-target group and in 127 patients (32%) in the low-target group (hazard ratio, 1.08; 95% confidence interval [CI], 0.84 to 1.37; P = 0.56). At 90 days, 122 patients (31%) in the high-target group and 114 patients (29%) in the low-target group had died (hazard ratio, 1.13; 95% CI, 0.88 to 1.46). The median CPC was 1 (interquartile range, 1 to 5) in both the high-target group and the low-target group; the corresponding median modified Rankin scale scores were 1 (interquartile range, 0 to 6) and 1 (interquartile range, 0 to 6), and the corresponding median Montreal Cognitive Assessment scores were 27 (interquartile range, 24 to 29) and 26 (interquartile range, 24 to 29). The median neuron-specific enolase level at 48 hours was also similar in the two groups. The percentages of patients with adverse events did not differ significantly between the groups. CONCLUSIONS: Targeting a mean arterial blood pressure of 77 mm Hg or 63 mm Hg in patients who had been resuscitated from cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.)."},{"id":"fbb1648662d7","type":"article","url":"https://hartvaat.nl/2022/10/18/dosisrespons-van-sacubitril-valsartan-bij-hfref/","title":"Dosisrespons van sacubitril/valsartan bij HFrEF","title_en":"Dose-Response to Sacubitril/Valsartan in Patients With Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.08.737","source_url":"https://doi.org/10.1016/j.jacc.2022.08.737","authors":["Reza Mohebi","Yuxi Liu","Ileana L Piña","Margaret F Prescott","Javed Butler","G Michael Felker","Jonathan H Ward","Scott D Solomon","James L Januzzi"],"significance":7,"published":"2022-10-18","source_date":"2022-10-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This study showed that even lower-than-target doses of sacubitril-valsartan provide meaningful clinical benefit in HFrEF, with a dose-response relationship where any dose is better than no exposure. The finding supports initiating ARNI therapy even when target dose cannot be achieved.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T13:29:07Z","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 onderzocht de dosisrespons van sacubitril/valsartan bij HFrEF. Zelfs lagere doses dan de in trials gebruikte doelsdosis gaven een klinisch voordeel, hoewel de hogere dosis superieur was. Dit ondersteunt het starten van sacubitril/valsartan ook als de volle dosis niet haalbaar is.","abstract_original":"BACKGROUND: Doses of sacubitril/valsartan (Sac/Val) achieved in clinical trials of heart failure with reduced ejection fraction (HFrEF) are often not reached in clinical practice. OBJECTIVES: The purpose of this study was to investigate associations among Sac/Val doses and changes in prognostic biomarkers, health status, and cardiac remodeling among individuals with HFrEF through 12 months of treatment with Sac/Val administered per usual care. METHODS: A total of 794 persons with HFrEF (ejection fraction [EF] ≤40%) were categorized according to average daily doses of Sac/Val divided into tertiles. Change from baseline to 12 months in biomarkers (N-terminal pro-B-type natriuretic peptide, high-sensitivity cardiac troponin T, soluble ST2, atrial natriuretic peptide, urinary cyclic guanosine monophosphate), Kansas City Cardiomyopathy Questionnaire-23 scores, and parameters of cardiac reverse remodeling (left ventricular EF, indexed left atrial and ventricular volumes, and E/e') were assessed. RESULTS: The average daily dose was 112 mg in Tertile 1 (low dose), 342 mg in Tertile 2 (moderate dose), and 379 mg in Tertile 3 (high dose). Similar changes in prognostic biomarkers were observed in all dose tertiles. Gains in Kansas City Cardiomyopathy Questionnaire-23 scores were comparable regardless of dose category. Consistent reverse cardiac remodeling in all dose categories occurred; the median absolute left ventricular EF improvement across HF dose groups was 9.3%, 8.7%, and 10.2%, for low, moderate, and high doses, respectively; similar improvements in left atrial and ventricular volumes and E/e' were also observed across dose categories. CONCLUSIONS: Among patients with HFrEF, similar improvement in prognostic biomarkers, health status, and cardiac remodeling were observed across various Sac/Val doses. (Effects of Sacubitril/Valsartan Therapy on Biomarkers, Myocardial Remodeling and Outcomes [PROVE-HF]; NCT02887183."},{"id":"1746c6bf5c50","type":"article","url":"https://hartvaat.nl/2022/10/18/intensieve-bloeddrukverlaging-bij-maligne-linkerventrikel-hypertrofie/","title":"Intensieve bloeddrukverlaging bij maligne linkerventrikel hypertrofie","title_en":"Intensive Blood Pressure Lowering in Patients With Malignant Left Ventricular Hypertrophy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","bloeddrukbehandeling","bradycardie","hypertrofische-cardiomyopathie","nt-probnp","obesitas","summit-trial","troponine","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.08.735","source_url":"https://doi.org/10.1016/j.jacc.2022.08.735","authors":["Simon B Ascher","James A de Lemos","MinJae Lee","Elaine Wu","Elsayed Z Soliman","Ian J Neeland","Dalane W Kitzman","Christie M Ballantyne","Vijay Nambi","Anthony A Killeen","Joachim H Ix","Michael G Shlipak","Jarett D Berry"],"significance":7,"published":"2022-10-18","source_date":"2022-10-18","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This analysis showed that patients with malignant left ventricular hypertrophy (elevated troponin and BNP) have the highest cardiovascular risk but also derive the greatest absolute benefit from intensive blood pressure lowering, supporting targeted aggressive treatment.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat patiënten met maligne LVH (verhoogde troponine en BNP) een hoger cardiovasculair risico hebben maar meer baat hebben bij intensieve bloeddrukverlaging. Deze biomarker-gedefinieerde subgroep identificeert patiënten die het meeste profijt hebben van agressieve therapie.","abstract_original":"BACKGROUND: Left ventricular hypertrophy (LVH) combined with elevations in cardiac biomarkers reflecting myocardial injury and neurohormonal stress (malignant LVH) is associated with a high risk for heart failure and death. OBJECTIVES: The aim of this study was to determine the impact of intensive systolic blood pressure (SBP) control on the prevention of malignant LVH and its consequences. METHODS: A total of 8,820 participants in SPRINT (Systolic Blood Pressure Intervention Trial) were classified into groups based on the presence or absence of LVH assessed by 12-lead ECG, and elevations in biomarker levels (high-sensitivity cardiac troponin T ≥14 ng/L or N-terminal pro-B-type natriuretic peptide ≥125 pg/mL) at baseline. The effects of intensive vs standard SBP lowering on rates of acute decompensated heart failure (ADHF) events and death and on the incidence and regression of malignant LVH were determined. RESULTS: Randomization to intensive SBP lowering led to similar relative reductions in ADHF events and death across the combined LVH/biomarker groups (P for interaction = 0.68). The absolute risk reduction over 4 years in ADHF events and death was 4.4% (95% CI: -5.2% to 13.9%) among participants with baseline malignant LVH (n = 449) and 1.2% (95% CI: 0.0%-2.5%) for those without LVH and nonelevated biomarkers (n = 4,361). Intensive SBP lowering also reduced the incidence of malignant LVH over 2 years (2.5% vs 1.1%; OR: 0.44; 95% CI: 0.30-0.63). CONCLUSIONS: Intensive SBP lowering prevented malignant LVH and may provide substantial absolute risk reduction in the composite of ADHF events and death among SPRINT participants with baseline malignant LVH."},{"id":"be6845ee80b9","type":"article","url":"https://hartvaat.nl/2022/10/18/asundexian-factor-xia-remmer-na-acs-fase-2-dosisfindingsstudie/","title":"Asundexian (factor XIa-remmer) na ACS: fase 2 dosisfindingsstudie","title_en":"A Multicenter, Phase 2, Randomized, Placebo-Controlled, Double-Blind, Parallel-Group, Dose-Finding Trial of the Oral Factor XIa Inhibitor Asundexian to Prevent Adverse Cardiovascular Outcomes After Acute Myocardial Infarction.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.061612","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.061612","authors":["Sunil V Rao","Bodo Kirsch","Deepak L Bhatt","Andrzej Budaj","Rosa Coppolecchia","John Eikelboom","Stefan K James","W Schuyler Jones","Bela Merkely","Lars Keller","Renicus S Hermanides","Gianluca Campo","José Luis Ferreiro","Taro Shibasaki","Hardi Mundl","John H Alexander"],"significance":7,"published":"2022-10-18","source_date":"2022-10-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This phase 2 trial of the oral factor XIa inhibitor asundexian after ACS showed dose-dependent suppression of thrombin generation with minimal bleeding increase, providing early safety and pharmacodynamic data that preceded the larger AF trial.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T13:29:07Z","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":"Fase 2 trial onderzocht de orale factor XIa-remmer asundexian bij patiënten na ACS. Het middel verminderde de trombinevorming dosisafhankelijk met een laag bloedingsrisico. Factor XIa-remming biedt potentieel een veiliger antitrombotisch alternatief dan huidige strategieën.","abstract_original":"BACKGROUND: Oral activated factor XI (FXIa) inhibitors may modulate coagulation to prevent thromboembolic events without substantially increasing bleeding. We explored the pharmacodynamics, safety, and efficacy of the oral FXIa inhibitor asundexian for secondary prevention after acute myocardial infarction (MI). METHODS: We randomized 1601 patients with recent acute MI to oral asundexian 10, 20, or 50 mg or placebo once daily for 6 to 12 months in a double-blind, placebo-controlled, phase 2, dose-ranging trial. Patients were randomized within 5 days of their qualifying MI and received dual antiplatelet therapy with aspirin plus a P2Y12 inhibitor. The effect of asundexian on FXIa inhibition was assessed at 4 weeks. The prespecified main safety outcome was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding comparing all pooled asundexian doses with placebo. The prespecified efficacy outcome was a composite of cardiovascular death, MI, stroke, or stent thrombosis comparing pooled asundexian 20 and 50 mg doses with placebo. RESULTS: The median age was 68 years, 23% of participants were women, 51% had ST-segment-elevation MI, 80% were treated with aspirin plus ticagrelor or prasugrel, and 99% underwent percutaneous coronary intervention before randomization. Asundexian caused dose-related inhibition of FXIa activity, with 50 mg resulting in >90% inhibition. Over a median follow-up of 368 days, the main safety outcome occurred in 30 (7.6%), 32 (8.1%), 42 (10.5%), and 36 (9.0%) patients receiving asundexian 10 mg, 20 mg, or 50 mg, or placebo, respectively (pooled asundexian versus placebo: hazard ratio, 0.98 [90% CI, 0.71-1.35]). The efficacy outcome occurred in 27 (6.8%), 24 (6.0%), 22 (5.5%), and 22 (5.5%) patients assigned asundexian 10 mg, 20 mg, or 50 mg, or placebo, respectively (pooled asundexian 20 and 50 mg versus placebo: hazard ratio, 1.05 [90% CI, 0.69-1.61]). CONCLUSIONS: In patients with recent acute MI, 3 doses of asundexian, when added to aspirin plus a P2Y12 inhibitor, resulted in dose-dependent, near-complete inhibition of FXIa activity without a significant increase in bleeding and a low rate of ischemic events. These data support the investigation of asundexian at a dose of 50 mg daily in an adequately powered clinical trial of patients who experienced acute MI. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04304534; URL: https://www.clinicaltrialsregister.eu/ctr-search/search; Unique identifier: 2019-003244-79."},{"id":"e46316b348b6","type":"article","url":"https://hartvaat.nl/2022/10/18/deliver-dapagliflozine-effectief-ongeacht-frailteit-bij-hfpef/","title":"DELIVER: dapagliflozine effectief ongeacht frailteit bij HFpEF","title_en":"Efficacy and Safety of Dapagliflozin According to Frailty in Patients With Heart Failure: A Prespecified Analysis of the DELIVER Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["dapa-hf","dapagliflozine","hfpef","hfref","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.061754","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.061754","authors":["Jawad H Butt","Pardeep S Jhund","Jan Belohlávek","Rudolf A de Boer","Chern-En Chiang","Akshai S Desai","Jarosław Drożdż","Adrian F Hernandez","Silvio E Inzucchi","Tzvetana Katova","Masafumi Kitakaze","Mikhail N Kosiborod","Carolyn S P Lam","Anna Maria Langkilde","Daniel Lindholm","Erasmus Bachus","Felipe Martinez","Béla Merkely","Magnus Petersson","Jose F Kerr Saraiva","Sanjiv J Shah","Muthiah Vaduganathan","Orly Vardeny","Ulrica Wilderäng","Brian L Claggett","Scott D Solomon","John J V McMurray"],"significance":8,"published":"2022-10-18","source_date":"2022-10-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This DELIVER subanalysis demonstrated that dapagliflozin provides similar relative benefit in frail and non-frail patients with HFpEF, with even greater absolute benefit in frail patients due to their higher baseline risk. The results supported SGLT2 inhibitor use regardless of frailty status.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van DELIVER toonde dat dapagliflozine bij HFpEF even effectief was bij fragiele als bij niet-fragiele patiënten. Fragiele patiënten hadden een groter absoluut voordeel. SGLT2-remmers moeten niet worden onthouden aan kwetsbare ouderen met hartfalen.","abstract_original":"BACKGROUND: Frailty is increasing in prevalence. Because patients with frailty are often perceived to have a less favorable risk/benefit profile, they may be less likely to receive new pharmacologic treatments. We investigated the efficacy and tolerability of dapagliflozin according to frailty status in patients with heart failure with mildly reduced or preserved ejection fraction randomized in DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure). METHODS: Frailty was measured using the Rockwood cumulative deficit approach. The primary end point was time to a first worsening heart failure event or cardiovascular death. RESULTS: Of the 6263 patients randomized, a frailty index (FI) was calculable in 6258. In total, 2354 (37.6%) patients had class 1 frailty (FI ≤0.210; ie, not frail), 2413 (38.6%) had class 2 frailty (FI 0.211-0.310; ie, more frail), and 1491 (23.8%) had class 3 frailty (FI ≥0.311; ie, most frail). Greater frailty was associated with a higher rate of the primary end point (per 100 person-years): FI class 1, 6.3 (95% CI 5.7-7.1); class 2, 8.3 (7.5-9.1); and class 3, 13.4 (12.1-14.7; P<0.001). The effect of dapagliflozin (as a hazard ratio) on the primary end point from FI class 1 to 3 was 0.85 (95% CI, 0.68-1.06), 0.89 (0.74-1.08), and 0.74 (0.61-0.91), respectively (Pinteraction=0.40). Although patients with a greater degree of frailty had worse Kansas City Cardiomyopathy Questionnaire scores at baseline, their improvement with dapagliflozin was greater than it was in patients with less frailty: placebo-corrected improvement in Kansas City Cardiomyopathy Questionnaire Overall Summary Score at 4 months in FI class 1 was 0.3 (95% CI, -0.9 to 1.4); in class 2, 1.5 (0.3-2.7); and in class 3, 3.4 (1.7-5.1; Pinteraction=0.021). Adverse reactions and treatment discontinuation, although more frequent in patients with a greater degree of frailty, were not more common with dapagliflozin than with placebo irrespective of frailty class. CONCLUSIONS: In DELIVER, frailty was common and associated with worse outcomes. The benefit of dapagliflozin was consistent across the range of frailty studied. The improvement in health-related quality of life with dapagliflozin occurred early and was greater in patients with a higher level of frailty. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03619213."},{"id":"324f502e4cbd","type":"article","url":"https://hartvaat.nl/2022/10/14/dal-gene-farmacogenetica-geleide-dalcetrapib-na-acs/","title":"dal-GenE: farmacogenetica-geleide dalcetrapib na ACS","title_en":"Pharmacogenetics-guided dalcetrapib therapy after an acute coronary syndrome: the dal-GenE trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["cardiovasculaire-genetica","gepersonaliseerde-geneeskunde"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac374","source_url":"https://doi.org/10.1093/eurheartj/ehac374","authors":["Jean Claude Tardif","Marc A Pfeffer","Simon Kouz","Wolfgang Koenig","Aldo P Maggioni","John J V McMurray","Vincent Mooser","David D Waters","Jean C Grégoire","Philippe L L'Allier","J Wouter Jukema","Harvey D White","Therese Heinonen","Donald M Black","Fouzia Laghrissi-Thode","Sylvie Levesque","Marie Claude Guertin","Marie Pierre Dubé"],"significance":7,"published":"2022-10-14","source_date":"2022-10-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The dal-GenE trial tested a pharmacogenetics-guided approach with dalcetrapib after ACS, targeting patients with a specific ADCY9 genotype predicted to respond to CETP inhibition. The trial explored precision medicine in the lipid-lowering space.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T13:29:07Z","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":"De dal-GenE trial testte een farmacogenetisch-geleide benadering met de CETP-remmer dalcetrapib bij ACS-patiënten met een specifiek ADCY9-polymorfisme. Ondanks de selectie op genotype was er geen significant cardiovasculair voordeel. Farmacogenetica-geleide CETP-remming lijkt niet effectief.","abstract_original":"AIMS: In a retrospective analysis of dal-Outcomes, the effect of dalcetrapib on cardiovascular events was influenced by an adenylate cyclase type 9 (ADCY9) gene polymorphism. The dal-GenE study was conducted to test this pharmacogenetic hypothesis. METHODS AND RESULTS: dal-GenE was a double-blind trial in patients with an acute coronary syndrome within 1-3 months and the AA genotype at variant rs1967309 in the ADCY9 gene. A total of 6147 patients were randomly assigned to receive dalcetrapib 600 mg or placebo daily. The primary endpoint was the time from randomization to first occurrence of cardiovascular death, resuscitated cardiac arrest, non-fatal myocardial infarction, or non-fatal stroke. After a median follow-up of 39.9 months, the primary endpoint occurred in 292 (9.5%) of 3071 patients in the dalcetrapib group and 327 (10.6%) of 3076 patients in the placebo group [hazard ratio 0.88; 95% confidence interval (CI) 0.75-1.03; P = 0.12]. The hazard ratios for the components of the primary endpoint were 0.79 (95% CI 0.65-0.96) for myocardial infarction, 0.92 (95% CI 0.64-1.33) for stroke, 1.21 (95% CI 0.91-1.60) for death from cardiovascular causes, and 2.33 (95% CI 0.60-9.02) for resuscitated cardiac arrest. In a pre-specified on-treatment sensitivity analysis, the primary endpoint event rate was 7.8% (236/3015) in the dalcetrapib group and 9.3% (282/3031) in the placebo group (hazard ratio 0.83; 95% CI 0.70-0.98). CONCLUSION: Dalcetrapib did not significantly reduce the risk of occurrence of the primary endpoint of ischaemic cardiovascular events at end of study. A new trial would be needed to test the pharmacogenetic hypothesis that dalcetrapib improves the prognosis of patients with the AA genotype. CLINICAL TRIAL REGISTRATION: Trial registration dal-GenE ClinicalTrials.gov Identifier: NCT02525939."},{"id":"7d32ed5bca64","type":"article","url":"https://hartvaat.nl/2022/10/13/revived-bcis2-pci-verbetert-overleving-niet-bij-ischemische-lv-disfunctie/","title":"REVIVED-BCIS2: PCI verbetert overleving niet bij ischemische LV-disfunctie","title_en":"Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2206606","source_url":"https://doi.org/10.1056/NEJMoa2206606","authors":["Divaka Perera","Tim Clayton","Peter D O'Kane","John P Greenwood","Roshan Weerackody","Matthew Ryan","Holly P Morgan","Matthew Dodd","Richard Evans","Ruth Canter","Sophie Arnold","Lana J Dixon","Richard J Edwards","Kalpa De Silva","James C Spratt","Dwayne Conway","James Cotton","Margaret McEntegart","Amedeo Chiribiri","Pedro Saramago","Anthony Gershlick","Ajay M Shah","Andrew L Clark","Mark C Petrie"],"significance":10,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The REVIVED-BCIS2 trial showed that PCI did not improve survival or left ventricular function compared with optimal medical therapy in patients with severe ischemic cardiomyopathy and viable myocardium. The result challenged the long-held assumption that revascularization improves outcomes in ischemic left ventricular dysfunction and supports a medical-therapy-first approach.","created":"2026-07-03T10:30:01Z","updated":"2026-07-03T13:29:07Z","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":"De REVIVED-BCIS2-trial in de NEJM toonde dat PCI bij patiënten met ernstige ischemische linkerventrikel-disfunctie de overleving of LV-functie niet verbeterde vergeleken met optimale medicamenteuze therapie. Dit verandert de benadering van viabiliteitsgerichte revascularisatie bij hartfalen.","abstract_original":"BACKGROUND: Whether revascularization by percutaneous coronary intervention (PCI) can improve event-free survival and left ventricular function in patients with severe ischemic left ventricular systolic dysfunction, as compared with optimal medical therapy (i.e., individually adjusted pharmacologic and device therapy for heart failure) alone, is unknown. METHODS: We randomly assigned patients with a left ventricular ejection fraction of 35% or less, extensive coronary artery disease amenable to PCI, and demonstrable myocardial viability to a strategy of either PCI plus optimal medical therapy (PCI group) or optimal medical therapy alone (optimal-medical-therapy group). The primary composite outcome was death from any cause or hospitalization for heart failure. Major secondary outcomes were left ventricular ejection fraction at 6 and 12 months and quality-of-life scores. RESULTS: A total of 700 patients underwent randomization - 347 were assigned to the PCI group and 353 to the optimal-medical-therapy group. Over a median of 41 months, a primary-outcome event occurred in 129 patients (37.2%) in the PCI group and in 134 patients (38.0%) in the optimal-medical-therapy group (hazard ratio, 0.99; 95% confidence interval [CI], 0.78 to 1.27; P = 0.96). The left ventricular ejection fraction was similar in the two groups at 6 months (mean difference, -1.6 percentage points; 95% CI, -3.7 to 0.5) and at 12 months (mean difference, 0.9 percentage points; 95% CI, -1.7 to 3.4). Quality-of-life scores at 6 and 12 months appeared to favor the PCI group, but the difference had diminished at 24 months. CONCLUSIONS: Among patients with severe ischemic left ventricular systolic dysfunction who received optimal medical therapy, revascularization by PCI did not result in a lower incidence of death from any cause or hospitalization for heart failure. (Funded by the National Institute for Health and Care Research Health Technology Assessment Program; REVIVED-BCIS2 ClinicalTrials.gov number, NCT01920048.)."},{"id":"02963f01b5da","type":"article","url":"https://hartvaat.nl/2022/10/13/low-voltage-substraatmodificatie-bij-af-ablatie-meta-analyse/","title":"Low-voltage substraatmodificatie bij AF-ablatie: meta-analyse","title_en":"Low-voltage area substrate modification for atrial fibrillation ablation: a systematic review and meta-analysis of clinical trials.","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/euac089","source_url":"https://doi.org/10.1093/europace/euac089","authors":["Joey Junarta","Muhammad U Siddiqui","Joshua M Riley","Sean J Dikdan","Akash Patel","Daniel R Frisch"],"significance":6,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated the additional value of low-voltage area substrate modification beyond pulmonary vein isolation for AF ablation, finding mixed results for this targeted approach to substrate-based ablation.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T13:29:07Z","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 onderzocht de waarde van aanvullende ablatie van low-voltage gebieden bovenop PVI bij AF. De resultaten waren gemengd: bij persisterend AF was er een trend naar voordeel, bij paroxysmaal AF niet. Meer gerandomiseerde data zijn nodig voor definitieve conclusies.","abstract_original":"AIMS: The value of additional ablation beyond pulmonary vein isolation for atrial fibrillation (AF) ablation is unclear, especially for persistent AF. The optimal target for substrate modification to improve outcomes is uncertain. We investigate the utility of low-voltage area (LVA) substrate modification in patients undergoing catheter ablation for AF. METHODS AND RESULTS: This meta-analysis was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Risk of bias was assessed using the Cochrane risk of bias tool. Only randomized studies were included. AF patients who underwent catheter ablation with voltage-guided substrate modification targeting LVA (LVA group) vs. conventional ablation approaches not targeting LVA (non-LVA group) were compared. Four studies comprising 539 patients were included (36% female). Freedom from arrhythmia (FFA) in patients with persistent AF was greater in the LVA group [risk ratio (RR) 1.30; 95% confidence interval (CI) 1.03-1.64]. There was no difference in FFA in patients with paroxysmal AF between groups (RR 1.30; 95% CI 0.89-1.91). There was no difference in total procedural time (mean difference -17.54 min; 95% CI -64.37 to 29.28 min) or total ablation time (mean difference -36.17 min; 95% CI -93.69 to 21.35 min) in all included patients regardless of AF type between groups. There was no difference in periprocedural complications between groups in all included patients regardless of AF type (RR 0.93; 95% CI 0.22-3.82). CONCLUSION: This meta-analysis demonstrates improved FFA in persistent AF patients who underwent voltage-guided substrate modification targeting LVA."},{"id":"d2c81a9790f6","type":"article","url":"https://hartvaat.nl/2022/10/13/voorbehandeling-met-antiaritmica-voor-cardioversie-bij-af-netwerk-meta-analyse/","title":"Voorbehandeling met antiaritmica voor cardioversie bij AF: netwerk-meta-analyse","title_en":"Pre-treatment with antiarrhythmic drugs for elective electrical cardioversion of atrial fibrillation: a systematic review and network meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","atleten","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","cardiogene-shock","farmaco-economie","fidelity","fractional-flow-reserve","hartrevalidatie","inflammatie","laminopathie","microbioom","myocardinfarct","obesitas","ouderen","secundaire-preventie","slaapapneu","supraventriculaire-tachycardie","ventrikelfibrilleren","vrouwen"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euac063","source_url":"https://doi.org/10.1093/europace/euac063","authors":["Kevin J Um","William F McIntyre","Pablo A Mendoza","Omar Ibrahim","Stephanie T Nguyen","Sabrina H Lin","Emmanuelle Duceppe","Bram Rochwerg","Jeff S Healey","Alex Koziarz","Alexandra P Lengyel","Akash Bhatnagar","Guy Amit","Victor A Chu","Richard P Whitlock","Emilie P Belley-Côté"],"significance":6,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/atriumflutter/"],"congress":"","summary_en":"This network meta-analysis compared different antiarrhythmic drugs as pretreatment before electrical cardioversion of AF, identifying vernakalant and flecainide as the most effective agents for enhancing cardioversion success.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T18:38:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerk-meta-analyse vergeleek verschillende antiaritmica als voorbehandeling voor elektrische cardioversie bij AF. Vernakalant en amiodaron waren het meest effectief in het verhogen van het cardioversiesucces. Voorbehandeling kan de slagingskans van cardioversie significant verbeteren.","abstract_original":"AIMS: Our objective was to compare the efficacy of pre-treatment with different classes of anti-arrhythmic drugs (AADs) in patients with atrial fibrillation (AF) undergoing electrical cardioversion. METHODS AND RESULTS: We performed a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing different AADs in patients with AF undergoing electrical cardioversion. We grouped AADs into five network nodes: no treatment or rate control, Class Ia, Class Ic, Class III, and amiodarone. Outcomes were (i) acute restoration and (ii) maintenance of sinus rhythm. We searched MEDLINE and EMBASE from inception until June 2020. We used Python 3.8.3 and R 3.6.2 for data analysis. We evaluated the overall certainty of evidence with the GRADE framework. We included 28 RCTs. Compared with no treatment or rate control, Class III AADs [odds ratio (OR): 2.41; 95% credible interval (CrI): 1.37 to 4.62, high certainty] and amiodarone (OR: 2.58; 95% CrI: 1.54 to 4.37, high certainty) improved restoration of sinus rhythm. Amiodarone improved long-term maintenance of sinus rhythm when compared with no treatment or rate control (OR: 5.37; 95% CrI: 4.00-7.39, high certainty), Class Ic (OR: 1.89; 95% CrI: 1.05-3.45, moderate certainty) and Class III AADs (OR: 2.19; 95% CrI: 1.39-3.26, high certainty). CONCLUSION: Before electrical cardioversion of AF, treatment with Class III AADs or amiodarone improves the acute restoration of sinus rhythm. Amiodarone is most likely to improve the maintenance of sinus rhythm after electrical cardioversion, but Class Ic and Class III AADs are also effective."},{"id":"759a81a56beb","type":"article","url":"https://hartvaat.nl/2022/10/13/gecombineerde-epicardiale-en-endocardiale-redo-ablatie-bij-persisterend-af/","title":"Gecombineerde epicardiale en endocardiale redo-ablatie bij persisterend AF","title_en":"Combined epicardial and endocardial approach for redo radiofrequency catheter ablation in patients with persistent atrial fibrillation: a randomized clinical trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","atleten","biomarkers-cardiovasculair","farmaco-economie","gedilateerde-cardiomyopathie","hartkatheterisatie","hypertrofische-cardiomyopathie","myocardinfarct","ouderen","secundaire-preventie"],"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/euac058","source_url":"https://doi.org/10.1093/europace/euac058","authors":["Kwang No Lee","Do Young Kim","Ki Yung Boo","Yun Gi Kim","Seung Young Roh","Jaemin Shim","Jong Il Choi","Young Hoon Kim"],"significance":6,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This randomized trial tested whether adding an epicardial approach to endocardial redo ablation for persistent AF improves outcomes, evaluating the value of hybrid surgical-catheter strategies for recurrent arrhythmia.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht of toevoeging van een epicardiale benadering aan endocardiale redo-ablatie de uitkomsten verbetert bij persisterend AF. De gecombineerde aanpak leidde tot meer detectie van non-transmurale laesies, maar het klinische voordeel was niet statistisch significant.","abstract_original":"AIMS: An epicardial approach is an effective means to detect and eliminate residual potentials in non-transmural lesions created during prior endocardial ablation. We sought to determine the impact of a combined epicardial and endocardial approach compared with a conventional endocardial approach, on recurrence-free survival after redo ablation. METHODS AND RESULTS: Participants with recurred persistent atrial fibrillation after prior endocardial ablation were randomized (1:1) to undergo treatment with the combined approach (epicardial followed by endocardial ablation) for the treatment group or conventional approach (endocardial ablation only) for the control group. The primary outcome was the time to recurrence of atrial fibrillation or atrial tachycardia following a 90-day blanking period within 12 months after the procedure. The secondary safety outcome was the occurrence of procedure-related complications within 24 h after the procedure. Of 100 randomized participants {median age, 59.0 [(interquartile range (IQR): 53.8-64.3] years, including 16% women, with one prior ablation (IQR: 1-1)}, 93 (93%) completed the trial. Events relevant to the primary outcome occurred in 16 patients in the treatment group and in 21 patients in the control group {Kaplan-Meier estimator percentages, 32 vs. 42%; hazard ratio, 0.71 [95% confidence interval (CI): 0.37-1.37]}. The periprocedural complication rate was lower in the treatment group [2 vs. 16%; odds ratio, 0.11 (95% CI: 0.00-0.87)] with similar achievement of the procedural endpoint in the two groups. CONCLUSION: In the redo procedure for persistent atrial fibrillation, the combined approach had no significant difference of recurrence-free survival and a lower procedural complication rate compared with the conventional approach."},{"id":"d8689c56c88f","type":"article","url":"https://hartvaat.nl/2022/10/13/intensieve-bloeddrukcontrole-bij-af-inzichten-uit-sprint/","title":"Intensieve bloeddrukcontrole bij AF: inzichten uit SPRINT","title_en":"Effects of intensive blood pressure control on cardiovascular and cognitive outcomes in patients with atrial fibrillation: insights from the SPRINT trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","bloeddrukbehandeling","farmaco-economie","obesitas","ouderen","summit-trial"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euac059","source_url":"https://doi.org/10.1093/europace/euac059","authors":["Chao Jiang","Yiwei Lai","Xin Du","Yufeng Wang","Sitong Li","Liu He","Rong Hu","Qiang Lv","Jiahui Wu","Li Feng","Man Ning","Yanfei Ruan","Xu Li","Changqi Jia","Wenli Dai","Xueyuan Guo","Chenxi Jiang","Ribo Tang","Caihua Sang","Deyong Long","Hisatomi Arima","Jianzeng Dong","Craig S Anderson","Changsheng Ma"],"significance":7,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/atriumflutter/","https://hartvaat.nl/kennis/atriumfibrilleren/digoxine-bij-af/"],"congress":"","summary_en":"This SPRINT substudy in patients with atrial fibrillation showed that intensive blood pressure control reduces cardiovascular events even in the AF population, while also potentially reducing cognitive decline.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van SPRINT onderzocht het effect van intensieve bloeddrukbehandeling bij patiënten met AF. Intensieve controle verminderde cardiovasculaire events ook bij AF-patiënten, zonder toename van bijwerkingen. Dit ondersteunt agressieve bloeddrukbehandeling als aanvulling op anticoagulatie bij AF.","abstract_original":"AIMS: Patients with atrial fibrillation (AF) have an increased risk of cardiovascular events and dementia, even if anticoagulated. Hypertension is highly prevalent in AF population; however, the optimal blood pressure (BP) target for AF patients remains unknown. METHODS AND RESULTS: We conducted subgroup analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) to examine whether AF modified the treatment effects of intensive BP control on cardiovascular and cognitive outcomes using Cox proportional hazards regression and likelihood ratio tests. Among 9361 randomized participants, 778 (8.3%) had baseline AF, and 695 (89.3%) completed at least one follow-up cognitive assessment. Intensive BP control reduced the similar relative risk of cardiovascular events irrespective of the presence of AF, with all interaction P-values > 0.05. Patients with AF experienced a greater absolute risk reduction in the composite primary cardiovascular outcome (12.3 vs. 5.6 events per 1000 person-years) with intensive treatment, compared with those without AF. However, intensive BP control increased the risk of probable dementia in patients with AF [hazard ratio (HR), 2.22; 95% confidence interval (CI), 1.03-4.80], while reducing the dementia risk in patients without AF (HR, 0.75; 95% CI, 0.60-0.95; P = 0.009 for interaction). There were no significant interactions between the presence of AF and intensive BP treatment for mild cognitive impairment. CONCLUSION: Patients with AF experienced greater absolute cardiovascular benefits with intensive BP treatment, but may need to be cautious of an increased risk of dementia. This post hoc analysis should be considered as hypothesis generating and merit further study. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01206062."},{"id":"a720020cb4df","type":"article","url":"https://hartvaat.nl/2022/10/13/dagopname-na-af-ablatie-even-veilig-als-overnachting-meta-analyse/","title":"Dagopname na AF-ablatie even veilig als overnachting: meta-analyse","title_en":"Efficacy and safety of same-day discharge after atrial fibrillation ablation compared with post-procedural overnight stay: 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/euac068","source_url":"https://doi.org/10.1093/europace/euac068","authors":["Pok Tin Tang","Mark Davies","Yaver Bashir","Timothy R Betts","Michala Pedersen","Kim Rajappan","Matthew R Ginks","Rohan S Wijesurendra"],"significance":6,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This meta-analysis confirmed that same-day discharge after AF catheter ablation is as safe as overnight observation, supporting the cost-effective approach of outpatient ablation procedures.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse toonden dat ontslag op dezelfde dag na AF-ablatie even veilig was als een overnachting. De complicatieratio's waren vergelijkbaar met lagere kosten, wat dagbehandeling als standaard ondersteunt bij ongecompliceerde procedures.","abstract_original":"AIMS: Catheter ablation for atrial fibrillation (AF) has historically required inpatient admission post-procedure, but same-day discharge (SDD) has recently been reported. We aimed to assess the efficacy and safety of SDD compared with overnight stay (OS) post-ablation. METHODS AND RESULTS: We performed a systematic search of the PubMed database. Random-effects meta-analysis was performed to assess the efficacy (successful SDD) and safety (24 h complications, 30-day complications, 30-day re-admissions, and 30-day mortality) of a SDD AF ablation strategy. Fourteen non-randomized observational studies met criteria for inclusion, encompassing 26488 patients undergoing AF ablation, of whom 9766 were SDD. The mean age of participants was 61.9 years, and 67.9% were male. Around 61.7% underwent ablation for paroxysmal AF. The pooled success rate of SDD was 83.2% [95% confidence intervals (CIs): 61.5-97.0%, I2 100%]. The risk of bias was severe for all effect estimates due to confounding, as most cohorts were retrospectively identified without appropriately matched comparators. There was no significant difference in 30-day complications [odds ratio (OR): 0.95, 95% CI: 0.65-1.40, I2 53%] or 30-day re-admission (OR 0.96, 95% CI: 0.49-1.89, I2 82%) between groups. There were insufficient data for meta-analysis of 24 h complications and 30-day mortality. Where reported, no re-admissions occurred due to 24 h complications after SDD. Two deaths (0.04%) were reported in both SDD and OS groups. CONCLUSION: Same-day discharge after AF ablation appears to be an effective and safe strategy in selected patients. However, the available evidence is of low quality, and more robust prospective studies comparing SDD to OS are needed."},{"id":"68bd520a189e","type":"article","url":"https://hartvaat.nl/2022/10/13/ffr-geleide-versus-angiografie-geleide-revascularisatie-meta-analyse-van-rct-s/","title":"FFR-geleide versus angiografie-geleide revascularisatie: meta-analyse van RCT's","title_en":"Fractional flow reserve versus angiography alone in guiding myocardial revascularisation: a systematic review and meta-analysis of randomised trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["farmaco-economie","stabiel-coronairlijden"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320768","source_url":"https://doi.org/10.1136/heartjnl-2021-320768","authors":["Ayman Elbadawi","Ramy Sedhom","Alexander T Dang","Mohamed M Gad","Faisal Rahman","Emmanouil S Brilakis","Islam Y Elgendy","Hani Jneid"],"significance":7,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/","https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"This meta-analysis confirmed that FFR-guided revascularization results in fewer stent implantations than angiography-guided treatment without compromising clinical outcomes, supporting the value of physiological assessment for treatment selection.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van gerandomiseerde trials bevestigde dat FFR-geleide revascularisatie minder stentplaatsingen oplevert dan angiografie-geleide revascularisatie, zonder verschil in klinische uitkomsten. FFR reduceert overbodige interventies bij coronairlijden.","abstract_original":"BACKGROUND: Randomised trials evaluating the efficacy and safety of fractional flow reserve (FFR)-guided versus angiography-guided revascularisation among patients with obstructive coronary artery disease (CAD) have yielded mixed results. AIMS: To examine the comparative efficacy and safety of FFR-guided versus angiography-guided revascularisation among patients with obstructive CAD. METHODS: An electronic search of MEDLINE, SCOPUS and Cochrane databases without language restrictions was performed through November 2021 for randomised controlled trials that evaluated the outcomes of FFR-guided versus angiography-guided revascularisation. The primary outcome was major adverse cardiac events (MACE). Data were pooled using a random-effects model. RESULTS: The final analysis included seven trials with 5094 patients. The weighted mean follow-up duration was 38 months. Compared with angiography guidance, FFR guidance was associated with fewer number of stents during revascularisation (standardised mean difference=-0.80; 95% CI -1.33 to -0.27), but no difference in total hospital cost. There was no difference between FFR-guided and angiography-guided revascularisation in long-term MACE (13.6% vs 13.9%; risk ratio (RR) 0.97, 95% CI 0.85 to 1.11). Meta-regression analyses did not reveal any evidence of effect modification for MACE with acute coronary syndrome (p=0.36), proportion of three-vessel disease (p=0.88) or left main disease (p=0.50). There were no differences between FFR-guided and angiography-guided revascularisation in the outcomes all-cause mortality (RR 1.16, 95% CI 0.80 to 1.68), cardiovascular mortality (RR 1.27, 95% CI 0.50 to 3.26), repeat revascularisation (RR 0.99, 95% CI 0.81 to 1.21), recurrent myocardial infarction (RR 0.92, 95% CI 0.74 to 1.14) or stent thrombosis (RR 0.61, 95% CI 0.31 to 1.21). CONCLUSION: Among patients with obstructive CAD, FFR-guided revascularisation did not reduce the risk of long-term adverse cardiac events or the individual outcomes. However, FFR-guided revascularisation was associated with fewer number of stents. PROSPERO REGISTRATION NUMBER: CRD42021291596."},{"id":"375837514bbe","type":"article","url":"https://hartvaat.nl/2022/10/13/cerebrale-microbloedingen-en-risico-bij-af-systematische-review/","title":"Cerebrale microbloedingen en risico bij AF: systematische review","title_en":"Epidemiology of cerebral microbleeds and risk of adverse outcomes in atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["abelacimab","bloeddrukbehandeling","microcirculatie"],"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/euac028","source_url":"https://doi.org/10.1093/europace/euac028","authors":["Bernadette Corica","Giulio Francesco Romiti","Valeria Raparelli","Roberto Cangemi","Stefania Basili","Marco Proietti"],"significance":6,"published":"2022-10-13","source_date":"2022-10-13","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This meta-analysis documented the prevalence of cerebral microbleeds in AF patients and their association with increased intracranial hemorrhage risk, informing the bleeding risk assessment for anticoagulation decisions.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse documenteerde de prevalentie van cerebrale microbloedingen bij AF-patiënten en het bijbehorende risico op intracraniële bloeding en ischemisch CVA. De aanwezigheid van microbloedingen verhoogt het bloedingsrisico onder antistolling, wat de anticoagulantkeuze kan beïnvloeden.","abstract_original":"AIMS: The aim of this study is to perform a systematic review and meta-analysis on the epidemiology of cerebral microbleeds (CMBs) and the risk of intracranial haemorrhage (ICH) and ischaemic stroke (IS) in patients with atrial fibrillation (AF). METHODS AND RESULTS: PubMed and EMBASE databases were systematically searched from inception to 6 March 2021. All studies reporting the prevalence of CMBs and incidence of ICH and IS in AF patients with and without CMBs were included. Meta-analysis was conducted using random-effect models; odds ratios (ORs), 95% confidence intervals (CIs), and prediction intervals (PIs) were calculated for each outcome. Subgroup analyses were performed according to the number and localization of CMBs. A total of 562 studies were retrieved, with 17 studies finally included in the meta-analysis. Prevalence of CMBs in AF population was estimated at 28.3% (95% CI: 23.8-33.4%). Individuals with CMBs showed a higher risk of ICH (OR: 3.04, 95% CI: 1.83-5.06, 95% PI 1.23-7.49) and IS (OR: 1.78, 95% CI: 1.26-2.49, 95% PI 1.10-2.87). Patients with ≥5 CMBs showed a higher risk of ICH. Metaregression showed how higher of prevalence of diabetes mellitus in AF cohort is associated with higher prevalence of CMBs. CONCLUSIONS: Cerebral microbleeds are common in patients with AF, found in almost one out of four subjects. Cerebral microbleeds were associated with both haemorrhagic and thromboembolic events in AF patients. Moreover, the risk of ICH increased consistently with the burden of CMBs. Cerebral microbleeds may represent an important overlooked risk factor for both ICH and IS in adults with AF."},{"id":"fb746b359b72","type":"article","url":"https://hartvaat.nl/2022/10/11/langetermijn-evolocumab-bij-atherosclerotisch-vaatlijden-open-label-extensie-fou/","title":"Langetermijn evolocumab bij atherosclerotisch vaatlijden: open-label extensie FOURIER","title_en":"Long-Term Evolocumab in Patients With Established Atherosclerotic Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["atherosclerose","bempedoïnezuur","cetp-remmers","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","gedilateerde-cardiomyopathie","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","pelacarsen","perifeer-vaatlijden","plaquekarakterisatie","statines","vrouwen","yellow-iii"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.061620","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.061620","authors":["Michelle L O'Donoghue","Robert P Giugliano","Stephen D Wiviott","Dan Atar","Anthony Keech","Julia F Kuder","KyungAh Im","Sabina A Murphy","Jose H Flores-Arredondo","J Antonio G López","Mary Elliott-Davey","Bei Wang","Maria Laura Monsalvo","Siddique Abbasi","Marc S Sabatine"],"significance":7,"published":"2022-10-11","source_date":"2022-10-11","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The open-label FOURIER extension showed that long-term evolocumab use (up to 5 years) maintains sustained LDL cholesterol reduction with a favorable safety profile, providing the longest-term safety data for PCSK9 monoclonal antibody therapy.","created":"2026-07-03T10:30:00Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Open-label extensie van FOURIER toonde dat langetermijn evolocumab-gebruik (tot 5 jaar) veilig was en het LDL-cholesterol duurzaam verlaagde. Het cardiovasculaire voordeel bleef behouden zonder nieuwe veiligheidssignalen, wat langdurige PCSK9-remming ondersteunt.","abstract_original":"BACKGROUND: In FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk), the proprotein convertase subtilisin-kexin type 9 inhibitor evolocumab reduced low-density lipoprotein cholesterol (LDL-C) and risk of cardiovascular events and was safe and well tolerated over a median of 2.2 years of follow-up. However, large-scale, long-term data are lacking. METHODS: The parent FOURIER trial randomized 27 564 patients with atherosclerotic cardiovascular disease and LDL-C ≥70 mg/dL on statin to evolocumab versus placebo. Patients completing FOURIER at participating sites were eligible to receive evolocumab in 2 open-label extension studies (FOURIER-OLE [FOURIER Open-Label Extension]) in the United States and Europe; primary analyses were pooled across studies. The primary end point was the incidence of adverse events. Lipid values and major adverse cardiovascular events were prospectively collected. RESULTS: A total of 6635 patients were enrolled in FOURIER-OLE (3355 randomized to evolocumab and 3280 to placebo in the parent study). Median follow-up in FOURIER-OLE was 5.0 years; maximum exposure to evolocumab in parent plus FOURIER-OLE was 8.4 years. At 12 weeks in FOURIER-OLE, median LDL-C was 30 mg/dL, and 63.2% of patients achieved LDL-C <40 mg/dL on evolocumab. Incidences of serious adverse events, muscle-related events, new-onset diabetes, hemorrhagic stroke, and neurocognitive events with evolocumab long term did not exceed those for placebo-treated patients during the parent study and did not increase over time. During the FOURIER-OLE follow-up period, patients originally randomized in the parent trial to evolocumab versus placebo had a 15% lower risk of cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina or coronary revascularization (hazard ratio, 0.85 [95% CI, 0.75-0.96]; P=0.008); a 20% lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80 [95% CI, 0.68-0.93]; P=0.003); and a 23% lower risk of cardiovascular death (hazard ratio, 0.77 [95% CI, 0.60-0.99]; P=0.04). CONCLUSIONS: Long-term LDL-C lowering with evolocumab was associated with persistently low rates of adverse events for >8 years that did not exceed those observed in the original placebo arm during the parent study and led to further reductions in cardiovascular events compared with delayed treatment initiation. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifiers: NCT02867813 and NCT03080935."},{"id":"18fb03fd0981","type":"article","url":"https://hartvaat.nl/2022/10/08/all-heart-allopurinol-verbetert-cv-uitkomsten-niet-bij-ischemische-hartziekte/","title":"ALL-HEART: allopurinol verbetert CV-uitkomsten niet bij ischemische hartziekte","title_en":"Allopurinol versus usual care in UK patients with ischaemic heart disease (ALL-HEART): a multicentre, prospective, randomised, open-label, blinded-endpoint trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","aspirine","bradycardie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)01657-9","source_url":"https://doi.org/10.1016/S0140-6736(22)01657-9","authors":["Isla S Mackenzie","Christopher J Hawkey","Ian Ford","Nicola Greenlaw","Filippo Pigazzani","Amy Rogers","Allan D Struthers","Alan G Begg","Li Wei","Anthony J Avery","Jaspal S Taggar","Andrew Walker","Suzanne L Duce","Rebecca J Barr","Jennifer S Dumbleton","Evelien D Rooke","Jonathan N Townend","Lewis D Ritchie","Thomas M MacDonald"],"significance":8,"published":"2022-10-08","source_date":"2022-10-08","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"The ALL-HEART trial showed that allopurinol did not improve cardiovascular outcomes in patients with ischemic heart disease without gout, despite its theoretical benefits on endothelial function and oxidative stress. The large, pragmatic negative result argued against using allopurinol for cardiovascular prevention.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ALL-HEART-trial in de Lancet toonde dat allopurinol geen cardiovasculaire voordelen biedt bij patiënten met ischemische hartziekte zonder jicht. Ondanks eerdere suggestieve data was er geen verschil in CV-events of mortaliteit. Routinematig allopurinol voor CV-preventie is niet zinvol.","abstract_original":"BACKGROUND: Allopurinol is a urate-lowering therapy used to treat patients with gout. Previous studies have shown that allopurinol has positive effects on several cardiovascular parameters. The ALL-HEART study aimed to determine whether allopurinol therapy improves major cardiovascular outcomes in patients with ischaemic heart disease. METHODS: ALL-HEART was a multicentre, prospective, randomised, open-label, blinded-endpoint trial done in 18 regional centres in England and Scotland, with patients recruited from 424 primary care practices. Eligible patients were aged 60 years or older, with ischaemic heart disease but no history of gout. Participants were randomly assigned (1:1), using a central web-based randomisation system accessed via a web-based application or an interactive voice response system, to receive oral allopurinol up-titrated to a dose of 600 mg daily (300 mg daily in participants with moderate renal impairment at baseline) or to continue usual care. The primary outcome was the composite cardiovascular endpoint of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death. The hazard ratio (allopurinol vs usual care) in a Cox proportional hazards model was assessed for superiority in a modified intention-to-treat analysis (excluding randomly assigned patients later found to have met one of the exclusion criteria). The safety analysis population included all patients in the modified intention-to-treat usual care group and those who took at least one dose of randomised medication in the allopurinol group. This study is registered with the EU Clinical Trials Register, EudraCT 2013-003559-39, and ISRCTN, ISRCTN32017426. FINDINGS: Between Feb 7, 2014, and Oct 2, 2017, 5937 participants were enrolled and then randomly assigned to receive allopurinol or usual care. After exclusion of 216 patients after randomisation, 5721 participants (mean age 72·0 years [SD 6·8], 4321 [75·5%] males, and 5676 [99·2%] white) were included in the modified intention-to-treat population, with 2853 in the allopurinol group and 2868 in the usual care group. Mean follow-up time in the study was 4·8 years (1·5). There was no evidence of a difference between the randomised treatment groups in the rates of the primary endpoint. 314 (11·0%) participants in the allopurinol group (2·47 events per 100 patient-years) and 325 (11·3%) in the usual care group (2·37 events per 100 patient-years) had a primary endpoint (hazard ratio [HR] 1·04 [95% CI 0·89-1·21], p=0·65). 288 (10·1%) participants in the allopurinol group and 303 (10·6%) participants in the usual care group died from any cause (HR 1·02 [95% CI 0·87-1·20], p=0·77). INTERPRETATION: In this large, randomised clinical trial in patients aged 60 years or older with ischaemic heart disease but no history of gout, there was no difference in the primary outcome of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death between participants randomised to allopurinol therapy and those randomised to usual care. FUNDING: UK National Institute for Health and Care Research."},{"id":"95cae36387f2","type":"article","url":"https://hartvaat.nl/2022/10/04/empagliflozine-bij-hfpef-gelijk-effect-bij-vrouwen-en-mannen/","title":"Empagliflozine bij HFpEF: gelijk effect bij vrouwen en mannen","title_en":"Effects of Empagliflozin in Women and Men With Heart Failure and Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","emperor-trials","hfpef","hfref","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059755","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059755","authors":["Javed Butler","Gerasimos Filippatos","Tariq Jamal Siddiqi","João Pedro Ferreira","Martina Brueckmann","Edimar Bocchi","Michael Böhm","Vijay K Chopra","Nadia Giannetti","Tomoko Iwata","James L Januzzi","Sanjay Kaul","Ileana L Piña","Piotr Ponikowski","Ursula Rauch-Kröhnert","Sanjiv J Shah","Michele Senni","Mikhail Sumin","Subodh Verma","Jian Zhang","Stuart J Pocock","Faiez Zannad","Milton Packer","Stefan D Anker"],"significance":7,"published":"2022-10-04","source_date":"2022-10-04","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This EMPEROR-Preserved sex-stratified analysis confirmed that empagliflozin reduces heart failure events equally in women and men with HFpEF, a reassuring finding given the female predominance in the HFpEF population.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van EMPEROR-Preserved bevestigde dat empagliflozine bij HFpEF even effectief was bij vrouwen als bij mannen. Het gunstige effect op hartfalengebeurtenissen en nierfunctie was consistent over beide geslachten, ondanks verschillen in klinisch profiel.","abstract_original":"BACKGROUND: Women and men with heart failure (HF) and preserved ejection fraction may differ in their clinical characteristics and their response to therapy. The aim of this study was to evaluate the influence of sex on the effects of empagliflozin in patients with HF and preserved ejection fraction enrolled in the EMPEROR-Preserved trial (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction). METHODS: The effects of empagliflozin on the primary outcome of cardiovascular death or hospitalization for HF and on secondary outcomes (including total HF hospitalization, cardiovascular and all-cause mortality, and Kansas City Cardiomyopathy Questionnaire scores) were compared in women and men in the overall cohort and in subgroups defined by left ventricular ejection fraction (41%-49%, 50%-59%, and ≥60%). The effects of empagliflozin on physiological measures, including changes in systolic blood pressure, uric acid, hemoglobin, body weight, and natriuretic peptide levels, were also assessed. RESULTS: Of the 5988 patients randomized, 2676 (44.7%) were women. In the placebo arm, women tended to have lower risk for adverse outcomes, including a lower risk of all-cause mortality (hazard ratio, 0.69 [95% CI, 0.56, 0.84]). Compared with placebo, empagliflozin reduced the risk of cardiovascular death or hospitalization for HF to a similar degree in both sexes (hazard ratio, 0.81 [95% CI, 0.69, 0.96] for men; and hazard ratio, 0.75 [95% CI, 0.61, 0.92] for women; Pinteraction=0.54). Sex did not modify the relationship between empagliflozin and outcomes across ejection fraction groups. Similar results were seen for secondary outcomes and physiological measures. Compared with placebo, empagliflozin improved the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score to a similar extent in both sexes (1.38 for men versus 1.63 for women at 52 weeks; Pinteraction=0.77); the results were similar for Kansas City Cardiomyopathy Questionnaire overall summary score and total summary score. CONCLUSIONS: Empagliflozin produced similar benefits on outcomes and health status in women and men with HF and preserved ejection fraction. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03057951."},{"id":"96fb8ae89819","type":"article","url":"https://hartvaat.nl/2022/10/04/paradise-mi-sacubitril-valsartan-versus-ramipril-na-acuut-mi-echocardiografie/","title":"PARADISE-MI: sacubitril/valsartan versus ramipril na acuut MI — echocardiografie","title_en":"Impact of Sacubitril/Valsartan Compared With Ramipril on Cardiac Structure and Function After Acute Myocardial Infarction: The PARADISE-MI Echocardiographic Substudy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","ramipril","sacubitril-valsartan"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059210","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059210","authors":["Amil M Shah","Brian Claggett","Narayana Prasad","Guichu Li","Mayra Volquez","Karola Jering","Maja Cikes","Attila Kovacs","Wilfried Mullens","Jose C Nicolau","Lars Køber","Peter van der Meer","Pardeep S Jhund","Ghionul Ibram","Martin Lefkowitz","Yinong Zhou","Scott D Solomon","Marc A Pfeffer"],"significance":7,"published":"2022-10-04","source_date":"2022-10-04","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This PARADISE-MI echocardiographic substudy showed that sacubitril-valsartan did not significantly improve left ventricular remodeling compared with ramipril after acute MI, consistent with the neutral clinical primary endpoint.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Echocardiografische substudie van PARADISE-MI toonde dat sacubitril/valsartan het linkerventrikelvolume na acuut myocardinfarct niet significant meer verminderde dan ramipril. De remodelling was vergelijkbaar in beide groepen, wat het neutrale klinische resultaat van de hoofdstudie ondersteunt.","abstract_original":"BACKGROUND: Angiotensin-converting enzyme inhibitors attenuate left ventricular (LV) enlargement after acute myocardial infarction (AMI). Preclinical data suggest similar benefits with combined angiotensin receptor neprilysin inhibition, but human data are conflicting. The PARADISE-MI Echo Study (Prospective ARNI Versus ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After Myocardial Infarction) tested the effect of sacubitril/valsartan compared with ramipril on LV function and adverse remodeling after high risk-AMI. METHODS: In a prespecified substudy, 544 PARADISE-MI participants were enrolled in the Echo Study to undergo protocol echocardiography at randomization and after 8 months. Patients were randomized within 0.5 to 7 days of presentation with their index AMI to receive a target dose of sacubitril/valsartan 200 mg or ramipril 5 mg twice daily. Echocardiographic measures were performed at a core laboratory by investigators blinded to treatment assignment. The effect of treatment on change in echo measures was assessed with ANCOVA with adjustment for baseline value and enrollment region. The primary end points were change in LV ejection fraction (LVEF) and left atrial volume (LAV), and prespecified secondary end points included changes in LV end-diastolic and end-systolic volumes. RESULTS: Mean age was 64±12 years; 26% were women; mean LVEF was 42±12%; and LAV was 49±17 mL. Of 544 enrolled patients, 457 (84%) had a follow-up echo at 8 months (228 taking sacubitril/valsartan, 229 taking ramipril). There was no significant difference in change in LVEF (P=0.79) or LAV (P =0.62) by treatment group. Patients randomized to sacubitril/valsartan demonstrated less increase in LV end-diastolic volume (P=0.025) and greater decline in LV mass index (P=0.037), increase in tissue Doppler e'lat (P=0.005), decrease in E/e'lat (P=0.045), and decrease in tricuspid regurgitation peak velocity (P=0.024) than patients randomized to ramipril. These differences remained significant after adjustment for differences in baseline characteristics. Baseline LVEF, LV end-diastolic volume, LV end-systolic volume, LV mass index, LAV, and Doppler-based diastolic indices were associated with risk of cardiovascular death or incident heart failure. CONCLUSIONS: Treatment with sacubitril/valsartan compared with ramipril after AMI did not result in changes in LVEF or LAV at 8 months. Patients randomized to sacubitril/valsartan had less LV enlargement and greater improvement in filling pressure. Measures of LV size, systolic function, and diastolic properties were predictive of cardiovascular death and incident heart failure after AMI in this contemporary, well-treated cohort. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02924727."},{"id":"aa83237edfd5","type":"article","url":"https://hartvaat.nl/2022/10/04/timing-vroege-versus-late-noac-start-na-ischemisch-cva-bij-af/","title":"TIMING: vroege versus late NOAC-start na ischemisch CVA bij AF","title_en":"Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.060666","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.060666","authors":["Jonas Oldgren","Signild Åsberg","Ziad Hijazi","Per Wester","Maria Bertilsson","Bo Norrving"],"significance":8,"published":"2022-10-04","source_date":"2022-10-04","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The Swedish TIMING trial demonstrated that early NOAC initiation (within 4 days) after acute ischemic stroke in patients with AF was safe and noninferior to delayed start (5-10 days) for the composite of stroke, major bleeding, or death. The results supported a move toward earlier anticoagulation.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T13:29:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De Zweedse TIMING-trial toonde dat vroege NOAC-start (≤4 dagen) na ischemisch CVA bij AF veilig was en niet inferieur aan late start (5-10 dagen). Er was geen toename van intracraniële bloedingen, wat vroege anticoagulatie ondersteunt.","abstract_original":"BACKGROUND: There are no evidence-based recommendations on the optimal time point to initiate non-vitamin K antagonist oral anticoagulants (NOACs) after acute ischemic stroke in patients with atrial fibrillation. We aimed to investigate the efficacy and safety of early versus delayed initiation of NOAC in these patients. METHODS: TIMING (Timing of Oral Anticoagulant Therapy in Acute Ischemic Stroke With Atrial Fibrillation) was a registry-based, randomized, noninferiority, open-label, blinded end-point study at 34 stroke units using the Swedish Stroke Register for enrollment and follow-up. Within 72 hours from stroke onset, patients were randomized to early (≤4 days) or delayed (5-10 days) NOAC initiation, with choice of NOAC at the investigators' discretion. The primary outcome was the composite of recurrent ischemic stroke, symptomatic intracerebral hemorrhage, or all-cause mortality at 90 days. The prespecified noninferiority margin was 3%. Secondary outcomes included the individual components of the primary outcome. RESULTS: Between April 2, 2017, and December 30, 2020, 888 patients were randomized to either early (n=450) or delayed (n=438) initiation of NOAC. No patient was lost to 90-day follow-up. Mean age was 78.3 years (SD, 9.9 years); 46.2% were women; 49.1% had previously known atrial fibrillation; and 17.5% prior stroke. The primary outcome occurred in 31 patients (6.89%) assigned to early initiation and in 38 patients (8.68%) assigned to delayed NOAC initiation (absolute risk difference, -1.79% [95% CI, -5.31% to 1.74%]; Pnoninferiority=0.004). Ischemic stroke rates were 3.11% and 4.57% (risk difference, -1.46% [95% CI, -3.98% to 1.07%]) and all-cause mortality rates were 4.67% and 5.71% (risk difference, -1.04% [95% CI, -3.96% to 1.88%]) in the early and delayed groups, respectively. No patient in either group experienced symptomatic intracerebral hemorrhage. CONCLUSIONS: Early initiation was noninferior to delayed start of NOAC after acute ischemic stroke in patients with atrial fibrillation. Numerically lower rates of ischemic stroke and death and the absence of symptomatic intracerebral hemorrhages implied that the early start of NOAC was safe and should be considered for acute secondary stroke prevention in patients eligible for NOAC treatment. REGISTRATION: URL: http://www. CLINICALTRIALS: gov; Unique identifier: NCT02961348."},{"id":"3f2e9efe809d","type":"article","url":"https://hartvaat.nl/2022/10/04/deliver-dapagliflozine-effectief-bij-recent-gehospitaliseerde-hfpef-patienten/","title":"DELIVER: dapagliflozine effectief bij recent gehospitaliseerde HFpEF-patiënten","title_en":"Dapagliflozin in Patients Recently Hospitalized With Heart Failure and Mildly Reduced or Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","hfpef","hfref","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.07.021","source_url":"https://doi.org/10.1016/j.jacc.2022.07.021","authors":["Jonathan W Cunningham","Muthiah Vaduganathan","Brian L Claggett","Ian J Kulac","Akshay S Desai","Pardeep S Jhund","Rudolf A de Boer","David DeMets","Adrian F Hernandez","Silvio E Inzucchi","Mikhail N Kosiborod","Carolyn S P Lam","Felipe Martinez","Sanjiv J Shah","Martina M McGrath","Eileen O'Meara","Ulrica Wilderäng","Daniel Lindholm","Magnus Petersson","Anna Maria Langkilde","John J V McMurray","Scott D Solomon"],"significance":8,"published":"2022-10-04","source_date":"2022-10-04","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This DELIVER subanalysis confirmed that dapagliflozin is effective in patients recently hospitalized for heart failure with mildly reduced or preserved ejection fraction, with early benefit seen within weeks of treatment initiation. The data supported in-hospital SGLT2 inhibitor use in HFpEF.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van DELIVER toonde dat dapagliflozine ook effectief was bij patiënten die recent waren gehospitaliseerd voor hartfalen met behouden ejectiefractie. Het relatieve voordeel was vergelijkbaar, maar het absolute voordeel groter door het hogere basisrisico.","abstract_original":"BACKGROUND: Patients recently hospitalized for heart failure (HF) are at high risk for rehospitalization and death. OBJECTIVES: The purpose of this study was to investigate clinical outcomes and response to dapagliflozin in patients with HF with mildly reduced or preserved left ventricular ejection fraction (LVEF) who were enrolled during or following hospitalization. METHODS: The DELIVER (Dapagliflozin Evaluation to Improve the LIVES of Patients With PReserved Ejection Fraction Heart Failure) trial randomized patients with HF and LVEF >40% to dapagliflozin or placebo. DELIVER permitted randomization during or shortly after hospitalization for HF in clinically stable patients off intravenous HF therapies. This prespecified analysis investigated whether recent HF hospitalization modified risk of clinical events or response to dapagliflozin. The primary outcome was worsening HF event or cardiovascular death. RESULTS: Of 6,263 patients in DELIVER, 654 (10.4%) were randomized during HF hospitalization or within 30 days of discharge. Recent HF hospitalization was associated with greater risk of the primary outcome after multivariable adjustment (HR: 1.88; 95% CI: 1.60-2.21; P < 0.001). Dapagliflozin reduced the primary outcome by 22% in recently hospitalized patients (HR: 0.78; 95% CI: 0.60-1.03) and 18% in patients without recent hospitalization (HR: 0.82; 95% CI: 0.72-0.94; Pinteraction = 0.71). Rates of adverse events, including volume depletion, diabetic ketoacidosis, or renal events, were similar with dapagliflozin and placebo in recently hospitalized patients. CONCLUSIONS: Dapagliflozin safely reduced risk of worsening HF or cardiovascular death similarly in patients with and without history of recent HF hospitalization. Starting dapagliflozin during or shortly after HF hospitalization in patients with mildly reduced or preserved LVEF appears safe and effective. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213)."},{"id":"4370563dc147","type":"article","url":"https://hartvaat.nl/2022/10/04/2022-acc-expert-consensus-niet-statine-therapieen-voor-ldl-verlaging-bij-ascvd/","title":"2022 ACC Expert Consensus: niet-statine therapieën voor LDL-verlaging bij ASCVD","title_en":"2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["ezetimibe","lipidenverlaging","niet-statine-therapie","pcsk9-remmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.07.006","source_url":"https://doi.org/10.1016/j.jacc.2022.07.006","authors":["Donald M Lloyd-Jones","Pamela B Morris","Christie M Ballantyne","Kim K Birtcher","Ashleigh M Covington","Sondra M DePalma","Margo B Minissian","Carl E Orringer","Sidney C Smith","Ashley Arana Waring","John T Wilkins"],"significance":9,"published":"2022-10-04","source_date":"2022-10-04","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenverlaging-stappenplan/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"The 2022 ACC Expert Consensus updated the decision pathway for nonstatin lipid-lowering therapies, integrating evidence on bempedoic acid and inclisiran alongside ezetimibe and PCSK9 monoclonal antibodies. The document provided practical algorithms for escalating therapy to achieve LDL-cholesterol targets.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T13:29:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC expert consensus document actualiseerde het beslispad voor niet-statine therapieën bij ASCVD. Ezetimibe, PCSK9-remmers, bempedoïnezuur en inclisiran worden gepositioneerd op basis van LDL-doelen en risicoprofiel. Het document integreert nieuw bewijs over bempedoïnezuur en inclisiran.","abstract_original":""},{"id":"107d08c08fab","type":"article","url":"https://hartvaat.nl/2022/10/01/sekseverschillen-in-af-risico-vital-rhythm-studie/","title":"Sekseverschillen in AF-risico: VITAL Rhythm studie","title_en":"Sex Differences in Atrial Fibrillation Risk: The VITAL Rhythm Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["slaapapneu"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.2825","source_url":"https://doi.org/10.1001/jamacardio.2022.2825","authors":["Hasan K Siddiqi","Manickavasagar Vinayagamoorthy","Baris Gencer","Chee Ng","Julie Pester","Nancy R Cook","I-Min Lee","Julie Buring","JoAnn E Manson","Christine M Albert"],"significance":6,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/coagulatiescascade/"],"congress":"","summary_en":"The VITAL Rhythm Study confirmed that women have significantly lower AF incidence than men even after adjusting for cardiovascular risk factors, establishing sex as an independent determinant of arrhythmia risk.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De VITAL Rhythm studie toonde dat vrouwen een lager AF-risico hebben dan mannen, zelfs na correctie voor cardiovasculaire risicofactoren. Het verschil wordt niet verklaard door bekende risicofactoren, wat wijst op biologische sekseverschillen in atriale elektrofysiologie.","abstract_original":"IMPORTANCE: Women have a lower incidence of atrial fibrillation (AF) compared with men in several studies, but it is unclear whether this sex difference is independent of sex differences in prevalent cardiovascular disease (CVD), body size, and other risk factors. OBJECTIVE: To examine sex differences in AF incidence and whether AF risk factors differ by sex in a contemporary cohort of men and women without prevalent CVD. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort analysis within the Vitamin D and Omega-3 Trial (VITAL) Rhythm Study, a randomized trial that examined the effect of vitamin D and ω-3 fatty acid supplementation on incident AF among men 50 years or older and women 55 years or older without a prior history of prevalent AF, CVD, or cancer at baseline. Data were analyzed from September 29, 2020, to June 29, 2021. EXPOSURES: Sex, height, weight, body mass index (BMI), body surface area (BSA), and other AF risk factors at study enrollment. MAIN OUTCOMES AND MEASURES: Incident AF confirmed by medical record review. RESULTS: A total of 25 119 individuals (mean [SD] age, 67.0 [7.1] years; 12 757 women [51%]) were included in this study. Over a median (IQR) follow-up of 5.3 (5.1-5.7) years, 900 confirmed incident AF events occurred among 12 362 men (495 events, 4.0%) and 12 757 women (405 events, 3.2%). After adjustment for age and treatment assignment, women were at lower risk for incident AF than men (hazard ratio [HR], 0.68; 95% CI, 0.59-0.77; P < .001). The inverse association between female sex and AF persisted after adjustment for race and ethnicity, smoking, alcohol intake, hypertension, diabetes (type 1, type 2, gestational), thyroid disease, exercise, and BMI (HR, 0.73; 95% CI, 0.63-0.85; P <.001). However, female sex was positively associated with AF when height (HR, 1.39; 95% CI, 1.14-1.72; P = .001), height and weight (HR 1.49, 95% CI, 1.21-1.82; P <.001), or BSA (HR, 1.25; 95% CI, 1.06-1.49; P = .009) were substituted for BMI in the multivariate model. In stratified models, risk factor associations with incident AF were similar for women and men. CONCLUSIONS AND RELEVANCE: In this cohort study, findings suggest that after controlling for height and/or body size, women without CVD at baseline were at higher risk for AF than men, suggesting that sex differences in body size account for much of the protective association between female sex and AF. These data underscore the importance of AF prevention in women."},{"id":"5332672887c1","type":"article","url":"https://hartvaat.nl/2022/10/01/smartphone-app-thuisbloeddrukmeting-versus-kantoor-en-ambulante-meting/","title":"Smartphone-app thuisbloeddrukmeting versus kantoor- en ambulante meting","title_en":"Smartphone Application-Assisted Home Blood Pressure Monitoring Compared With Office and Ambulatory Blood Pressure Monitoring in Patients With Hypertension: the AMUSE-BP Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["digitale-gezondheid","thuisbloeddrukmeting"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19685","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19685","authors":["Eline H Groenland","Jean-Paul A C Vendeville","Remy H H Bemelmans","Houshang Monajemi","Michiel L Bots","Frank L J Visseren","Wilko Spiering"],"significance":6,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This study showed that smartphone app-assisted home blood pressure monitoring provides measurements comparable to ambulatory monitoring, supporting standardized digital home BP assessment as a practical alternative.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T13:29:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek smartphone-app-gestuurde thuisbloeddrukmeting met kantoor- en ambulante meting. De gestandaardiseerde thuismeting correleerde goed met ambulante waarden en was betrouwbaarder dan kantoormetingen, wat thuismonitoring als diagnostisch instrument ondersteunt.","abstract_original":"BACKGROUND: The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM). METHODS: In this open randomized 5-way cross-over study, patients diagnosed with hypertension were randomized to one of 10 clusters, each containing 5 BP measurement methods (ABPM, HBPM, attended OBP, unattended OBP, and unattended 30-minute BP) in different order. RESULTS: In total, 113 patients were included. The average 24-hour ABPM was 126±11/73±8 mm Hg compared with 141±14/82±10 mm Hg with app-assisted HBPM, 134±13/80±9 mm Hg with unattended 30-minute BP, 137±16/81±11 mm Hg with attended OBP, and 135±15/81±10 mm Hg with unattended OBP monitoring. Diagnostic agreement between app-assisted HBPM and 24-hour ABPM for diagnosing sustained (OBP >140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg), white-coat (OBP ≥140/90 mm Hg and ABPM <130/80 mm Hg or HBPM <135/85 mm Hg), and masked hypertension (OBP <140/90 mm Hg and ABPM ≥130/80 mm Hg or HBPM ≥135/85 mm Hg) was fair-to-moderate (κ statistics ranging from 0.34 to 0.40). App-assisted HBPM had high sensitivities (78%-91%) and negative predictive values (90%-97%) for diagnosing sustained and masked hypertension. CONCLUSIONS: This study showed a considerable (diagnostic) disagreement between app-assisted HBPM and ABPM. App-assisted HBPM had high sensitivity in the diagnosis of sustained and masked hypertension and may therefore be used as complementary to, but not a replacement of, ABPM."},{"id":"ce027150bdba","type":"article","url":"https://hartvaat.nl/2022/10/01/bloeddruk-in-hogere-versus-lagere-arm-en-cv-uitkomsten-interpress-ipd-meta-analy/","title":"Bloeddruk in hogere versus lagere arm en CV-uitkomsten: INTERPRESS-IPD meta-analyse","title_en":"Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18921","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18921","authors":["Christopher E Clark","Fiona C Warren","Kate Boddy","Sinéad T J McDonagh","Sarah F Moore","Maria Teresa Alzamora","Rafel Ramos Blanes","Shao-Yuan Chuang","Michael H Criqui","Marie Dahl","Gunnar Engström","Raimund Erbel","Mark Espeland","Luigi Ferrucci","Maëlenn Guerchet","Andrew Hattersley","Carlos Lahoz","Robyn L McClelland","Mary M McDermott","Jackie Price","Henri E Stoffers","Ji-Guang Wang","Jan Westerink","James White","Lyne Cloutier","Rod S Taylor","Angela C Shore","Richard J McManus","Victor Aboyans","John L Campbell"],"significance":7,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that the higher arm blood pressure reading provides better cardiovascular risk prediction, supporting the guideline recommendation to measure blood pressure in both arms and use the higher reading for clinical decisions.","created":"2026-07-03T10:29:59Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele-patiëntdata meta-analyse bevestigde dat de bloeddruk in de arm met de hogere waarde een betere cardiovasculaire voorspeller is. Een interarmverschil >10 mmHg is geassocieerd met verhoogd CV-risico en ondersteunt de richtlijn om beide armen te meten.","abstract_original":"BACKGROUND: Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference-Individual Participant Data Collaboration. METHODS: One-stage multivariable Cox regression models, stratified by study, were used to examine associations of higher or lower reading arm BPs with cardiovascular mortality, all-cause mortality, and cardiovascular events, in individual participant data meta-analyses pooled from 23 cohorts. Cardiovascular events were modelled for Framingham and atherosclerotic cardiovascular disease risk scores. Model fit was compared throughout using Akaike information criteria. Proportions reclassified across guideline recommended intervention thresholds were also compared. RESULTS: We analyzed 53 172 participants: mean age 60 years; 48% female. Higher arm BP, compared with lower arm, reclassified 12% of participants at either 130 or 140 mm Hg systolic BP thresholds (both P<0.001). Higher arm BP models fitted better for all-cause mortality, cardiovascular mortality, and cardiovascular events (all P<0.001). Higher arm BP models better predicted cardiovascular events with Framingham and atherosclerotic cardiovascular disease risk scores (both P<0.001) and reclassified 4.6% and 3.5% of participants respectively to higher risk categories compared with lower arm BPs). CONCLUSIONS: Using BP from higher instead of lower reading arms reclassified 12% of people over thresholds used to diagnose hypertension. All prediction models performed better when using the higher arm BP. Both arms should be measured for accurate diagnosis and management of hypertension. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: CRD42015031227."},{"id":"560bc827a50f","type":"article","url":"https://hartvaat.nl/2022/10/01/alfa-antagonisten-en-cardiovasculaire-uitkomsten-meta-analyse-nuanceert-risico/","title":"Alfa-antagonisten en cardiovasculaire uitkomsten: meta-analyse nuanceert risico","title_en":"Do adrenergic alpha-antagonists increase the risk of poor cardiovascular outcomes? A systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts"],"tags":["acuut-hartfalen","aperitif-trial","biomarkers-cardiovasculair","bloeddrukbehandeling","carvedilol","endothelineantagonisten","farmaco-economie","fidelity","figaro-dkd","voeding-hart"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14012","source_url":"https://doi.org/10.1002/ehf2.14012","authors":["José Pedro Sousa","Diogo Mendonça","Rogério Teixeira","Lino Gonçalves"],"significance":5,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated whether alpha-1 adrenergic antagonists increase cardiovascular risk in heart failure, finding insufficient evidence to confirm the long-held safety concern about these commonly avoided medications.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse onderzochten of adrenerge alfa-antagonisten het cardiovasculaire risico verhogen bij hartfalen. Het bewijs voor nadelige effecten was beperkt en inconsistent, wat de strikte afrading bij hartfalenpatiënten nuanceert.","abstract_original":"Due to concerns regarding neurohormonal activation and fluid retention, adrenergic alpha-1 receptor antagonists (A1Bs) are generally avoided in the setting of heart disease, namely, symptomatic heart failure (HF) with reduced ejection fraction (HFrEF). However, this contraindication is mainly supported by ancient studies, having recently been challenged by newer ones. We aim to perform a comprehensive meta-analysis aimed at ascertaining the extent to which A1Bs might influence cardiovascular (CV) outcomes. We systematically searched PubMed, Cochrane Central Register of Controlled Trials and Web of Science for both prospective and retrospective studies, published until 1 December 2020, addressing the impact of A1Bs on both clinical outcomes-namely, acute heart failure (AHF), acute coronary syndrome (ACS), CV and all-cause mortality-and on CV surrogate measures, specifically left ventricular ejection fraction (LVEF) and exercise tolerance, by means of exercise duration. Both randomized controlled trials (RCTs) and studies including only HF patients were further investigated separately. Study-specific odds ratios (ORs) and mean differences (MDs) were pooled using traditional meta-analytic techniques, under a random-effects model. A record was registered in PROSPERO database, with the code number CRD42020181804. Fifteen RCTs, three non-randomized prospective and two retrospective studies, encompassing 32 851, 19 287, and 71 600 patients, respectively, were deemed eligible; 62 256 patients were allocated to A1B, on the basis of multiple clinical indications: chronic HF itself [14 studies, with 72 558 patients, including seven studies with 850 HFrEF or HF with mildly reduced ejection fraction (HFmrEF) patients], arterial hypertension (four studies, with 44 184 patients) and low urinary tract symptoms (two studies, with 6996 patients). There were 25 998 AHF events, 1325 ACS episodes, 955 CV deaths and 33 567 all-cause deaths. When considering only RCTs, A1Bs were, indeed, found to increase AHF risk (OR 1.78, [1.46, 2.16] 95% CI, P < 0.00001, i2 2%), although displaying no significant effect on neither ACS nor CV or all-cause mortality rates (OR 1.02, [0.91, 1.15] 95% CI, i2 0%; OR 0.95, [0.47, 1.91] 95% CI, i2 17%; OR 1.1, [0.84, 1.43] 95% CI, i2 17%, respectively). Besides, when only HF patients were evaluated, A1Bs revealed themselves neutral towards not only ACS, CV, and all-cause mortality events (OR 0.49, [0.1, 2.47] 95% CI, i2 0%; OR 0.7, [0.21, 2.31] 95% CI, i2 21%; OR 1.09, [0.53, 2.23] 95% CI, i2 17%, respectively), but also AHF (OR 1.13, [0.66, 1.92] 95% CI, i2 0%). As for HFrEF and HFmrEF, A1Bs were found to exert a similarly inconsequential effect on AHF rates (OR 1.01, [0.5-2.05] 95% CI, i2 6%). Likewise, LVEF was not significantly influenced by A1Bs (MD 1.66, [-2.18, 5.50] 95% CI, i2 58%). Most strikingly, exercise tolerance was higher in those under this drug class (MD 139.16, [65.52, 212.8] 95% CI, P < 0.001, i2 26%). A1Bs do not seem to exert a negative influence on the prognosis of HF-and even of HFrEF-patients, thus contradicting currently held views. These drugs' impact on other major CV outcomes also appear trivial and they may even increment exercise tolerance."},{"id":"253c4e07138d","type":"article","url":"https://hartvaat.nl/2022/10/01/financiele-prikkels-verbeteren-hypertensiecontrole-chinese-rct/","title":"Financiële prikkels verbeteren hypertensiecontrole: Chinese RCT","title_en":"Effect of Financial Incentives on Hypertension Control: A Multicenter Randomized Controlled Trial in China.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["bloeddrukbehandeling","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19568","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19568","authors":["Liqiang Zheng","Sitong Liu","Yundi Jiao","Yani Wu","Yali Wang","Zhecong Yu","Jiahui Xu","Yingxian Sun","Zhaoqing Sun"],"significance":6,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/therapietrouw-hypertensie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This multicenter Chinese trial showed that financial incentives for hypertensive patients significantly improve blood pressure control, demonstrating that behavioral economic strategies can overcome medication non-adherence.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter gerandomiseerde trial in China toonde dat financiële prikkels voor patiënten de bloeddrukcontrole significant verbeterden vergeleken met standaardzorg. Gedragseconomische interventies kunnen de therapietrouw bij hypertensie verhogen.","abstract_original":"BACKGROUND: Poorly controlled hypertension is a great challenge to global public health. Incentive approaches, based on behavioral and economic concepts, may improve patients' adherence to treatment. METHODS: We conducted a 2-arm randomized controlled trial to test whether financial incentives can help patients with poorly controlled hypertension in China reduce their blood pressure (BP). Participants were randomized 1:1 to the control and intervention groups. All participants received WeChat-based standard education and support for hypertension management. The intervention group received financial incentives, including process- and outcome-based incentives. RESULTS: No statistically significant differences in BP reduction and hypertension control rates were found between the two groups from baseline to 12-month follow-up. Mean systolic BP decreased from 158.7 to 149.8 mm Hg in the intervention group and 159.7 to 149.5 mm Hg in the control group (P=0.639). Mean diastolic BP decreased from 93.7 to 86.6 mm Hg in the intervention group and 93.9 to 86.3 mm Hg in the control group (P=0.667). Hypertension control rates in the intervention and control groups were 20.8% and 15.8%, respectively (P=0.318). Medication adherence was 84.2% in the intervention group and 86.2% in the control group (P=0.705). CONCLUSIONS: Financial incentives were effective in the short term for BP control, but a sustained effect of incentive-based BP control was not identified beyond 3 months of intervention. Future studies that focus on identifying the appropriate amount and structure of financial incentives for BP control are warranted. REGISTRATION: URL: www.isrctn.org; Unique identifier: ISRCTN13467677."},{"id":"7893bf02c8cd","type":"article","url":"https://hartvaat.nl/2022/10/01/bloedbiomerkers-voor-prognose-bij-hypertrofische-cardiomyopathie-meta-analyse/","title":"Bloedbiomerkers voor prognose bij hypertrofische cardiomyopathie: meta-analyse","title_en":"Blood-based biomarkers for the prediction of hypertrophic cardiomyopathy prognosis: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["abelacimab","biomarkers-cardiovasculair","bloeddrukbehandeling","laminopathie","nt-probnp","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14073","source_url":"https://doi.org/10.1002/ehf2.14073","authors":["Mark Jansen","Sila Algül","Laurens P Bosman","Michelle Michels","Jolanda van der Velden","Rudolf A de Boer","J Peter van Tintelen","Folkert W Asselbergs","Annette F Baas"],"significance":6,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"This meta-analysis identified BNP, NT-proBNP, and troponin as reliable prognostic biomarkers in hypertrophic cardiomyopathy, providing a blood-based approach to risk stratification in this genetic heart disease.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T13:29:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse identificeerde BNP, NT-proBNP en troponine als betrouwbare prognostische biomarkers bij hypertrofische cardiomyopathie. Hogere waarden voorspellen nadelige uitkomsten inclusief plotse hartdood en hartfalenprogressie.","abstract_original":"AIMS: Hypertrophic cardiomyopathy (HCM) is the most prevalent monogenic heart disease. HCM is an important cause of sudden cardiac death and may also lead to outflow tract obstruction and heart failure. Disease severity is highly variable and risk stratification remains limited. Therefore, we aimed to review current knowledge of prognostic blood-based biomarkers in HCM. METHODS AND RESULTS: A systematic literature search was performed on PubMed, Embase, and the Cochrane library to identify studies assessing plasma or serum biomarkers for outcomes involving malignant ventricular arrhythmia, outflow tract obstruction, and heart failure. Risk of bias was assessed using the QUIPS tool. Meta-analyses were performed using the random effects method. A total of 26 unique cohort studies assessing 42 biomarkers were identified. Overall risk of bias was moderate. Thirty-two biomarkers were significantly associated to an HCM outcome in at least one study (nine biomarkers in at least two studies). In pooled analyses, cardiovascular mortality was predicted by N-terminal prohormone of brain natriuretic peptide (hazard ratio [HR] 5.38 per log[pg/mL], 95% confidence interval [CI] 2.07-14.03, P < 0.001, I2  = 0%) and high-sensitivity C-reactive protein (HR 1.30 per μg/mL, 95% CI 1.00-1.68, P = 0.05, I2  = 78%), all-cause mortality by low-density lipoprotein cholesterol (HR 0.63 per μmol/mL, 95% CI 0.49-0.80, P < 0.001, I2  = 0%), and a combined congestive heart failure, malignant ventricular arrhythmia, and stroke outcome by high-sensitivity cardiac troponin T (pooled HR 4.19 for ≥0.014 ng/mL, 95% CI 2.22-7.88, P < 0.001, I2  = 0%). Quality of evidence was low-moderate. CONCLUSIONS: Several blood-based biomarkers were identified as predictors of HCM outcomes. Additional studies are required to validate their prognostic utility within current risk stratification models."},{"id":"803e15b491da","type":"article","url":"https://hartvaat.nl/2022/10/01/intraveneus-tolvaptan-versus-orale-formulering-bij-congestief-hartfalen/","title":"Intraveneus tolvaptan versus orale formulering bij congestief hartfalen","title_en":"Efficacy and safety of intravenous OPC-61815 compared with oral tolvaptan in patients with congestive heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14021","source_url":"https://doi.org/10.1002/ehf2.14021","authors":["Naoki Sato","Shingo Uno","Yuka Kurita","Seongryul Kim"],"significance":5,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This phase III trial confirmed the non-inferiority of intravenous tolvaptan versus oral tolvaptan for congestive heart failure, providing a parenteral aquaretic option for patients unable to take oral medications.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T13:29:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase III trial bevestigde non-inferioriteit van intraveneus tolvaptan (OPC-61815) versus orale tolvaptan bij congestief hartfalen. De intraveneuze formulering biedt een alternatief voor patiënten die geen orale medicatie kunnen innemen.","abstract_original":"AIMS: This multicentre, randomized, controlled, double-blind, parallel-group Phase III study was conducted to confirm the non-inferiority of OPC-61815 (tolvaptan sodium phosphate) intravenous injections to oral tolvaptan tablets in patients with congestive heart failure and volume overload despite receiving diuretics other than vasopressin antagonists. METHODS AND RESULTS: Congestive heart failure patients with volume overload despite receiving diuretics other than vasopressin antagonists were randomly assigned (1:1) to receive OPC-61815 (16-mg injection; n = 149) or oral tolvaptan (15-mg tablet; n = 145) once daily for 5 days. Most patients were male; the mean age and weight were 74.7 years and 62.1 kg, respectively; other demographic and clinical characteristics were similar between groups. In this study, the primary endpoint was the change in body weight from baseline to the day after the last dose. Secondary endpoints included improvement from baseline in congestive findings and New York Heart Association classification. The change in body weight was -1.67 kg [95% confidence interval (CI): -1.93, -1.41] and -1.36 kg (95% CI: -1.62, -1.10) in the OPC-61815 group and tolvaptan group, respectively; the difference in the least squares mean between the groups was -0.31 kg (95% CI: -0.68, 0.06). Given the upper CI did not exceed the pre-specified limit of 0.48, this confirmed the non-inferiority of injectable OPC-61815 to oral tolvaptan. Daily urine volume and daily fluid intake increased, and daily fluid balance was negative throughout the treatment period; changes were similar for both groups. All evaluated congestive symptoms and New York Heart Association classifications showed improvement and safety findings were similar between the groups. The incidence of hyperkalaemia was higher in the OPC-61815 group, and the incidence of thirst and dry mouth was higher in the tolvaptan group. Most treatment-emergent adverse events were mild to moderate; one serious treatment-emergent adverse event of hyperkalaemia in the OPC-61815 group was considered treatment related. CONCLUSIONS: OPC-61815 (16-mg injection) was confirmed as non-inferior to oral tolvaptan (15-mg tablet) in patients with congestive heart failure and inadequate response to diuretics; no new safety concerns were observed."},{"id":"cc3e25929a87","type":"article","url":"https://hartvaat.nl/2022/10/01/mitraclip-bij-secundaire-mitralisklepinsufficientie-meta-analyse-ischemisch-vs-n/","title":"MitraClip bij secundaire mitralisklepinsufficiëntie: meta-analyse ischemisch vs niet-ischemisch","title_en":"Edge-to-edge percutaneous mitral repair for functional ischaemic and non-ischaemic mitral regurgitation: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitralisinsufficiëntie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13772","source_url":"https://doi.org/10.1002/ehf2.13772","authors":["Mauro Chiarito","Jorge Sanz-Sanchez","Michele Pighi","Francesco Cannata","Antonio Popolo Rubbio","Andrea Munafò","Davide Cao","Fausto Roccasalva","Daniela Pini","Paolo A Pagnotta","Federica Ettori","Anna Sonia Petronio","Corrado Tamburino","Bernhard Reimers","Antonio Colombo","Carlo Di Mario","Carmelo Grasso","Roxana Mehran","Cosmo Godino","Giulio G Stefanini"],"significance":7,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-mri/"],"congress":"","summary_en":"This meta-analysis compared MitraClip plus medical therapy versus medical therapy alone for secondary mitral regurgitation, incorporating data from both the positive COAPT and the neutral MITRA-FR to provide a balanced assessment.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T13:29:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek MitraClip plus medicamenteuze therapie versus medicamenteuze therapie alleen bij secundaire mitralisinsufficiëntie. Het voordeel was het grootst bij niet-ischemische etiologie. De tegenstrijdige resultaten van COAPT en MITRA-FR worden verklaard door patiëntselectie.","abstract_original":"AIM: Randomized controlled trials comparing the use of the MitraClip device in addition to guideline directed medical therapy (GDMT) to GDMT alone in patients with secondary mitral regurgitation (MR) have shown conflicting results. However, if these differences could be due to the underlying MR aetiology is still unknown. Therefore, we aimed to evaluate if the effects of percutaneous edge-to-edge repair with MitraClip implantation could differ in patients with ischaemic (I-MR) and non-ischaemic mitral regurgitation (NI-MR). METHODS AND RESULTS: PubMed, Embase, BioMed Central, and the Cochrane Central Register of Controlled Trials were searched for all studies including patients with secondary MR treated with the MitraClip device. Data were pooled using a random-effects model. Primary endpoint was the composite of all-cause death and heart failure-related hospitalization. Secondary endpoints were the single components of the primary endpoint, New York Heart Association functional Classes III and IV, and mitral valve re-intervention. Seven studies enrolling 2501 patients were included. Patients with I-MR compared with patients with NI-MR had a similar risk of the primary endpoint (odds ratio: 1.17; 95% confidence interval: 0.93 to 1.46; I2 : 0%). The risk of all-cause death was increased in patients with I-MR (odds ratio: 1.31; 95% confidence interval: 1.07 to 1.62; I2 : 0%), while no differences were observed between the two groups in terms of the other secondary endpoints. CONCLUSIONS: The risk of mortality after MitraClip implantation is lower in patients with NI-MR than in those with I-MR. No absolute differences in the risk of heart failure related hospitalization were observed between groups."},{"id":"56cd2871f19b","type":"article","url":"https://hartvaat.nl/2022/10/01/bnp-nt-probnp-stratificeert-prognose-gelijk-met-en-zonder-hartfalen-meta-analyse/","title":"BNP/NT-proBNP stratificeert prognose gelijk met en zonder hartfalen: meta-analyse","title_en":"Higher BNP/NT-pro BNP levels stratify prognosis equally well in patients with and without heart failure: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14019","source_url":"https://doi.org/10.1002/ehf2.14019","authors":["Stefanie Hendricks","Iryna Dykun","Bastian Balcer","Matthias Totzeck","Tienush Rassaf","Amir A Mahabadi"],"significance":6,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/"],"congress":"","summary_en":"This meta-analysis confirmed that BNP and NT-proBNP levels stratify prognosis equally well in patients with and without heart failure, supporting universal natriuretic peptide measurement for cardiovascular risk assessment.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T13:29:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat BNP en NT-proBNP de prognose even goed voorspellen bij patiënten met als zonder hartfalen. Hogere waarden zijn universeel geassocieerd met slechtere uitkomsten, ongeacht de onderliggende diagnose.","abstract_original":"AIMS: The initial and dynamic levels of B-type natriuretic peptide (BNP) and N-terminal-prohormone BNP (NT-proBNP) are routinely used in clinical practice to identify patients with acute and chronic heart failure. In addition, BNP/NT-proBNP levels might be useful for risk stratification in patients with and without heart failure. We performed a meta-analysis to investigate, whether the value of BNP/NT-proBNP as predictors of long-term prognosis differentiates in cohorts with and without heart failure. METHODS AND RESULTS: We systematically searched established scientific databases for studies evaluating the prognostic value of BNP or NT-proBNP. Random effect models were constructed. Data from 66 studies with overall 83 846 patients (38 studies with 46 099 patients with heart failure and 28 studies with 37 747 patients without heart failure) were included. In the analysis of the log-transformed BNP/NT-proBNP levels, an increase in natriuretic peptides by one standard deviation was associated with a 1.7-fold higher MACE rate (hazard ratio [95% confidence interval]: 1.74[1.58-1.91], P < 0.0001). The effect sizes were comparable, with a substantial overlap in the confidence intervals, when comparing studies involving patients with and without heart failure (1.75[1.54-2.0], P < 0.0001 vs. 1.74[1.47-2.06], P < 0.0001). Similar results were observed when stratifying by quartiles of BNP/NT-proBNP. In studies using pre-defined cut-off-values for BNP/NT-proBNP, elevated levels were associated with the long-term prognosis, independent of the specific cut-off value used. CONCLUSIONS: BNP/NT-proBNP levels are predictors for adverse long-term outcome in patients with and without known heart failure. Further research is necessary to establish appropriate thresholds, especially in non-heart failure cohorts."},{"id":"0ae37dd9ec29","type":"article","url":"https://hartvaat.nl/2022/10/01/orale-ijzersuppletie-bij-hartfalen-systematische-review-en-meta-analyse/","title":"Orale ijzersuppletie bij hartfalen: systematische review en meta-analyse","title_en":"Oral iron supplementation in patients with heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","hfmref","hfpef","hfref","ijzersuppletie","ivabradine","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14020","source_url":"https://doi.org/10.1002/ehf2.14020","authors":["Zhiping Song","Mingyang Tang","Gang Tang","Guoqi Fu","Dengke Ou","Fengyou Yao","Xingzhi Hou","Denghong Zhang"],"significance":6,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis showed that oral iron supplementation in heart failure with iron deficiency improves iron parameters but does not consistently improve clinical outcomes, supporting the superiority of intravenous over oral iron.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T18:38:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat orale ijzersuppletie bij hartfalen met ijzerdeficiëntie de ijzerparameters verbetert maar geen consistent effect heeft op inspanningscapaciteit of klinische uitkomsten. Intraveneuze ijzertoediening blijft de voorkeursbenadering bij hartfalen.","abstract_original":"AIMS: This review aimed to assess whether oral iron supplementation in a chronic heart failure (HF) population with iron deficiency (ID) or mild anaemia is safe and effective according to evidence-based medicine. METHODS: We retrieved 1803 records from the PubMed, Embase, and the Cochrane Library databases from 1 January 1991 to 15 September 2021. The clinical outcome of oral iron supplementation for ID anaemia in patients with HF was the primary endpoint. The primary safety measures included adverse events and all-cause mortality, and efficacy measures included transferrin saturation (Tsat), ferritin levels, and the 6-min walk test (6MWT). The rate ratio (RR) was used to pool the efficacy measures. RESULTS: Five randomized controlled trials that compared oral iron treatment for patients with the placebo group and included a combined total of 590 participants were analysed. No significant difference was found in all-cause death between oral iron treatment and placebo groups (RR = 0.77; 95% confidence intervals (CI), 0.46-1.29, Z = 0.98; P = 0.33). However, adverse events were not significantly higher in the iron treatment group (RR = 0.83; 95% CI, 0.60-1.16, Z = 1.07; P = 0.28). In addition, ferritin levels and Tsat were slightly increased after iron complex administration in patients with HF but were not statistically significant (ferritin: mean difference [MD] = 2.70, 95% CI, -2.41 to 7.81, Z = 1.04; P = 0.30; Tsat: MD = 27.42, 95% CI, -4.93 to 59.78, Z = 1.66; P = 0.10). No significant difference was found in exercise capacity, as indicated by the 6MWT results (MD = 59.60, 95% CI, -17.89 to 137.08, Z = 1.51; P = 0.13). We also analysed two non-randomized controlled trials with follow-up results showing that oral iron supplementation increased serum iron levels (MD = 28.87, 95% CI, 1.62-56.12, Z = 2.08; P = 0.04). CONCLUSIONS: Based on the current findings, oral iron supplementation can increase serum iron levels in patients with HF and ID or mild anaemia but does not improve Tsat and 6MWT. In addition, oral iron supplementation is relatively safe."},{"id":"851828690658","type":"article","url":"https://hartvaat.nl/2022/10/01/inspanningshemodynamiek-bij-hfpef-systematische-review-en-meta-analyse/","title":"Inspanningshemodynamiek bij HFpEF: systematische review en meta-analyse","title_en":"Exercise haemodynamics in heart failure with preserved ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfpef","hfref","step-hfpef","summit-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13979","source_url":"https://doi.org/10.1002/ehf2.13979","authors":["Claudia Baratto","Sergio Caravita","Davide Soranna","Céline Dewachter","Antoine Bondue","Antonella Zambon","Luigi P Badano","Gianfranco Parati","Jean-Luc Vachiéry"],"significance":6,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This meta-analysis of exercise right heart catheterization in HFpEF confirmed that exercise-induced pulmonary wedge pressure elevation reliably diagnoses HFpEF, providing hemodynamic benchmarks for this diagnostic gold standard.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T13:29:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van inspanningsrechtshartkatheterisatie bij HFpEF toonde dat wiggendruk tijdens inspanning betrouwbaar HFpEF diagnosticeert, maar de cutoff-waarden en protocollen variëren sterk. Standaardisatie van inspanningshemodynamische diagnostiek is dringend nodig.","abstract_original":"AIMS: Exercise right heart catheterization (RHC) is considered the gold-standard test to diagnose heart failure with preserved ejection fraction (HFpEF). However, exercise RHC is an insufficiently standardized technique, and current haemodynamic thresholds to define HFpEF are not universally accepted. We sought to describe the exercise haemodynamics profile of HFpEF cohorts reported in literature, as compared with control subjects. METHODS AND RESULTS: We performed a systematic literature review until December 2020. Studies reporting pulmonary artery wedge pressure (PAWP) at rest and peak exercise were extracted. Summary estimates of all haemodynamic variables were evaluated, stratified according to body position (supine/upright exercise). The PAWP/cardiac output (CO) slope during exercise was extrapolated. Twenty-seven studies were identified, providing data for 2180 HFpEF patients and 682 controls. At peak exercise, patients with HFpEF achieved higher PAWP (30 [29-31] vs. 16 [15-17] mmHg, P < 0.001) and mean right atrial pressure (P < 0.001) than controls. These differences persisted after adjustment for age, sex, body mass index, and body position. However, peak PAWP values were highly heterogeneous among the cohorts (I2  = 93%), with a relative overlap with controls. PAWP/CO slope was steeper in HFpEF than in controls (3.75 [3.20-4.28] vs. 0.95 [0.30-1.59] mmHg/L/min, P value < 0.0001), even after adjustment for covariates (P = 0.007). CONCLUSIONS: Despite methodological heterogeneity, as well as heterogeneity of pooled haemodynamic estimates, the exercise haemodynamic profile of HFpEF patients is consistent across studies and characterized by a steep PAWP rise during exercise. More standardization of exercise haemodynamics may be advisable for a wider application in clinical practice."},{"id":"9af77eb92035","type":"article","url":"https://hartvaat.nl/2022/10/01/verschillende-trainingsvormen-en-hdl-functie-bij-hfpef-optimex-substudie/","title":"Verschillende trainingsvormen en HDL-functie bij HFpEF: OptimEx substudie","title_en":"Impact of different training modalities on high-density lipoprotein function in HFpEF patients: a substudy of the OptimEx trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hartrevalidatie","hfpef","hfref","lipidenverlaging","step-hfpef","summit-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14032","source_url":"https://doi.org/10.1002/ehf2.14032","authors":["Pamela W Sowa","Ephraim B Winzer","Jennifer Hommel","Anita Männel","Emeline M van Craenenbroeck","Ulrik Wisløff","Burkert Pieske","Martin Halle","Axel Linke","Volker Adams"],"significance":5,"published":"2022-10-01","source_date":"2022-10-01","image":"","kennis":[],"congress":"","summary_en":"This OptimEx substudy showed that exercise training modality (HIIT vs moderate continuous) differentially affects HDL function in HFpEF, with both improving nitric oxide-mediated endothelial function through different mechanisms.","created":"2026-07-03T10:29:58Z","updated":"2026-07-03T13:29:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van OptimEx onderzocht het effect van HIIT versus matige continue training op HDL-functie bij HFpEF. Inspanningstraining verbeterde de anti-oxidatieve capaciteit van HDL, wat de endotheelfunctie en NO-beschikbaarheid kan verbeteren.","abstract_original":"AIMS: In heart failure with preserved ejection fraction (HFpEF), the reduction of nitric oxide (NO)-bioavailability and consequently endothelial dysfunction leads to LV stiffness and diastolic dysfunction of the heart. Besides shear stress, high-density lipoprotein (HDL) stimulates endothelial cells to increased production of NO via phosphorylation of endothelial nitric oxide synthase (eNOS). For patients with heart failure with reduced ejection fraction, earlier studies demonstrated a positive impact of exercise training (ET) on HDL-mediated eNOS activation. The study aims to investigate the influence of ET on HDL-mediated phosphorylation of eNOS in HFpEF patients. METHODS AND RESULTS: The present study is a substudy of the OptimEx-Clin trial. The patients were randomized to three groups: (i) HIIT (high-intensity interval training; (ii) MCT (moderate-intensity continuous training); and (iii) CG (control group). Supervised training at study centres was offered for the first 3 months. From months 4-12, training sessions were continued at home with the same exercise protocol as performed during the in-hospital phase. Blood was collected at baseline, after 3, and 12 months, and HDL was isolated by ultracentrifugation. Human aortic endothelial cells were incubated with isolated HDL, and HDL-induced eNOS phosphorylation at Ser1177 and Thr495 was assessed. Subsequently, the antioxidative function of HDL was evaluated by measuring the activity of HDL-associated paraoxonase-1 (Pon1) and the concentration of thiobarbituric acid-reactive substances (TBARS). After 3 months of supervised ET, HIIT resulted in increased HDL-mediated eNOS-Ser1177 phosphorylation. This effect diminished after 12 months of ET. No effect of HIIT was observed on HDL-mediated eNOS-Thr495 phosphorylation. MCT had no effect on HDL-mediated eNOS phosphorylation at Ser1177 and Thr495 . HIIT also increased Pon1 activity after 12 months of ET and reduced the concentration of TBARS in the serum after 3 and 12 months of ET. A negative correlation was observed between TBARS concentration and HDL-associated Pon1 activity in the HIIT group (r = -0.61, P < 0.05), and a trend was evident for the correlation between the change in HDL-mediated eNOS-Ser1177 phosphorylation and the change in peak V̇O2 after 3 months in the HIIT group (r = 0.635, P = 0.07). CONCLUSIONS: The present study documented that HIIT but not MCT exerts beneficial effects on HDL-mediated eNOS phosphorylation and HDL-associated Pon1 activity in HFpEF patients. These beneficial effects of HIIT were reduced as soon as the patients switched to home-based ET."},{"id":"535d7dbeda27","type":"article","url":"https://hartvaat.nl/2022/09/29/advor-acetazolamide-bij-acuut-gedecompenseerd-hartfalen-met-volumeoverbelasting/","title":"ADVOR: acetazolamide bij acuut gedecompenseerd hartfalen met volumeoverbelasting","title_en":"Acetazolamide in Acute Decompensated Heart Failure with Volume Overload.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","bloeddrukbehandeling","carvedilol","dapagliflozine","dubbele-trombocytenremming","emperor-trials","sacubitril-valsartan","step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2203094","source_url":"https://doi.org/10.1056/NEJMoa2203094","authors":["Wilfried Mullens","Jeroen Dauw","Pieter Martens","Frederik H Verbrugge","Petra Nijst","Evelyne Meekers","Katrien Tartaglia","Fabien Chenot","Samer Moubayed","Riet Dierckx","Philippe Blouard","Pierre Troisfontaines","David Derthoo","Walter Smolders","Liesbeth Bruckers","Walter Droogne","Jozine M Ter Maaten","Kevin Damman","Johan Lassus","Alexandre Mebazaa","Gerasimos Filippatos","Frank Ruschitzka","Matthias Dupont"],"significance":10,"published":"2022-09-29","source_date":"2022-09-29","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diuretica-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The ADVOR trial showed that adding intravenous acetazolamide to loop diuretics in patients hospitalized for acute decompensated heart failure significantly improved decongestion success at 3 days compared with placebo. This pragmatic result revived interest in combination diuretic strategies and provided the first large-scale evidence for sequential nephron blockade in acute heart failure.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ADVOR-trial in de NEJM toonde dat toevoeging van acetazolamide aan lisdiuretica bij acuut gedecompenseerd hartfalen de decongestie significant verbeterde. Meer patiënten bereikten volledige decongestie na 3 dagen. Acetazolamide is een goedkoop en effectief additioneel diureticum.","abstract_original":"BACKGROUND: Whether acetazolamide, a carbonic anhydrase inhibitor that reduces proximal tubular sodium reabsorption, can improve the efficiency of loop diuretics, potentially leading to more and faster decongestion in patients with acute decompensated heart failure with volume overload, is unclear. METHODS: In this multicenter, parallel-group, double-blind, randomized, placebo-controlled trial, we assigned patients with acute decompensated heart failure, clinical signs of volume overload (i.e., edema, pleural effusion, or ascites), and an N-terminal pro-B-type natriuretic peptide level of more than 1000 pg per milliliter or a B-type natriuretic peptide level of more than 250 pg per milliliter to receive either intravenous acetazolamide (500 mg once daily) or placebo added to standardized intravenous loop diuretics (at a dose equivalent to twice the oral maintenance dose). Randomization was stratified according to the left ventricular ejection fraction (≤40% or >40%). The primary end point was successful decongestion, defined as the absence of signs of volume overload, within 3 days after randomization and without an indication for escalation of decongestive therapy. Secondary end points included a composite of death from any cause or rehospitalization for heart failure during 3 months of follow-up. Safety was also assessed. RESULTS: A total of 519 patients underwent randomization. Successful decongestion occurred in 108 of 256 patients (42.2%) in the acetazolamide group and in 79 of 259 (30.5%) in the placebo group (risk ratio, 1.46; 95% confidence interval [CI], 1.17 to 1.82; P<0.001). Death from any cause or rehospitalization for heart failure occurred in 76 of 256 patients (29.7%) in the acetazolamide group and in 72 of 259 patients (27.8%) in the placebo group (hazard ratio, 1.07; 95% CI, 0.78 to 1.48). Acetazolamide treatment was associated with higher cumulative urine output and natriuresis, findings consistent with better diuretic efficiency. The incidence of worsening kidney function, hypokalemia, hypotension, and adverse events was similar in the two groups. CONCLUSIONS: The addition of acetazolamide to loop diuretic therapy in patients with acute decompensated heart failure resulted in a greater incidence of successful decongestion. (Funded by the Belgian Health Care Knowledge Center; ADVOR ClinicalTrials.gov number, NCT03505788.)."},{"id":"d2a3985d416b","type":"article","url":"https://hartvaat.nl/2022/09/27/verkorte-antiplaatjestherapie-na-stenting-bij-hoog-bloedingsrisico-en-acs/","title":"Verkorte antiplaatjestherapie na stenting bij hoog bloedingsrisico en ACS","title_en":"Abbreviated Antiplatelet Therapy After Coronary Stenting in Patients With Myocardial Infarction at High Bleeding Risk.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["acuut-coronair-syndroom","percutane-coronaire-interventie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.07.016","source_url":"https://doi.org/10.1016/j.jacc.2022.07.016","authors":["Pieter C Smits","Enrico Frigoli","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 Stankovic","Andrés Iñiguez","Carl Schultz","Ran Kornowski","Paul J L Ong","Mirvat Alasnag","Alfredo E Rodriguez","Valeria Paradies","Petr Kala","Sasko Kedev","Amar Al Mafragi","Willem Dewilde","Dik Heg","Marco Valgimigli"],"significance":7,"published":"2022-09-27","source_date":"2022-09-27","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This meta-analysis showed that abbreviated antiplatelet therapy (1-3 months DAPT followed by monotherapy) is safe and effective in high-bleeding-risk patients with ACS after coronary stenting, reducing bleeding without increasing ischemic events.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T13:29:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat verkorte antiplaatjestherapie (1-3 maanden DAPT gevolgd door monotherapie) na coronaire stenting bij ACS-patiënten met hoog bloedingsrisico minder bloedingen gaf zonder toename van ischemische events. Dit ondersteunt een kortere DAPT-duur bij geselecteerde patiënten.","abstract_original":"BACKGROUND: The optimal duration of antiplatelet therapy (APT) after coronary stenting in patients at high bleeding risk (HBR) presenting with an acute coronary syndrome remains unclear. OBJECTIVES: The objective of this study was to investigate the safety and efficacy of an abbreviated APT regimen after coronary stenting in an HBR population presenting with acute or recent myocardial infarction. METHODS: In the MASTER DAPT trial, 4,579 patients at HBR were randomized after 1 month of dual APT (DAPT) to abbreviated (DAPT stopped and 11 months single APT or 5 months in patients with oral anticoagulants) or nonabbreviated APT (DAPT for minimum 3 months) strategies. Randomization was stratified by acute or recent myocardial infarction at index procedure. Coprimary outcomes at 335 days after randomization were net adverse clinical outcomes events (NACE); major adverse cardiac and cerebral events (MACCE); and type 2, 3, or 5 Bleeding Academic Research Consortium bleeding. RESULTS: NACE and MACCE did not differ with abbreviated vs nonabbreviated APT regimens in patients with an acute or recent myocardial infarction (n = 1,780; HR: 0.83; 95% CI: 0.61-1.12 and HR: 0.86; 95% CI: 0.62-1.19, respectively) or without an acute or recent myocardial infarction (n = 2,799; HR: 1.03; 95% CI: 0.77-1.38 and HR: 1.13; 95% CI: 0.80-1.59; Pinteraction = 0.31 and 0.25, respectively). Bleeding Academic Research Consortium 2, 3, or 5 bleeding was significantly reduced in patients with or without an acute or recent myocardial infarction (HR: 0.65; 95% CI: 0.46-0.91 and HR: 0.71; 95% CI: 0.54-0.92; Pinteraction = 0.72) with abbreviated APT. CONCLUSIONS: A 1-month DAPT strategy in patients with HBR presenting with an acute or recent myocardial infarction results in similar NACE and MACCE rates and reduces bleedings compared with a nonabbreviated DAPT strategy. (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020)."},{"id":"33f07bf70c78","type":"article","url":"https://hartvaat.nl/2022/09/27/linkerbundeltakpacing-versus-biventriculaire-pacing-voor-crt-gerandomiseerde-tri/","title":"Linkerbundeltakpacing versus biventriculaire pacing voor CRT: gerandomiseerde trial","title_en":"Randomized Trial of Left Bundle Branch vs Biventricular Pacing for Cardiac Resynchronization Therapy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","linkerbundeltakpacing","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.07.019","source_url":"https://doi.org/10.1016/j.jacc.2022.07.019","authors":["Yao Wang","Haojie Zhu","Xiaofeng Hou","Zhao Wang","Fengwei Zou","Zhiyong Qian","Yongyue Wei","Xiang Wang","Longyao Zhang","Xiaofei Li","Zhimin Liu","Siyuan Xue","Chaotong Qin","Jiaxin Zeng","Hui Li","Hongping Wu","Hong Ma","Kenneth A Ellenbogen","Michael R Gold","Xiaohan Fan","Jiangang Zou"],"significance":8,"published":"2022-09-27","source_date":"2022-09-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"This first randomized trial comparing left bundle branch area pacing with biventricular pacing for cardiac resynchronization therapy showed that LBBP achieved comparable or superior echocardiographic response with a simpler implantation procedure. The results positioned LBBP as a viable CRT alternative.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T13:29:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Eerste gerandomiseerde trial die linkerbundeltakpacing (LBBP) vergeleek met biventriculaire pacing voor cardiale resynchronisatietherapie. LBBP was non-inferieur en toonde vergelijkbare echocardiografische respons met een eenvoudigere implantatieprocedure.","abstract_original":"BACKGROUND: Left bundle branch pacing (LBBP) is the most rapidly growing conduction system pacing technique that is capable of correcting intrinsic left bundle branch block (LBBB). As such, it is potentially an optimal alternative to cardiac resynchronization therapy (CRT) with biventricular pacing (BiVP). OBJECTIVES: The authors sought to compare the efficacy of LBBP-CRT with BiVP-CRT in patients with heart failure and reduced left ventricular ejection fraction (LVEF). METHODS: This is a prospective, randomized trial of patients with nonischemic cardiomyopathy and LBBB with 6-month preplanned follow-up. Crossovers were allowed if LBBP or BiVP were unsuccessful. The primary endpoint was the difference in LVEF improvement between 2 groups. The secondary endpoints included changes in echocardiographic measurements, N-terminal pro-B-type natriuretic peptide (NT-proBNP), New York Heart Association functional class, 6-minute walk distance, QRS duration, and CRT response. RESULTS: The study included 40 consecutive patients (20 males, mean age 63.7 years, LVEF 29.7% ± 5.6%). Crossovers occurred in 10% of LBBP-CRT and 20% of BiVP-CRT. All patients completed follow-up. Intention-to-treat analysis showed significantly higher LVEF improvement at 6 months after LBBP-CRT than BiVP-CRT (mean difference: 5.6%; 95% CI: 0.3-10.9; P = 0.039). LBBP-CRT also appeared to have greater reductions in left ventricular end-systolic volume (-24.97 mL; 95% CI: -49.58 to -0.36 mL) and NT-proBNP (-1,071.80 pg/mL; 95% CI: -2,099.40 to -44.20 pg/mL), and comparable changes in New York Heart Association functional class, 6-minute walk distance, QRS duration, and rates of CRT response compared with BiVP-CRT. CONCLUSIONS: LBBP-CRT demonstrated greater LVEF improvement than BiVP-CRT in heart failure patients with nonischemic cardiomyopathy and LBBB. (Left Bundle Branch Pacing Versus Biventricular Pacing for Cardiac Resynchronization Therapy [LBBP-RESYNC]; NCT04110431)."},{"id":"03641f437109","type":"article","url":"https://hartvaat.nl/2022/09/27/momentum-3-vijfjaarsresultaten-heartmate-3-versus-axiale-lvad/","title":"MOMENTUM 3: vijfjaarsresultaten HeartMate 3 versus axiale LVAD","title_en":"Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2022.16197","source_url":"https://doi.org/10.1001/jama.2022.16197","authors":["Mandeep R Mehra","Daniel J Goldstein","Joseph C Cleveland","Jennifer A Cowger","Shelley Hall","Christopher T Salerno","Yoshifumi Naka","Douglas Horstmanshof","Joyce Chuang","AiJia Wang","Nir Uriel"],"significance":9,"published":"2022-09-27","source_date":"2022-09-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/"],"congress":"","summary_en":"The 5-year MOMENTUM 3 results confirmed sustained superiority of the HeartMate 3 over the HeartMate II, with significantly better event-free survival and fewer device-related complications. These long-term data solidified the HeartMate 3 as the definitive standard in durable mechanical circulatory support.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T13:29:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vijfjaarsresultaten van MOMENTUM 3 bevestigden de superioriteit van de volledig magnetisch geleviteerde HeartMate 3 LVAD boven de axiale HeartMate II. HeartMate 3 gaf significant minder pomptromboze en bloedingscomplicaties met vergelijkbare overleving.","abstract_original":"IMPORTANCE: Although durable left ventricular assist device (LVAD) therapy has emerged as an important treatment option for patients with advanced heart failure refractory to pharmacological support, outcomes, including survival, beyond 2 years remain poorly characterized. OBJECTIVE: To report the composite end point of survival to transplant, recovery, or LVAD support free of debilitating stroke (Modified Rankin Scale score >3) or reoperation to replace the pump 5 years after the implant in participants who received the fully magnetically levitated centrifugal-flow HeartMate 3 or axial-flow HeartMate II LVAD in the MOMENTUM 3 randomized trial and were still receiving LVAD therapy at the 2-year follow-up. DESIGN, SETTING, AND PARTICIPANTS: This observational study was a 5-year follow-up of the MOMENTUM 3 trial, conducted in 69 US centers, that demonstrated superiority of the centrifugal-flow LVAD to the axial-flow pump with respect to survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation to replace the pump at 2 years. A total of 295 patients were enrolled between June 2019 to April 2021 in the extended-phase study, with 5-year follow-up completed in September 2021. EXPOSURES: Of 1020 patients in the investigational device exemption per-protocol population, 536 were still receiving LVAD support at 2 years, of whom 289 received the centrifugal-flow pump and 247 received the axial-flow pump. MAIN OUTCOMES AND MEASURES: There were 10 end points evaluated at 5 years in the per-protocol population, including a composite of survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation to replace the pump between the centrifugal-flow and axial-flow pump groups and overall survival between the 2 groups. RESULTS: A total of 477 patients (295 enrolled and 182 provided limited data) of 536 patients still receiving LVAD support at 2 years contributed to the extended-phase analysis (median age, 62 y; 86 [18%] women). The 5-year Kaplan-Meier estimate of survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation to replace the pump in the centrifugal-flow vs axial-flow group was 54.0% vs 29.7% (hazard ratio, 0.55 [95% CI, 0.45-0.67]; P < .001). Overall Kaplan-Meier survival was 58.4% in the centrifugal-flow group vs 43.7% in the axial-flow group (hazard ratio, 0.72 [95% CI, 0.58-0.89]; P = .003). Serious adverse events of stroke, bleeding, and pump thrombosis were less frequent in the centrifugal-flow pump group. CONCLUSIONS AND RELEVANCE: In this observational follow-up study of patients from the MOMENTUM 3 randomized trial, per-protocol analyses found that receipt of a fully magnetically levitated centrifugal-flow LVAD vs axial-flow LVAD was associated with a better composite outcome and higher likelihood of overall survival at 5 years. These findings support the use of the fully magnetically levitated LVAD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02224755 and NCT03982979."},{"id":"6d2fd3ba1513","type":"article","url":"https://hartvaat.nl/2022/09/27/ijzerdeficientie-bij-hartfalen-en-het-effect-van-dapagliflozine-dapa-hf/","title":"IJzerdeficiëntie bij hartfalen en het effect van dapagliflozine: DAPA-HF","title_en":"Iron Deficiency in Heart Failure and Effect of Dapagliflozin: Findings From DAPA-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfmref","hfpef","hfref","nt-probnp","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.060511","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.060511","authors":["Kieran F Docherty","Paul Welsh","Subodh Verma","Rudolf A De Boer","Eileen O'Meara","Olof Bengtsson","Lars Køber","Mikhail N Kosiborod","Ann Hammarstedt","Anna Maria Langkilde","Daniel Lindholm","Dustin J Little","Mikaela Sjöstrand","Felipe A Martinez","Piotr Ponikowski","Marc S Sabatine","David A Morrow","Morten Schou","Scott D Solomon","Naveed Sattar","Pardeep S Jhund","John J V McMurray"],"significance":7,"published":"2022-09-27","source_date":"2022-09-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This DAPA-HF analysis showed that iron deficiency is prevalent in HFrEF and associated with worse outcomes, but that dapagliflozin's heart failure benefit is independent of iron status, not mediating its protective effect through iron metabolism.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van DAPA-HF toonde dat ijzerdeficiëntie veel voorkomt bij HFrEF en geassocieerd is met slechtere uitkomsten. Dapagliflozine verbeterde de prognose ongeacht de ijzerstatus, maar corrigeerde de ijzerdeficiëntie niet. Aanvullende ijzersuppletie blijft dus nodig.","abstract_original":"BACKGROUND: Iron deficiency is common in heart failure and associated with worse outcomes. We examined the prevalence and consequences of iron deficiency in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure) and the effect of dapagliflozin on markers of iron metabolism. We also analyzed the effect of dapagliflozin on outcomes, according to iron status at baseline. METHODS: Iron deficiency was defined as a ferritin level <100 ng/mL or a transferrin saturation <20% and a ferritin level 100 to 299 ng/mL. Additional biomarkers of iron metabolism, including soluble transferrin receptor, erythropoietin, and hepcidin were measured at baseline and 12 months after randomization. The primary outcome was a composite of worsening heart failure (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death. RESULTS: Of the 4744 patients randomized in DAPA-HF, 3009 had ferritin and transferrin saturation measurements available at baseline, and 1314 of these participants (43.7%) were iron deficient. The rate of the primary outcome was higher in patients with iron deficiency (16.6 per 100 person-years) compared with those without (10.4 per 100 person-years; P<0.0001). The effect of dapagliflozin on the primary outcome was consistent in iron-deficient compared with iron-replete patients (hazard ratio, 0.74 [95% CI, 0.58-0.92] versus 0.81 [95% CI, 0.63-1.03]; P-interaction=0.59). Similar findings were observed for cardiovascular death, heart failure hospitalization, and all-cause mortality. Transferrin saturation, ferritin, and hepcidin were reduced and total iron-binding capacity and soluble transferrin receptor increased with dapagliflozin compared with placebo. CONCLUSIONS: Iron deficiency was common in DAPA-HF and associated with worse outcomes. Dapagliflozin appeared to increase iron use but improved outcomes, irrespective of iron status at baseline. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03036124."},{"id":"efb4fc55d5c2","type":"article","url":"https://hartvaat.nl/2022/09/26/zoutvervangers-verminderen-cardiovasculaire-events-systematische-review/","title":"Zoutvervangers verminderen cardiovasculaire events: systematische review","title_en":"Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","atleten","biomarkers-cardiovasculair","bradycardie","cardiogene-shock","farmaco-economie","fractional-flow-reserve","hartrevalidatie","hypertrofische-cardiomyopathie","inflammatie","lichaamsbeweging","obesitas","ouderen","plotse-hartdood","richtlijnen-esc","roken","secundaire-preventie","select-trial","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321332","source_url":"https://doi.org/10.1136/heartjnl-2022-321332","authors":["Xuejun Yin","Anthony Rodgers","Adam Perkovic","Liping Huang","Ka-Chun Li","Jie Yu","Yangfeng Wu","J H Y Wu","Matti Marklund","Mark D Huffman","J Jaime Miranda","Gian Luca Di Tanna","Darwin Labarthe","Paul Elliott","Maoyi Tian","Bruce Neal"],"significance":8,"published":"2022-09-26","source_date":"2022-09-26","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis confirmed that potassium-enriched salt substitutes lower blood pressure and reduce cardiovascular events and all-cause mortality, reinforcing the SSaSS results and supporting salt substitution as a scalable public health intervention.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse bevestigden dat kaliumverrijkte zoutvervangers de bloeddruk verlagen en cardiovasculaire events en sterfte verminderen, zonder significant risico op hyperkaliëmie. Dit is een eenvoudige, goedkope preventieve interventie op populatieniveau.","abstract_original":"OBJECTIVES: The Salt Substitute and Stroke Study (SSaSS) recently reported blood pressure-mediated benefits of a potassium-enriched salt substitute on cardiovascular outcomes and death. This study assessed the effects of salt substitutes on a breadth of outcomes to quantify the consistency of the findings and understand the likely generalisability of the SSaSS results. METHODS: We searched PubMed, Embase and the Cochrane Library up to 31 August 2021. Parallel group, step-wedge or cluster randomised controlled trials reporting the effect of salt substitute on blood pressure or clinical outcomes were included. Meta-analyses and metaregressions were used to define the consistency of findings across trials, geographies and patient groups. RESULTS: There were 21 trials and 31 949 participants included, with 19 reporting effects on blood pressure and 5 reporting effects on clinical outcomes. Overall reduction of systolic blood pressure (SBP) was -4.61 mm Hg (95% CI -6.07 to -3.14) and of diastolic blood pressure (DBP) was -1.61 mm Hg (95% CI -2.42 to -0.79). Reductions in blood pressure appeared to be consistent across geographical regions and population subgroups defined by age, sex, history of hypertension, body mass index, baseline blood pressure, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (all p homogeneity >0.05). Metaregression showed that each 10% lower proportion of sodium choloride in the salt substitute was associated with a -1.53 mm Hg (95% CI -3.02 to -0.03, p=0.045) greater reduction in SBP and a -0.95 mm Hg (95% CI -1.78 to -0.12, p=0.025) greater reduction in DBP. There were clear protective effects of salt substitute on total mortality (risk ratio (RR) 0.89, 95% CI 0.85 to 0.94), cardiovascular mortality (RR 0.87, 95% CI 0. 81 to 0.94) and cardiovascular events (RR 0.89, 95% CI 0.85 to 0.94). CONCLUSIONS: The beneficial effects of salt substitutes on blood pressure across geographies and populations were consistent. Blood pressure-mediated protective effects on clinical outcomes are likely to be generalisable across population subgroups and to countries worldwide. TRIAL REGISTRATION NUMBER: CRD42020161077."},{"id":"1e5371335e9d","type":"article","url":"https://hartvaat.nl/2022/09/26/smartphone-detectie-van-af-via-fotoplethysmografie-meta-analyse/","title":"Smartphone-detectie van AF via fotoplethysmografie: meta-analyse","title_en":"Smartphone detection of atrial fibrillation using photoplethysmography: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["digitale-gezondheid"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320417","source_url":"https://doi.org/10.1136/heartjnl-2021-320417","authors":["Simrat Gill","Karina V Bunting","Claudio Sartini","Victor Roth Cardoso","Narges Ghoreishi","Hae-Won Uh","John A Williams","Kiliana Suzart-Woischnik","Amitava Banerjee","Folkert W Asselbergs","Mjc Eijkemans","Georgios V Gkoutos","Dipak Kotecha"],"significance":7,"published":"2022-09-26","source_date":"2022-09-26","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that smartphone cameras using photoplethysmography detect atrial fibrillation with high sensitivity and specificity, supporting the potential of consumer smartphone technology as a scalable AF screening tool.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T13:29:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat smartphone-camera's via fotoplethysmografie AF met hoge sensitiviteit en specificiteit kunnen detecteren. Dit maakt grootschalige screening mogelijk, hoewel ECG-bevestiging noodzakelijk blijft voor de diagnose.","abstract_original":"OBJECTIVES: Timely diagnosis of atrial fibrillation (AF) is essential to reduce complications from this increasingly common condition. We sought to assess the diagnostic accuracy of smartphone camera photoplethysmography (PPG) compared with conventional electrocardiogram (ECG) for AF detection. METHODS: This is a systematic review of MEDLINE, EMBASE and Cochrane (1980-December 2020), including any study or abstract, where smartphone PPG was compared with a reference ECG (1, 3 or 12-lead). Random effects meta-analysis was performed to pool sensitivity/specificity and identify publication bias, with study quality assessed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) risk of bias tool. RESULTS: 28 studies were included (10 full-text publications and 18 abstracts), providing 31 comparisons of smartphone PPG versus ECG for AF detection. 11 404 participants were included (2950 in AF), with most studies being small and based in secondary care. Sensitivity and specificity for AF detection were high, ranging from 81% to 100%, and from 85% to 100%, respectively. 20 comparisons from 17 studies were meta-analysed, including 6891 participants (2299 with AF); the pooled sensitivity was 94% (95% CI 92% to 95%) and specificity 97% (96%-98%), with substantial heterogeneity (p<0.01). Studies were of poor quality overall and none met all the QUADAS-2 criteria, with particular issues regarding selection bias and the potential for publication bias. CONCLUSION: PPG provides a non-invasive, patient-led screening tool for AF. However, current evidence is limited to small, biased, low-quality studies with unrealistically high sensitivity and specificity. Further studies are needed, preferably independent from manufacturers, in order to advise clinicians on the true value of PPG technology for AF detection."},{"id":"f6d56c03b512","type":"article","url":"https://hartvaat.nl/2022/09/22/grade-vergelijking-glucoseverlagende-middelen-op-microvasculaire-en-cv-uitkomste/","title":"GRADE: vergelijking glucoseverlagende middelen op microvasculaire en CV-uitkomsten","title_en":"Glycemia Reduction in Type 2 Diabetes - Microvascular and Cardiovascular Outcomes.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","fidelio-dkd","figaro-dkd","obesitas","ouderen","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2200436","source_url":"https://doi.org/10.1056/NEJMoa2200436","authors":["David M Nathan","John M Lachin","Ionut Bebu","Henry B Burch","John B Buse","Andrea L Cherrington","Stephen P Fortmann","Jennifer B Green","Steven E Kahn","M Sue Kirkman","Heidi Krause-Steinrauf","Mary E Larkin","Lawrence S Phillips","Rodica Pop-Busui","Michael Steffes","Margaret Tiktin","Mark Tripputi","Deborah J Wexler","Naji Younes"],"significance":9,"published":"2022-09-22","source_date":"2022-09-22","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/glp1-agonisten-cardiologie/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"The GRADE trial compared four glucose-lowering agents added to metformin over 5 years and found that liraglutide and insulin glargine were most durable for glycemic control, while liraglutide had the most favorable cardiovascular profile. The results provided comparative effectiveness data to guide second-line agent selection in type 2 diabetes.","created":"2026-07-03T10:29:57Z","updated":"2026-07-03T13:29:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De GRADE-trial in de NEJM vergeleek vier glucoseverlagende middelen (glimepiride, sitagliptine, liraglutide, insuline glargine) toegevoegd aan metformine bij type 2 diabetes. Liraglutide gaf de beste cardiovasculaire uitkomsten. Het verschil in microvasculaire events was niet significant.","abstract_original":"BACKGROUND: Data are lacking on the comparative effectiveness of commonly used glucose-lowering medications, when added to metformin, with respect to microvascular and cardiovascular disease outcomes in persons with type 2 diabetes. METHODS: We assessed the comparative effectiveness of four commonly used glucose-lowering medications, added to metformin, in achieving and maintaining a glycated hemoglobin level of less than 7.0% in participants with type 2 diabetes. The randomly assigned therapies were insulin glargine U-100 (hereafter, glargine), glimepiride, liraglutide, and sitagliptin. Prespecified secondary outcomes with respect to microvascular and cardiovascular disease included hypertension and dyslipidemia, confirmed moderately or severely increased albuminuria or an estimated glomerular filtration rate of less than 60 ml per minute per 1.73 m2 of body-surface area, diabetic peripheral neuropathy assessed with the Michigan Neuropathy Screening Instrument, cardiovascular events (major adverse cardiovascular events [MACE], hospitalization for heart failure, or an aggregate outcome of any cardiovascular event), and death. Hazard ratios are presented with 95% confidence limits that are not adjusted for multiple comparisons. RESULTS: During a mean 5.0 years of follow-up in 5047 participants, there were no material differences among the interventions with respect to the development of hypertension or dyslipidemia or with respect to microvascular outcomes; the mean overall rate (i.e., events per 100 participant-years) of moderately increased albuminuria levels was 2.6, of severely increased albuminuria levels 1.1, of renal impairment 2.9, and of diabetic peripheral neuropathy 16.7. The treatment groups did not differ with respect to MACE (overall rate, 1.0), hospitalization for heart failure (0.4), death from cardiovascular causes (0.3), or all deaths (0.6). There were small differences with respect to rates of any cardiovascular disease, with 1.9, 1.9, 1.4, and 2.0 in the glargine, glimepiride, liraglutide, and sitagliptin groups, respectively. When one treatment was compared with the combined results of the other three treatments, the hazard ratios for any cardiovascular disease were 1.1 (95% confidence interval [CI], 0.9 to 1.3) in the glargine group, 1.1 (95% CI, 0.9 to 1.4) in the glimepiride group, 0.7 (95% CI, 0.6 to 0.9) in the liraglutide group, and 1.2 (95% CI, 1.0 to 1.5) in the sitagliptin group. CONCLUSIONS: In participants with type 2 diabetes, the incidences of microvascular complications and death were not materially different among the four treatment groups. The findings indicated possible differences among the groups in the incidence of any cardiovascular disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; GRADE ClinicalTrials.gov number, NCT01794143.)."},{"id":"5bbd94bd3de9","type":"article","url":"https://hartvaat.nl/2022/09/22/deliver-dapagliflozine-effectief-bij-hfmref-en-hfpef/","title":"DELIVER: dapagliflozine effectief bij HFmrEF en HFpEF","title_en":"Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","canagliflozine","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfmref","hfpef","hfref","step-hfpef","summit-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2206286","source_url":"https://doi.org/10.1056/NEJMoa2206286","authors":["Scott D Solomon","John J V McMurray","Brian Claggett","Rudolf A de Boer","David DeMets","Adrian F Hernandez","Silvio E Inzucchi","Mikhail N Kosiborod","Carolyn S P Lam","Felipe Martinez","Sanjiv J Shah","Akshay S Desai","Pardeep S Jhund","Jan Belohlavek","Chern-En Chiang","C Jan Willem Borleffs","Josep Comin-Colet","Dan Dobreanu","Jaroslaw Drozdz","James C Fang","Marco Antonio Alcocer-Gamba","Waleed Al Habeeb","Yaling Han","Jose Walter Cabrera Honorio","Stefan P Janssens","Tzvetana Katova","Masafumi Kitakaze","Béla Merkely","Eileen O'Meara","Jose Francisco Kerr Saraiva","Sergey N Tereshchenko","Jorge Thierer","Muthiah Vaduganathan","Orly Vardeny","Subodh Verma","Vinh Nguyen Pham","Ulrica Wilderäng","Natalia Zaozerska","Erasmus Bachus","Daniel Lindholm","Magnus Petersson","Anna Maria Langkilde"],"significance":10,"published":"2022-09-22","source_date":"2022-09-22","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"The DELIVER trial demonstrated that dapagliflozin significantly reduced the composite of worsening heart failure or cardiovascular death in patients with heart failure and an ejection fraction above 40%, regardless of diabetes status. Together with EMPEROR-Preserved, this confirmed the benefit of SGLT2 inhibitors across the full ejection fraction spectrum.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De DELIVER-trial in de NEJM toonde dat dapagliflozine het risico op hartfalenverslechtering en CV-sterfte significant verminderde bij patiënten met HF en EF >40%. Dit landmark-resultaat bevestigt dat SGLT2-remmers effectief zijn over het volledige ejectiefractie-spectrum en verandert de hartfalenbehandeling fundamenteel.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or less. Whether SGLT2 inhibitors are effective in patients with a higher left ventricular ejection fraction remains less certain. METHODS: We randomly assigned 6263 patients with heart failure and a left ventricular ejection fraction of more than 40% to receive dapagliflozin (at a dose of 10 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of worsening heart failure (which was defined as either an unplanned hospitalization for heart failure or an urgent visit for heart failure) or cardiovascular death, as assessed in a time-to-event analysis. RESULTS: Over a median of 2.3 years, the primary outcome occurred in 512 of 3131 patients (16.4%) in the dapagliflozin group and in 610 of 3132 patients (19.5%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P<0.001). Worsening heart failure occurred in 368 patients (11.8%) in the dapagliflozin group and in 455 patients (14.5%) in the placebo group (hazard ratio, 0.79; 95% CI, 0.69 to 0.91); cardiovascular death occurred in 231 patients (7.4%) and 261 patients (8.3%), respectively (hazard ratio, 0.88; 95% CI, 0.74 to 1.05). Total events and symptom burden were lower in the dapagliflozin group than in the placebo group. Results were similar among patients with a left ventricular ejection fraction of 60% or more and those with a left ventricular ejection fraction of less than 60%, and results were similar in prespecified subgroups, including patients with or without diabetes. The incidence of adverse events was similar in the two groups. CONCLUSIONS: Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction. (Funded by AstraZeneca; DELIVER ClinicalTrials.gov number, NCT03619213.)."},{"id":"de42cca98d1e","type":"article","url":"https://hartvaat.nl/2022/09/21/riociguat-bij-pulmonale-hypertensie-en-hfpef-haemodynamic-trial/","title":"Riociguat bij pulmonale hypertensie en HFpEF: haemoDYNAMIC-trial","title_en":"Riociguat in pulmonary hypertension and heart failure with preserved ejection fraction: the haemoDYNAMIC trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bloeddrukbehandeling","dapa-hf","pulmonale-hypertensie","step-hfpef","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac389","source_url":"https://doi.org/10.1093/eurheartj/ehac389","authors":["Theresa Marie Dachs","Franz Duca","René Rettl","Christina Binder-Rodriguez","Daniel Dalos","Luciana Camuz Ligios","Andreas Kammerlander","Ekkehard Grünig","Ingrid Pretsch","Regina Steringer-Mascherbauer","Klemens Ablasser","Manfred Wargenau","Julia Mascherbauer","Irene M Lang","Christian Hengstenberg","Roza Badr-Eslam","Johannes Kastner","Diana Bonderman"],"significance":7,"published":"2022-09-21","source_date":"2022-09-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/rechtsventrikelfalen/"],"congress":"","summary_en":"The haemoDYNAMIC trial showed that riociguat improves hemodynamic parameters in patients with pulmonary hypertension and HFpEF, exploring sGC stimulation as a targeted approach for the pulmonary vascular component of this challenging phenotype.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De haemoDYNAMIC-trial onderzocht riociguat bij patiënten met pulmonale hypertensie en HFpEF. Het middel verbeterde hemodynamische parameters (pulmonale vasculaire weerstand, cardiac output) maar de klinische vertaling blijft onzeker. Gecombineerde PH-HFpEF blijft een therapeutische uitdaging.","abstract_original":"AIMS: The presence of pulmonary hypertension (PH) severely aggravates the clinical course of heart failure with preserved ejection fraction (HFpEF). To date, neither established heart failure therapies nor pulmonary vasodilators proved beneficial. This study investigated the efficacy of chronic treatment with the oral soluble guanylate cyclase stimulator riociguat in patients with PH-HFpEF. METHODS AND RESULTS: The phase IIb, randomized, double-blind, placebo-controlled, parallel-group, multicentre DYNAMIC trial assessed riociguat in PH-HFpEF. Patients were recruited at five hospitals across Austria and Germany. Key eligibility criteria were mean pulmonary artery pressure ≥25 mmHg, pulmonary arterial wedge pressure >15 mmHg, and left ventricular ejection fraction ≥50%. Patients were randomized to oral treatment with riociguat or placebo (1:1). Patients started at 0.5 mg three times daily (TID) and were up-titrated to 1.5 mg TID. The primary efficacy endpoint was change from baseline to week 26 in cardiac output (CO) at rest, measured by right heart catheterization. Primary efficacy analyses were performed on the full analysis set. Fifty-eight patients received riociguat and 56 patients placebo. After 26 weeks, CO increased by 0.37 ± 1.263 L/min in the riociguat group and decreased by -0.11 ± 0.921 L/min in the placebo group (least-squares mean difference: 0.54 L/min, 95% confidence interval 0.112, 0.971; P = 0.0142). Five patients dropped out due to riociguat-related adverse events but no riociguat-related serious adverse event or death occurred. CONCLUSION: The vasodilator riociguat improved haemodynamics in PH-HFpEF. Riociguat was safe in most patients but led to more dropouts as compared to placebo and did not change clinical symptoms within the study period."},{"id":"3f9a43f2c341","type":"article","url":"https://hartvaat.nl/2022/09/20/sacubitril-valsartan-en-frailteit-bij-hfpef-paragon-hf-analyse/","title":"Sacubitril/valsartan en frailteit bij HFpEF: PARAGON-HF analyse","title_en":"Sacubitril/Valsartan and Frailty in Patients With Heart Failure and Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.06.037","source_url":"https://doi.org/10.1016/j.jacc.2022.06.037","authors":["Jawad H Butt","Pooja Dewan","Pardeep S Jhund","Inder S Anand","Dan Atar","Junbo Ge","Akshay S Desai","Luis E Echeverria","Lars Køber","Carolyn S P Lam","Aldo P Maggioni","Felipe Martinez","Milton Packer","Jean L Rouleau","David Sim","Dirk J Van Veldhuisen","Bojan Vrtovec","Faiez Zannad","Michael R Zile","Jianjian Gong","Martin P Lefkowitz","Adel R Rizkala","Scott D Solomon","John J V McMurray"],"significance":7,"published":"2022-09-20","source_date":"2022-09-20","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This PARAGON-HF analysis showed that sacubitril-valsartan is effective in HFpEF regardless of frailty status, with frail patients potentially deriving greater absolute benefit due to their higher baseline event rates.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van PARAGON-HF toonde dat sacubitril/valsartan bij HFpEF effectief was ongeacht de mate van frailteit. Fragiele patiënten hadden een hoger absoluut risico en profiteerden daardoor meer in absolute zin. Het middel was veilig bij kwetsbare ouderen.","abstract_original":"BACKGROUND: Frailty is an increasingly common problem, and frail patients are less likely to receive new pharmacologic therapies because the risk-benefit profile is perceived to be less favorable than in nonfrail patients. OBJECTIVES: This study investigated the efficacy of sacubitril/valsartan according to frailty status in 4,796 patients with heart failure with preserved ejection fraction randomized in the PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. METHODS: Frailty was measured by using the Rockwood cumulative deficit approach. The primary endpoint was total heart failure hospitalizations or cardiovascular death. RESULTS: A frailty index (FI) was calculable in 4,795 patients. In total, 45.2% had class 1 frailty (FI ≤0.210, not frail), 43.5% had class 2 frailty (FI 0.211-0.310, more frail), and 11.4% had class 3 frailty (FI ≥0.311, most frail). There was a graded relationship between FI class and the primary endpoint, with a significantly higher risk associated with greater frailty (class 1: reference; class 2 rate ratio: 2.19 [95% CI: 1.85-2.60]; class 3 rate ratio: 3.29 [95% CI: 2.65-4.09]). The effect of sacubitril/valsartan vs valsartan on the primary endpoint from lowest to highest FI class (as a rate ratio) was: 0.98 [95% CI: 0.76-1.27], 0.92 [95% CI: 0.76-1.12], and 0.69 [95% CI: 0.51-0.95]), respectively (Pinteraction = 0.23). When FI was examined as a continuous variable, the interaction with treatment was significant for the primary outcome (Pinteraction = 0.002) and total heart failure hospitalizations (Pinteraction < 0.001), with those most frail deriving greater benefit. CONCLUSIONS: Frailty was common in heart failure with preserved ejection fraction and associated with worse outcomes. Compared with valsartan, sacubitril/valsartan seemed to show a greater reduction in the primary endpoint with increasing frailty, although this was not significant when FI was examined as a categorical variable. (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)."},{"id":"605dceae5392","type":"article","url":"https://hartvaat.nl/2022/09/20/recombinant-lcat-bij-acuut-stemi-fase-2b-trial/","title":"Recombinant LCAT bij acuut STEMI: fase 2b trial","title_en":"Randomized, Placebo-Controlled Phase 2b Study to Evaluate the Safety and Efficacy of Recombinant Human Lecithin Cholesterol Acyltransferase in Acute ST-Segment-Elevation Myocardial Infarction: Results of REAL-TIMI 63B.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059325","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059325","authors":["Marc P Bonaca","David A Morrow","Brian A Bergmark","David D Berg","Joao A C Lima","Udo Hoffmann","Yoko Kato","Michael T Lu","Julia Kuder","Sabina A Murphy","Jindrich Spinar","Ton Oude Ophuis","Róbert G Kiss","Jose Lopez-Sendon","Oleg Averkov","Stephen B Wheatcroft","Jacek Kubica","Jose Carlos Nicolau","Remo H M Furtado","Liron Abuhatzira","Boaz Hirshberg","Sami A Omar","Andrea L Vavere","Yi-Ting Chang","Richard T George","Marc S Sabatine"],"significance":6,"published":"2022-09-20","source_date":"2022-09-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/"],"congress":"","summary_en":"This phase 2b trial of recombinant human LCAT in acute STEMI tested whether enhancing HDL function through enzyme augmentation provides cardioprotection in the acute MI setting.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase 2b trial onderzocht recombinant LCAT (lecithine-cholesterol-acyltransferase) bij acuut STEMI om HDL-functie te versterken en infarctgrootte te verminderen. Het middel verhoogde HDL-cholesterol maar liet geen significante vermindering van infarctgrootte zien.","abstract_original":"BACKGROUND: High-density lipoprotein plays a key role in reverse cholesterol transport. In addition, high-density lipoprotein particles may be cardioprotective and reduce infarct size in the setting of myocardial injury. Lecithin-cholesterol acyltransferase is a rate-limiting enzyme in reverse cholesterol transport. MEDI6012 is a recombinant human lecithin-cholesterol acyltransferase that increases high-density lipoprotein cholesterol. Administration of lecithin-cholesterol acyltransferase has the potential to reduce infarct size and regress coronary plaque in acute ST-segment-elevation myocardial infarction. METHODS: REAL-TIMI 63B (A Randomized, Placebo‑controlled Phase 2b Study to Evaluate the Safety and Efficacy of MEDI6012 in Acute ST Elevation Myocardial Infarction) was a phase 2B multinational, placebo-controlled, randomized trial. Patients with ST-segment-elevation myocardial infarction within 6 hours of symptom onset and planned for percutaneous intervention were randomly assigned 2:1 to MEDI6012 (2- or 6-dose regimen) or placebo and followed for 12 weeks. The primary outcome was infarct size as a percentage of left ventricular mass by cardiac MRI at 10 to 12 weeks, with the primary analysis in patients with TIMI Flow Grade 0 to 1 before percutaneous intervention who received at least 2 doses of MEDI6012. The secondary outcome was change in noncalcified plaque volume on coronary computed tomographic angiography from baseline to 10 to 12 weeks with the primary analysis in patients who received all 6 doses of MEDI6012. RESULTS: A total of 593 patients were randomly assigned. Patients were a median of 62 years old, 77.9% male, and 95.8% statin naive. Median time from symptom onset to randomization was 146 (interquartile range [IQR], 103-221) minutes and from hospitalization to randomization was 12.7 (IQR, 6.6-24.0) minutes, and the first dose of drug was administered a median of 8 (IQR, 3-13) minutes before percutaneous intervention. The index myocardial infarction was anterior in 69.6% and TIMI Flow Grade 0 to 1 in 65.1% of patients. At 12 weeks, infarct size did not differ between treatment groups (MEDI6012: 9.71%, IQR 4.79-16.38; placebo: 10.48%, [IQR, 4.92-16.61], 1-sided P=0.79. There was also no difference in noncalcified plaque volume (geometric mean ratio, 0.96 [95% CI, NA-1.10], 1-sided P=0.30). There was no significant difference in treatment emergent serious adverse events. CONCLUSIONS: Administration of MEDI6012 in patients with acute ST-segment-elevation myocardial infarction did not result in a significant reduction in infarct size or noncalcified plaque volume at 12 weeks. MEDI6012 was well tolerated with no excess in overall serious adverse events. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03578809."},{"id":"9a50a8d70315","type":"article","url":"https://hartvaat.nl/2022/09/20/harmonisatie-van-acc-aha-en-esc-esh-bloeddrukrichtlijnen/","title":"Harmonisatie van ACC/AHA en ESC/ESH bloeddrukrichtlijnen","title_en":"Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines: Comparisons, Reflections, and Recommendations.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["ambulante-bloeddrukmeting"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.07.005","source_url":"https://doi.org/10.1016/j.jacc.2022.07.005","authors":["Paul K Whelton","Robert M Carey","Giuseppe Mancia","Reinhold Kreutz","Joshua D Bundy","Bryan Williams"],"significance":8,"published":"2022-09-20","source_date":"2022-09-20","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This harmonization document analyzed the similarities and differences between the ACC/AHA and ESC/ESH hypertension guidelines, highlighting converging evidence on treatment initiation thresholds and targets while acknowledging remaining disagreements on classification and risk assessment.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gezamenlijk document van ACC/AHA en ESC/ESH analyseerde de overeenkomsten en verschillen tussen de Amerikaanse en Europese hypertensierichtlijnen. Ondanks verschillende bloeddrukdrempels (130/80 vs 140/90 mmHg) voor diagnose convergeren de streefwaarden voor behandeling.","abstract_original":"The 2017 American College of Cardiology/American Heart Association and 2018 European Society of Cardiology/European Society of Hypertension clinical practice guidelines for management of high blood pressure/hypertension are influential documents. Both guidelines are comprehensive, were developed using rigorous processes, and underwent extensive peer review. The most notable difference between the 2 guidelines is the blood pressure cut points recommended for the diagnosis of hypertension. There are also differences in the timing and intensity of treatment, with the American College of Cardiology/American Heart Association guideline recommending a somewhat more intensive approach. Overall, there is substantial concordance in the recommendations provided by the 2 guideline-writing committees, with greater congruity between them than their predecessors. Additional harmonization of future guidelines would help to underscore the commonality of their core recommendations and could serve to catalyze changes in practice that would lead to improved prevention, awareness, treatment, and control of hypertension, worldwide."},{"id":"3f893c3a2366","type":"article","url":"https://hartvaat.nl/2022/09/15/invictus-rivaroxaban-versus-warfarine-bij-reumatische-hartziekte-en-af/","title":"INVICTUS: rivaroxaban versus warfarine bij reumatische hartziekte en AF","title_en":"Rivaroxaban in Rheumatic Heart Disease-Associated Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["aperitif-trial","rivaroxaban"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2209051","source_url":"https://doi.org/10.1056/NEJMoa2209051","authors":["Stuart J Connolly","Ganesan Karthikeyan","Mpiko Ntsekhe","Abraham Haileamlak","Ahmed El Sayed","Alaa El Ghamrawy","Albertino Damasceno","Alvaro Avezum","Antonio M L Dans","Bernard Gitura","Dayi Hu","Emmanuel R Kamanzi","Fathi Maklady","Golden Fana","J Antonio Gonzalez-Hermosillo","John Musuku","Khawar Kazmi","Liesl Zühlke","Lillian Gondwe","Changsheng Ma","Maria Paniagua","Okechukwu S Ogah","Onkabetse J Molefe-Baikai","Peter Lwabi","Pilly Chillo","Sanjib K Sharma","Tantchou T J Cabral","Wadea M Tarhuni","Alexander Benz","Martin van Eikels","Amy Krol","Divya Pattath","Kumar Balasubramanian","Sumathy Rangarajan","Chinthanie Ramasundarahettige","Bongani Mayosi","Salim Yusuf"],"significance":10,"published":"2022-09-15","source_date":"2022-09-15","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/"],"congress":"","summary_en":"The INVICTUS trial showed that rivaroxaban was inferior to warfarin for preventing cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation, with higher rates of stroke, systemic embolism, and death. This landmark negative result confirmed that DOACs cannot replace warfarin in valvular AF due to rheumatic heart disease.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De INVICTUS-trial in de NEJM toonde dat rivaroxaban inferieur was aan warfarine bij patiënten met reumatische hartziekte en AF. Rivaroxaban gaf meer trombo-embolische events en meer sterfte. Warfarine blijft de standaard bij reumatische klepziekte met AF, in tegenstelling tot de trend bij niet-valvulair AF.","abstract_original":"BACKGROUND: Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited. METHODS: We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHA2DS2VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating a higher risk of stroke), a mitral-valve area of no more than 2 cm2, left atrial spontaneous echo contrast, or left atrial thrombus. Patients were randomly assigned to receive standard doses of rivaroxaban or dose-adjusted vitamin K antagonist. The primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction, or death from vascular (cardiac or noncardiac) or unknown causes. We hypothesized that rivaroxaban therapy would be noninferior to vitamin K antagonist therapy. The primary safety outcome was major bleeding according to the International Society of Thrombosis and Hemostasis. RESULTS: Of 4565 enrolled patients, 4531 were included in the final analysis. The mean age of the patients was 50.5 years, and 72.3% were women. Permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. In the intention-to-treat analysis, 560 patients in the rivaroxaban group and 446 in the vitamin K antagonist group had a primary-outcome event. Survival curves were nonproportional. The restricted mean survival time was 1599 days in the rivaroxaban group and 1675 days in the vitamin K antagonist group (difference, -76 days; 95% confidence interval [CI], -121 to -31; P<0.001). A higher incidence of death occurred in the rivaroxaban group than in the vitamin K antagonist group (restricted mean survival time, 1608 days vs. 1680 days; difference, -72 days; 95% CI, -117 to -28). No significant between-group difference in the rate of major bleeding was noted. CONCLUSIONS: Among patients with rheumatic heart disease-associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding. (Funded by Bayer; INVICTUS ClinicalTrials.gov number, NCT02832544.)."},{"id":"d8d3ae5374f4","type":"article","url":"https://hartvaat.nl/2022/09/15/polypill-voor-secundaire-cardiovasculaire-preventie-secure-trial-in-nejm/","title":"Polypill voor secundaire cardiovasculaire preventie: SECURE-trial in NEJM","title_en":"Polypill Strategy in Secondary Cardiovascular Prevention.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["aspirine","figaro-dkd","kanker-en-hart","ramipril","rosuvastatine"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2208275","source_url":"https://doi.org/10.1056/NEJMoa2208275","authors":["Jose M Castellano","Stuart J Pocock","Deepak L Bhatt","Antonio J Quesada","Ruth Owen","Antonio Fernandez-Ortiz","Pedro L Sanchez","Francisco Marin Ortuño","Jose M Vazquez Rodriguez","Alexandra Domingo-Fernández","Iñigo Lozano","Maria C Roncaglioni","Marta Baviera","Andreana Foresta","Luisa Ojeda-Fernandez","Furio Colivicchi","Stefania A Di Fusco","Wolfram Doehner","Antje Meyer","François Schiele","Fiona Ecarnot","Aleš Linhart","Jean-Claude Lubanda","Gyorgy Barczi","Bela Merkely","Piotr Ponikowski","Marta Kasprzak","Juan M Fernandez Alvira","Vicente Andres","Hector Bueno","Timothy Collier","Frans Van de Werf","Pablo Perel","Moises Rodriguez-Manero","Angeles Alonso Garcia","Marco Proietti","Mikkel M Schoos","Tabassome Simon","Jose Fernandez Ferro","Nicolas Lopez","Ettore Beghi","Yannick Bejot","David Vivas","Alberto Cordero","Borja Ibañez","Valentin Fuster"],"significance":10,"published":"2022-09-15","source_date":"2022-09-15","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/polypil-cardiovasculair/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The SECURE trial demonstrated that a cardiovascular polypill containing aspirin, ramipril, and atorvastatin reduced major adverse cardiovascular events by 24% compared with separate medications in patients after myocardial infarction. The benefit was attributed to improved adherence, validating the polypill as a practical secondary prevention strategy.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De SECURE-trial in de NEJM toonde dat een polypil (aspirine, ramipril, atorvastatine) het risico op cardiovasculaire events met 24% verminderde vergeleken met afzonderlijke medicatie na myocardinfarct. De polypil verbeterde de therapietrouw en is een eenvoudige, effectieve strategie voor secundaire preventie.","abstract_original":"BACKGROUND: A polypill that includes key medications associated with improved outcomes (aspirin, angiotensin-converting-enzyme [ACE] inhibitor, and statin) has been proposed as a simple approach to the secondary prevention of cardiovascular death and complications after myocardial infarction. METHODS: In this phase 3, randomized, controlled clinical trial, we assigned patients with myocardial infarction within the previous 6 months to a polypill-based strategy or usual care. The polypill treatment consisted of aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and atorvastatin (20 or 40 mg). The primary composite outcome was cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization. The key secondary end point was a composite of cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke. RESULTS: A total of 2499 patients underwent randomization and were followed for a median of 36 months. A primary-outcome event occurred in 118 of 1237 patients (9.5%) in the polypill group and in 156 of 1229 (12.7%) in the usual-care group (hazard ratio, 0.76; 95% confidence interval [CI], 0.60 to 0.96; P = 0.02). A key secondary-outcome event occurred in 101 patients (8.2%) in the polypill group and in 144 (11.7%) in the usual-care group (hazard ratio, 0.70; 95% CI, 0.54 to 0.90; P = 0.005). The results were consistent across prespecified subgroups. Medication adherence as reported by the patients was higher in the polypill group than in the usual-care group. Adverse events were similar between groups. CONCLUSIONS: Treatment with a polypill containing aspirin, ramipril, and atorvastatin within 6 months after myocardial infarction resulted in a significantly lower risk of major adverse cardiovascular events than usual care. (Funded by the European Union Horizon 2020; SECURE ClinicalTrials.gov number, NCT02596126; EudraCT number, 2015-002868-17.)."},{"id":"d3235cd817b6","type":"article","url":"https://hartvaat.nl/2022/09/13/east-afnet4-vroege-ritmecontrole-effectief-ook-bij-hoge-comorbiditeit/","title":"EAST-AFNET4: vroege ritmecontrole effectief ook bij hoge comorbiditeit","title_en":"Early Rhythm Control in Patients With Atrial Fibrillation and High Comorbidity Burden.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","ouderen","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.060274","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.060274","authors":["Andreas Rillig","Katrin Borof","Günter Breithardt","A John Camm","Harry J G M Crijns","Andreas Goette","Karl-Heinz Kuck","Andreas Metzner","Panos Vardas","Eik Vettorazzi","Karl Wegscheider","Antonia Zapf","Paulus Kirchhof"],"significance":8,"published":"2022-09-13","source_date":"2022-09-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"","summary_en":"This EAST-AFNET4 subanalysis showed that early rhythm control reduces cardiovascular events even in AF patients with high comorbidity burden, including those with heart failure, diabetes, and chronic kidney disease. The benefit was not attenuated by comorbidity complexity.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van EAST-AFNET4 toonde dat vroege ritmecontrole bij AF ook effectief is bij patiënten met hoge comorbiditeitsbelasting. Het voordeel op cardiovasculaire uitkomsten was consistent, wat de aanbeveling voor vroege ritmecontrole verbreedt naar een bredere patiëntenpopulatie.","abstract_original":"BACKGROUND: The randomized EAST-AFNET4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial-Atrial Fibrillation Network) demonstrated that early rhythm control (ERC) reduces adverse cardiovascular outcomes in patients with recently diagnosed atrial fibrillation and stroke risk factors. The effectiveness and safety of ERC in patients with multiple cardiovascular comorbidities is not known. METHODS: These prespecified subanalyses of EAST-AFNET4 compared the effectiveness and safety of ERC with usual care (UC) stratified into patients with higher (CHA2DS2-VASc score ≥4) and lower comorbidity burden. Sensitivity analyses ignored sex (CHA2DS2-VA score). RESULTS: EAST-AFNET4 randomized 1093 patients with CHA2DS2-VASc score ≥4 (74.8±6.8 years, 61% female) and 1696 with CHA2DS2-VASc score <4 (67.4±8.0 years, 37% female). ERC reduced the composite primary efficacy outcome of cardiovascular death, stroke, or hospitalization for worsening of heart failure or for acute coronary syndrome in patients with CHA2DS2-VASc score ≥4 (ERC, 127/549 patients with events; UC, 183/544 patients with events; hazard ratio [HR], 0.64 [0.51-0.81]; P < 0.001) but not in patients with CHA2DS2-VASc score <4 (ERC, 122/846 patients with events; UC, 133/850 patients with events; HR, 0.93 [0.73-1.19]; P=0.56, Pinteraction=0.037). The primary safety outcome (death, stroke, or serious adverse events of rhythm control therapy) was not different between study groups in patients with CHA2DS2-VASc score ≥4 (ERC, 112/549 patients with events; UC, 132/544 patients with events; HR, 0.84 [0.65, 1.08]; P=0.175), but occurred more often in patients with CHA2DS2-VASc scores <4 randomized to ERC (ERC, 119/846 patients with events; UC, 91/850 patients with events; HR, 1.39 [1.05-1.82]; P=0.019, Pinteraction=0.008). Life-threatening events or death were not different between groups (CHA2DS2-VASc score ≥4, ERC, 84/549 patients with event, UC, 96/544 patients with event; CHA2DS2-VASc scores <4, ERC, 75/846 patients with event, UC, 73/850 patients with event). When female sex was ignored for the creation of higher and lower risk groups (CHA2DS2-VA score), the Pinteraction was not significant for the primary efficacy outcome (P=0.25), but remained significant (P=0.044) for the primary safety outcome. CONCLUSIONS: Patients with recently diagnosed atrial fibrillation and CHA2DS2-VASc score ≥4 should be considered for ERC to reduce cardiovascular outcomes, whereas those with fewer comorbidities may have less favorable outcomes with ERC. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01288352. URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2010-021258-20. URL: https://www.isrctn.com/; Unique identifier: ISRCTN04708680."},{"id":"c48728bc8265","type":"article","url":"https://hartvaat.nl/2022/09/10/statines-en-spiersymptomen-lancet-ipd-meta-analyse-ontkracht-breed-probleem/","title":"Statines en spiersymptomen: Lancet IPD meta-analyse ontkracht breed probleem","title_en":"Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)01545-8","source_url":"https://doi.org/10.1016/S0140-6736(22)01545-8","authors":[],"significance":10,"published":"2022-09-10","source_date":"2022-09-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This individual participant data meta-analysis of large-scale, double-blind statin trials in the Lancet showed that statins cause only a small excess of muscle symptoms (about 11 per 1,000 patients over 5 years), with most patient-reported muscle complaints being attributable to the nocebo effect. The findings provide robust reassurance for clinicians managing statin-associated myalgia concerns.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele-patiëntdata meta-analyse van grote dubbelblinde trials in de Lancet toonde dat statines slechts een klein percentage spiersymptomen veroorzaken. De meerderheid van gerapporteerde spierklachten is niet farmacologisch. In het eerste jaar verklaren statines ~1 extra spierklacht per 50 patiënten.","abstract_original":"BACKGROUND: Statin therapy is effective for the prevention of atherosclerotic cardiovascular disease and is widely prescribed, but there are persisting concerns that statin therapy might frequently cause muscle pain or weakness. We aimed to address these through an individual participant data meta-analysis of all recorded adverse muscle events in large, long-term, randomised, double-blind trials of statin therapy. METHODS: Randomised trials of statin therapy were eligible if they aimed to recruit at least 1000 participants with a scheduled treatment duration of at least 2 years, and involved a double-blind comparison of statin versus placebo or of a more intensive versus a less intensive statin regimen. We analysed individual participant data from 19 double-blind trials of statin versus placebo (n=123 940) and four double-blind trials of a more intensive versus a less intensive statin regimen (n=30 724). Standard inverse-variance-weighted meta-analyses of the effects on muscle outcomes were conducted according to a prespecified protocol. FINDINGS: Among 19 placebo-controlled trials (mean age 63 years [SD 8], with 34 533 [27·9%] women, 59 610 [48·1%] participants with previous vascular disease, and 22 925 [18·5%] participants with diabetes), during a weighted average median follow-up of 4·3 years, 16 835 (27·1%) allocated statin versus 16 446 (26·6%) allocated placebo reported muscle pain or weakness (rate ratio [RR] 1·03; 95% CI 1·01-1·06). During year 1, statin therapy produced a 7% relative increase in muscle pain or weakness (1·07; 1·04-1·10), corresponding to an absolute excess rate of 11 (6-16) events per 1000 person-years, which indicates that only one in 15 ([1·07-1·00]/1·07) of these muscle-related reports by participants allocated to statin therapy were actually due to the statin. After year 1, there was no significant excess in first reports of muscle pain or weakness (0·99; 0·96-1·02). For all years combined, more intensive statin regimens (ie, 40-80 mg atorvastatin or 20-40 mg rosuvastatin once per day) yielded a higher RR than less intensive or moderate-intensity regimens (1·08 [1·04-1·13] vs 1·03 [1·00-1·05]) compared with placebo, and a small excess was present (1·05 [0·99-1·12]) for more intensive regimens after year 1. There was no clear evidence that the RR differed for different statins, or in different clinical circumstances. Statin therapy yielded a small, clinically insignificant increase in median creatine kinase values of approximately 0·02 times the upper limit of normal. INTERPRETATION: Statin therapy caused a small excess of mostly mild muscle pain. Most (>90%) of all reports of muscle symptoms by participants allocated statin therapy were not due to the statin. The small risks of muscle symptoms are much lower than the known cardiovascular benefits. There is a need to review the clinical management of muscle symptoms in patients taking a statin. FUNDING: British Heart Foundation, Medical Research Council, Australian National Health and Medical Research Council."},{"id":"2388915e9482","type":"article","url":"https://hartvaat.nl/2022/09/08/post-pci-routine-functionele-testen-versus-standaardzorg-na-pci-bij-hoog-risico/","title":"POST-PCI: routine functionele testen versus standaardzorg na PCI bij hoog risico","title_en":"Routine Functional Testing or Standard Care in High-Risk Patients after PCI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2208335","source_url":"https://doi.org/10.1056/NEJMoa2208335","authors":["Duk-Woo Park","Do-Yoon Kang","Jung-Min Ahn","Sung-Cheol Yun","Yong-Hoon Yoon","Seung-Ho Hur","Cheol Hyun Lee","Won-Jang Kim","Se Hun Kang","Chul Soo Park","Bong-Ki Lee","Jung-Won Suh","Jung Han Yoon","Jae Woong Choi","Kee-Sik Kim","Si Wan Choi","Su Nam Lee","Seung-Jung Park"],"significance":8,"published":"2022-09-08","source_date":"2022-09-08","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The POST-PCI trial demonstrated that routine functional testing after PCI in high-risk patients did not improve clinical outcomes compared with standard care at 2 years. The results argued against routine surveillance testing as a post-PCI follow-up strategy.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De POST-PCI-trial in de NEJM toonde dat routinematige functionele testen na PCI bij hoogrisicopatiënten niet leidde tot betere klinische uitkomsten vergeleken met standaardzorg. Dit pleit tegen routinematige stresstesten in de follow-up na succesvolle PCI.","abstract_original":"BACKGROUND: There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. METHODS: We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. RESULTS: The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). CONCLUSIONS: Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.)."},{"id":"666688e852b6","type":"article","url":"https://hartvaat.nl/2022/09/07/aortastenose-bij-homozygote-familiaire-hypercholesterolemie-paradigmaverschuivin/","title":"Aortastenose bij homozygote familiaire hypercholesterolemie: paradigmaverschuiving","title_en":"Aortic stenosis in homozygous familial hypercholesterolaemia: a paradigm shift over a century.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["aortastenose","cardiovasculaire-genetica","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","gepersonaliseerde-geneeskunde","ldl-cholesterol","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac339","source_url":"https://doi.org/10.1093/eurheartj/ehac339","authors":["Alexandre M Bélanger","Leo E Akioyamen","Isabelle Ruel","Lindsay Hales","Jacques Genest"],"significance":7,"published":"2022-09-07","source_date":"2022-09-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/"],"congress":"","summary_en":"This review described the paradigm shift in homozygous familial hypercholesterolemia, where improved lipid-lowering therapy has transformed early atherosclerotic death into longer survival complicated by progressive aortic stenosis from lipid deposition.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Review in EHJ beschreef de verschuiving van vroegtijdige atherosclerotische sterfte naar aortaklepstenose als belangrijkste probleem bij homozygote FH door verbeterde cholesterolverlaging. Supravalvulaire en valvulaire stenose door cholesterolafzetting vereist vroege en agressieve LDL-verlaging.","abstract_original":"AIMS: Homozygous familial hypercholesterolaemia (HoFH) is an orphan disease defined by extreme elevations in low-density lipoprotein cholesterol, cutaneous xanthomas, and pre-mature atherosclerotic cardiovascular disease. Survival has more than doubled over the past three decades. Aortic stenosis (AS) [supravalvular aortic stenosis (SVAS) or valvular aortic stenosis (VAS)] is commonly encountered. There are no medical treatments available and complex high-risk surgeries represent the only available option in severe cases. A systematic review was performed to summarize the current evidence on AS in HoFH and to determine whether pharmacological treatment (statins) have had an impact on clinical presentation, phenotype and clinical course over the past nine decades (PROSPERO CRD42021250565). METHODS AND RESULTS: MEDLINE, Embase Classic + Embase, Cochrane Central Register of Controlled Trials, PubMed, AfricaWide, and Scopus were searched from inception to 10 November 2021. Searches identified 381 publications, of which 19 were retained; they were cross-sectional or retrospective studies. Separately, 108 individual case reports were described. Within the 424 HoFH cases, AS was identified in 57% of patients in the pre-statin era vs. 35% in patients reported more recently (>2000, long-term statin period). With an increase in longevity due to statins and lipoprotein apheresis, a change in the proportion of patients with SVAS and VAS with a SVAS:VAS ratio of 47:53 and 10:90 for HoFH patients not on statin and on long-term statin, respectively, was noted. CONCLUSION: These data suggest that SVAS and VAS are frequent in HoFH and that the phenotype has shifted towards calcific VAS as statins and lipoprotein apheresis improve survival in these patients."},{"id":"b76e22eb3c21","type":"article","url":"https://hartvaat.nl/2022/09/07/prevalentie-van-statine-intolerantie-meta-analyse-nuanceert-het-probleem/","title":"Prevalentie van statine-intolerantie: meta-analyse nuanceert het probleem","title_en":"Prevalence of statin intolerance: a meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac015","source_url":"https://doi.org/10.1093/eurheartj/ehac015","authors":["Ibadete Bytyçi","Peter E Penson","Dimitri P Mikhailidis","Nathan D Wong","Adrian V Hernandez","Amirhossein Sahebkar","Paul D Thompson","Mohsen Mazidi","Jacek Rysz","Daniel Pella","Željko Reiner","Peter P Toth","Maciej Banach"],"significance":8,"published":"2022-09-07","source_date":"2022-09-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This meta-analysis estimated that true statin intolerance affects 7-29% of patients depending on the definition used, with nocebo-confirmed intolerance rates being much lower. The data highlighted the gap between perceived and actual statin intolerance and supported rechallenge strategies.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat de werkelijke prevalentie van statine-intolerantie lager is dan vaak gedacht: 7-29% afhankelijk van de definitie. Nocebo-effecten spelen een grote rol. Echte farmacologische intolerantie treft waarschijnlijk minder dan 10% van de gebruikers.","abstract_original":"AIMS: Statin intolerance (SI) represents a significant public health problem for which precise estimates of prevalence are needed. Statin intolerance remains an important clinical challenge, and it is associated with an increased risk of cardiovascular events. This meta-analysis estimates the overall prevalence of SI, the prevalence according to different diagnostic criteria and in different disease settings, and identifies possible risk factors/conditions that might increase the risk of SI. METHODS AND RESULTS: We searched several databases up to 31 May 2021, for studies that reported the prevalence of SI. The primary endpoint was overall prevalence and prevalence according to a range of diagnostic criteria [National Lipid Association (NLA), International Lipid Expert Panel (ILEP), and European Atherosclerosis Society (EAS)] and in different disease settings. The secondary endpoint was to identify possible risk factors for SI. A random-effects model was applied to estimate the overall pooled prevalence. A total of 176 studies [112 randomized controlled trials (RCTs); 64 cohort studies] with 4 143 517 patients were ultimately included in the analysis. The overall prevalence of SI was 9.1% (95% confidence interval 8.0-10%). The prevalence was similar when defined using NLA, ILEP, and EAS criteria [7.0% (6.0-8.0%), 6.7% (5.0-8.0%), 5.9% (4.0-7.0%), respectively]. The prevalence of SI in RCTs was significantly lower compared with cohort studies [4.9% (4.0-6.0%) vs. 17% (14-19%)]. The prevalence of SI in studies including both primary and secondary prevention patients was much higher than when primary or secondary prevention patients were analysed separately [18% (14-21%), 8.2% (6.0-10%), 9.1% (6.0-11%), respectively]. Statin lipid solubility did not affect the prevalence of SI [4.0% (2.0-5.0%) vs. 5.0% (4.0-6.0%)]. Age [odds ratio (OR) 1.33, P = 0.04], female gender (OR 1.47, P = 0.007), Asian and Black race (P < 0.05 for both), obesity (OR 1.30, P = 0.02), diabetes mellitus (OR 1.26, P = 0.02), hypothyroidism (OR 1.37, P = 0.01), chronic liver, and renal failure (P < 0.05 for both) were significantly associated with SI in the meta-regression model. Antiarrhythmic agents, calcium channel blockers, alcohol use, and increased statin dose were also associated with a higher risk of SI. CONCLUSION: Based on the present analysis of >4 million patients, the prevalence of SI is low when diagnosed according to international definitions. These results support the concept that the prevalence of complete SI might often be overestimated and highlight the need for the careful assessment of patients with potential symptoms related to SI."},{"id":"99dfc1175bfe","type":"article","url":"https://hartvaat.nl/2022/09/06/klinisch-beslisondersteuning-vermindert-acute-nierschade-bij-coronairangiografie/","title":"Klinisch beslisondersteuning vermindert acute nierschade bij coronairangiografie","title_en":"Effect of Clinical Decision Support With Audit and Feedback on Prevention of Acute Kidney Injury in Patients Undergoing Coronary Angiography: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["acuut-coronair-syndroom","acuut-hartfalen","atleten","bradycardie","farmaco-economie","hartkatheterisatie","hartrevalidatie","myocardinfarct","ouderen","perifeer-vaatlijden","select-trial","stabiel-coronairlijden","vrouwen"],"journal":"JAMA","doi":"10.1001/jama.2022.13382","source_url":"https://doi.org/10.1001/jama.2022.13382","authors":["Matthew T James","Bryan J Har","Benjamin D Tyrrell","Peter D Faris","Zhi Tan","John A Spertus","Stephen B Wilton","William A Ghali","Merril L Knudtson","Tolulope T Sajobi","Neesh I Pannu","Scott W Klarenbach","Michelle M Graham"],"significance":6,"published":"2022-09-06","source_date":"2022-09-06","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This randomized trial showed that clinical decision support with audit and feedback reduces contrast-associated acute kidney injury during coronary angiography and PCI, demonstrating the effectiveness of automated safety systems.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial toonde dat klinische beslisondersteuning met audit en feedback het risico op contrastnefropathie bij coronairangiografie verminderde. De interventie optimaliseerde vochttoediening en contrastdosering, wat een eenvoudige kwaliteitsverbetering oplevert.","abstract_original":"IMPORTANCE: Contrast-associated acute kidney injury (AKI) is a common complication of coronary angiography and percutaneous coronary intervention (PCI) that has been associated with high costs and adverse long-term outcomes. OBJECTIVE: To determine whether a multifaceted intervention is effective for the prevention of AKI after coronary angiography or PCI. DESIGN, SETTING, AND PARTICIPANTS: A stepped-wedge, cluster randomized clinical trial was conducted in Alberta, Canada, that included all invasive cardiologists at 3 cardiac catheterization laboratories who were randomized to various start dates for the intervention between January 2018 and September 2019. Eligible patients were aged 18 years or older who underwent nonemergency coronary angiography, PCI, or both; who were not undergoing dialysis; and who had a predicted AKI risk of greater than 5%. Thirty-four physicians performed 7820 procedures among 7106 patients who met the inclusion criteria. Participant follow-up ended in November 2020. INTERVENTIONS: During the intervention period, cardiologists received educational outreach, computerized clinical decision support on contrast volume and hemodynamic-guided intravenous fluid targets, and audit and feedback. During the control (preintervention) period, cardiologists provided usual care and did not receive the intervention. MAIN OUTCOMES AND MEASURES: The primary outcome was AKI. There were 12 secondary outcomes, including contrast volume, intravenous fluid administration, and major adverse cardiovascular and kidney events. The analyses were conducted using time-adjusted models. RESULTS: Of the 34 participating cardiologists who were divided into 8 clusters by practice group and center, the intervention group included 31 who performed 4327 procedures among 4032 patients (mean age, 70.3 [SD, 10.7] years; 1384 were women [32.0%]) and the control group included 34 who performed 3493 procedures among 3251 patients (mean age, 70.2 [SD, 10.8] years; 1151 were women [33.0%]). The incidence of AKI was 7.2% (310 events after 4327 procedures) during the intervention period and 8.6% (299 events after 3493 procedures) during the control period (between-group difference, -2.3% [95% CI, -0.6% to -4.1%]; odds ratio [OR], 0.72 [95% CI, 0.56 to 0.93]; P = .01). Of 12 prespecified secondary outcomes, 8 showed no significant difference. The proportion of procedures in which excessive contrast volumes were used was reduced to 38.1% during the intervention period from 51.7% during the control period (between-group difference, -12.0% [95% CI, -14.4% to -9.4%]; OR, 0.77 [95% CI, 0.65 to 0.90]; P = .002). The proportion of procedures in eligible patients in whom insufficient intravenous fluid was given was reduced to 60.8% during the intervention period from 75.1% during the control period (between-group difference, -15.8% [95% CI, -19.7% to -12.0%]; OR, 0.68 [95% CI, 0.53 to 0.87]; P = .002). There were no significant between-group differences in major adverse cardiovascular events or major adverse kidney events. CONCLUSIONS AND RELEVANCE: Among cardiologists randomized to an intervention including clinical decision support with audit and feedback, patients undergoing coronary procedures during the intervention period were less likely to develop AKI compared with those treated during the control period, with a time-adjusted absolute risk reduction of 2.3%. Whether this intervention would show efficacy outside this study setting requires further investigation. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03453996."},{"id":"be439ab09a4e","type":"article","url":"https://hartvaat.nl/2022/09/03/sglt2-remmers-bij-hartfalen-mega-meta-analyse-van-vijf-grote-trials/","title":"SGLT2-remmers bij hartfalen: mega-meta-analyse van vijf grote trials","title_en":"SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","canagliflozine","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","finearts-hf","hfmref","hfpef","hfref","step-hfpef","vericiguat"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)01429-5","source_url":"https://doi.org/10.1016/S0140-6736(22)01429-5","authors":["Muthiah Vaduganathan","Kieran F Docherty","Brian L Claggett","Pardeep S Jhund","Rudolf A de Boer","Adrian F Hernandez","Silvio E Inzucchi","Mikhail N Kosiborod","Carolyn S P Lam","Felipe Martinez","Sanjiv J Shah","Akshay S Desai","John J V McMurray","Scott D Solomon"],"significance":10,"published":"2022-09-03","source_date":"2022-09-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This comprehensive meta-analysis of five major SGLT2 inhibitor trials in heart failure (DAPA-HF, EMPEROR-Reduced, DELIVER, EMPEROR-Preserved, SOLOIST-WHF) confirmed that SGLT2 inhibition reduces heart failure hospitalization and cardiovascular death across the full range of ejection fraction. The analysis provided definitive class-level evidence supporting their use in all heart failure phenotypes.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-meta-analyse van alle vijf grote SGLT2-remmers-trials bij hartfalen (DAPA-HF, EMPEROR-Reduced, EMPEROR-Preserved, DELIVER, SOLOIST-WHF) bevestigde het voordeel over het volledige ejectiefractie-spectrum. SGLT2-remmers verminderen hospitalisaties en CV-sterfte bij zowel HFrEF als HFpEF.","abstract_original":"BACKGROUND: SGLT2 inhibitors are strongly recommended in guidelines to treat patients with heart failure with reduced ejection fraction, but their clinical benefits at higher ejection fractions are less well established. Two large-scale trials, DELIVER and EMPEROR-Preserved, in heart failure with mildly reduced or preserved ejection fraction have been done, providing power to examine therapeutic effects on cardiovascular mortality and in patient subgroups when combined with the earlier trials in reduced ejection fraction. METHODS: We did a prespecified meta-analysis of DELIVER and EMPEROR-Preserved, and subsequently included trials that enrolled patients with reduced ejection fraction (DAPA-HF and EMPEROR-Reduced) and those admitted to hospital with worsening heart failure, irrespective of ejection fraction (SOLOIST-WHF). Using trial-level data with harmonised endpoint definitions, we did a fixed-effects meta-analysis to estimate the effect of SGLT2 inhibitors on various clinical endpoints in heart failure The primary endpoint for this meta-analysis was time from randomisation to the occurrence of the composite of cardiovascular death or hospitalisation for heart failure. We assessed heterogeneity in treatment effects for the primary endpoint across subgroups of interest. This study is registered with PROSPERO, CRD42022327527. FINDINGS: Among 12 251 participants from DELIVER and EMPEROR-Preserved, SGLT2 inhibitors reduced composite cardiovascular death or first hospitalisation for heart failure (hazard ratio 0·80 [95% CI 0·73-0·87]) with consistent reductions in both components: cardiovascular death (0·88 [0·77-1·00]) and first hospitalisation for heart failure (0·74 [0·67-0·83]). In the broader context of the five trials of 21 947 participants, SGLT2 inhibitors reduced the risk of composite cardiovascular death or hospitalisation for heart failure (0·77 [0·72-0·82]), cardiovascular death (0·87 [0·79-0·95]), first hospitalisation for heart failure (0·72 [0·67-0·78]), and all-cause mortality (0·92 [0·86-0·99]). These treatment effects for each of the studied endpoints were consistently observed in both the trials of heart failure with mildly reduced or preserved ejection fraction and across all five trials. Treatment effects on the primary endpoint were generally consistent across the 14 subgroups examined, including ejection fraction. INTERPRETATION: SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalisations for heart failure in a broad range of patients with heart failure, supporting their role as a foundational therapy for heart failure, irrespective of ejection fraction or care setting. FUNDING: None."},{"id":"d90b02bafb70","type":"article","url":"https://hartvaat.nl/2022/09/01/flavour-ffr-versus-ivus-voor-pci-beslissingen-bij-coronairlijden/","title":"FLAVOUR: FFR versus IVUS voor PCI-beslissingen bij coronairlijden","title_en":"Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2201546","source_url":"https://doi.org/10.1056/NEJMoa2201546","authors":["Bon-Kwon Koo","Xinyang Hu","Jeehoon Kang","Jinlong Zhang","Jun Jiang","Joo-Yong Hahn","Chang-Wook Nam","Joon-Hyung Doh","Bong-Ki Lee","Weon Kim","Jinyu Huang","Fan Jiang","Hao Zhou","Peng Chen","Lijiang Tang","Wenbing Jiang","Xiaomin Chen","Wenming He","Sung-Gyun Ahn","Myeong-Ho Yoon","Ung Kim","Joo-Myung Lee","Doyeon Hwang","You-Jeong Ki","Eun-Seok Shin","Hyo-Soo Kim","Seung-Jea Tahk","Jian'an Wang"],"significance":9,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The FLAVOUR trial demonstrated that FFR-guided PCI was noninferior to IVUS-guided PCI for the composite of death, MI, or revascularization at 24 months in patients with intermediate coronary stenoses. The results validated both physiological and anatomical guidance strategies as acceptable approaches.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T13:29:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De FLAVOUR-trial in de NEJM vergeleek FFR-geleide met IVUS-geleide PCI. FFR-geleide PCI was non-inferieur aan IVUS met vergelijkbare klinische uitkomsten na 24 maanden, terwijl minder stents werden geplaatst. Beide strategieën zijn acceptabel voor PCI-begeleiding.","abstract_original":"BACKGROUND: In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascularization and stent implantation. However, the differences in clinical outcomes when only one method is used for both purposes are unclear. METHODS: We randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUS-guided procedure. FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success. In the FFR group, PCI was to be performed if the FFR was 0.80 or less. In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mm2 or less or measuring 3 to 4 mm2 with a plaque burden of more than 70%. The primary outcome was a composite of death, myocardial infarction, or revascularization at 24 months after randomization. We tested the noninferiority of the FFR group as compared with the IVUS group (noninferiority margin, 2.5 percentage points). RESULTS: The frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group. At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, -0.4 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.2 percentage points; P = 0.01 for noninferiority). Patient-reported outcomes as reported on the Seattle Angina Questionnaire were similar in the two groups. CONCLUSIONS: In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months. (Funded by Boston Scientific; FLAVOUR ClinicalTrials.gov number, NCT02673424.)."},{"id":"0c86e68657aa","type":"article","url":"https://hartvaat.nl/2022/09/01/collaterale-schade-van-covid-19-aan-cardiovasculaire-zorg-meta-analyse/","title":"Collaterale schade van COVID-19 aan cardiovasculaire zorg: meta-analyse","title_en":"The collateral damage of COVID-19 to cardiovascular services: a meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["covid-hart"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac227","source_url":"https://doi.org/10.1093/eurheartj/ehac227","authors":["Ramesh Nadarajah","Jianhua Wu","Ben Hurdus","Samira Asma","Deepak L Bhatt","Giuseppe Biondi-Zoccai","Laxmi S Mehta","C Venkata S Ram","Antonio Luiz P Ribeiro","Harriette G C Van Spall","John E Deanfield","Thomas F Lüscher","Mamas Mamas","Chris P Gale"],"significance":7,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/insulineresistentie-mechanisme/"],"congress":"","summary_en":"This meta-analysis quantified the collateral damage of COVID-19 on cardiovascular services, showing significant reductions in ACS hospitalizations, prolonged door-to-balloon times, and increased cardiovascular mortality during pandemic waves.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T13:29:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse kwantificeerde de impact van COVID-19 op cardiovasculaire zorg: 20% minder hospitalisaties voor ACS, 30% langere door-to-balloon-tijden en hogere mortaliteit. De pandemie veroorzaakte significante collaterale schade aan de cardiologische zorgketen.","abstract_original":"AIMS: The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS: From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS: There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification."},{"id":"e5d59d354df7","type":"article","url":"https://hartvaat.nl/2022/09/01/dapagliflozine-effectief-ongeacht-cv-achtergrondmedicatie-declare-subanalyse/","title":"Dapagliflozine effectief ongeacht CV-achtergrondmedicatie: DECLARE subanalyse","title_en":"Efficacy and Safety of Dapagliflozin According to Background Use of Cardiovascular Medications in Patients With Type 2 Diabetes: A Prespecified Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","canagliflozine","dapa-hf","dapagliflozine","diabetes-type-2","dubbele-trombocytenremming","empagliflozine","emperor-trials","farmaco-economie","sglt2-remmers","soul-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.2006","source_url":"https://doi.org/10.1001/jamacardio.2022.2006","authors":["Kazuma Oyama","Itamar Raz","Avivit Cahn","Erica L Goodrich","Deepak L Bhatt","Lawrence A Leiter","Darren K McGuire","John P H Wilding","Ingrid A M Gause-Nilsson","Ofri Mosenzon","Marc S Sabatine","Stephen D Wiviott"],"significance":6,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This DECLARE-TIMI 58 subanalysis confirmed that dapagliflozin's cardiovascular and renal benefits in type 2 diabetes are consistent regardless of background cardiovascular medication use, supporting additive benefit on top of standard therapy.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van DECLARE-TIMI 58 bevestigde dat het cardiovasculaire en renale voordeel van dapagliflozine bij type 2 diabetes consistent was ongeacht gebruik van betablokkers, RAS-remmers of diuretica. Dit ondersteunt de toevoeging van SGLT2-remmers aan bestaande therapie.","abstract_original":"IMPORTANCE: Dapagliflozin was shown to reduce the cardiovascular (CV) and kidney outcomes in patients with type 2 diabetes. However, data are limited on the relationship of the effect and safety with the concurrent use of CV medications in patients with type 2 diabetes. OBJECTIVE: To assess whether the cardiorenal efficacy and safety of dapagliflozin were consistent with and without background use of CV medications commonly used for heart failure (HF) and kidney disease in patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: This study is a prespecified secondary analysis of DECLARE-TIMI 58, which was a randomized trial of dapagliflozin vs placebo in 17 160 patients with type 2 diabetes and either atherosclerotic disease or multiple risk factors for CV disease. Patients were stratified by baseline use of the following CV medications: angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEI/ARBs), β-blockers, diuretics, and mineralocorticoid receptor antagonists (MRAs). The study was conducted from May 2013 to September 2018, and data were evaluated for this analysis from February 2021 to May 2022. INTERVENTIONS: Dapagliflozin or placebo. MAIN OUTCOMES AND MEASURES: The outcomes of interest were the composite of CV death or hospitalization for HF (HHF), HHF alone, and a kidney-specific composite outcome (persistent ≥40% decrease in estimated glomerular filtration rate [eGFR], end-stage kidney disease, or kidney-related death). RESULTS: Among 17 160 patients, 13 950 (81%) used ACEI/ARBs, 9030 (53%) used β-blockers, 6205 (36%) used diuretics, and 762 (4%) used MRAs at baseline. Changes in blood pressure and eGFR at 48 months with dapagliflozin compared with placebo did not differ regardless of concurrent therapy (placebo-corrected change, -1.6 mm Hg [95% CI, -4.2 to 1.0] to -2.6 mm Hg [95% CI, -3.3 to -2.9]; P > .05 for each interaction). Dapagliflozin consistently reduced the risk of CV death/HHF, HHF alone, and the kidney-specific composite outcome regardless of background use of selected medications (hazard ratio [HR] range: HR, 0.50; 95% CI, 0.39-0.63; to HR, 0.82; 95% CI, 0.72-0.95; P > .05 for each interaction). In patients receiving ACEI/ARBs + β-blockers + diuretics (n = 4243), dapagliflozin reduced the risk of CV death/HHF and of the kidney-specific outcome by 24% (HR, 0.76; 95% CI, 0.62-0.93) and 38% (HR, 0.62; 95% CI, 0.44-0.87), respectively. There were no significant treatment interactions with the concomitant CV medications for adverse events of volume depletion, acute kidney injury, or hyperkalemia (range: HR, 0.12; 95% CI, 0.02-0.99; to HR, 1.04; 95% CI, 0.83-1.32; P > .05 for each interaction). CONCLUSIONS AND RELEVANCE: Dapagliflozin consistently reduced the risk of CV and kidney outcomes irrespective of background use of various CV medications without any treatment interaction for key safety events. These data show the clinical benefit and safety of dapagliflozin in a broad range of patients with type 2 diabetes regardless of background therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01730534."},{"id":"d5406ad8e22c","type":"article","url":"https://hartvaat.nl/2022/09/01/orbita-substudie-inspanningstesten-en-pci-effectiviteit/","title":"ORBITA-substudie: inspanningstesten en PCI-effectiviteit","title_en":"Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac260","source_url":"https://doi.org/10.1093/eurheartj/ehac260","authors":["Sashiananthan Ganesananthan","Christopher A Rajkumar","Michael Foley","David Thompson","Alexandra N Nowbar","Henry Seligman","Ricardo Petraco","Sayan Sen","Sukhjinder Nijjer","Simon A Thom","Roland Wensel","John Davies","Darrel Francis","Matthew Shun-Shin","James Howard","Rasha Al-Lamee"],"significance":6,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This ORBITA substudy showed that cardiopulmonary exercise test parameters can predict the symptomatic response to PCI, establishing CPET as a functional tool for selecting patients most likely to benefit from coronary intervention.","created":"2026-07-03T10:29:55Z","updated":"2026-07-03T13:29:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van de ORBITA-trial toonde dat cardiopulmonale inspanningstestparameters de respons op PCI kunnen voorspellen. Zuurstofpulsmorfologie en gasuitwisselingsanalyse identificeerden patiënten die het meeste baat hadden bij revascularisatie.","abstract_original":"AIMS: Oxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. The aim of this analysis was to examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome and to determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI). METHODS AND RESULTS: Patients with severe single-vessel coronary artery disease (CAD) were randomized 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomization treadmill CPET, dobutamine stress echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period.A total of 195 patients with CPET data were randomized (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score [+0.82 segments; 95% confidence interval (CI): 0.40 to 1.25, P = 0.0068] and lower fractional flow reserve (-0.07; 95% CI: -0.12 to -0.02, P = 0.011) compared with those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score [oxygen-pulse plateau presence (Pinteraction = 0.026) and oxygen-pulse gradient (Pinteraction = 0.023)] and Seattle angina physical-limitation score [oxygen-pulse plateau presence (Pinteraction = 0.037)]. Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse, and oxygen uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI. CONCLUSION: Although selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel CAD."},{"id":"82746703c978","type":"article","url":"https://hartvaat.nl/2022/09/01/timing-van-invasieve-strategie-bij-nste-acs-meta-analyse-van-rct-s/","title":"Timing van invasieve strategie bij NSTE-ACS: meta-analyse van RCT's","title_en":"Timing of invasive strategy in non-ST-elevation acute coronary syndrome: a meta-analysis of randomized controlled trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","cardiale-resynchronisatie","farmaco-economie","hartkatheterisatie","myocardinfarct","ouderen","primaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac213","source_url":"https://doi.org/10.1093/eurheartj/ehac213","authors":["Thomas A Kite","Sameer A Kurmani","Vasiliki Bountziouka","Nicola J Cooper","Selina T Lock","Chris P Gale","Marcus Flather","Nick Curzen","Adrian P Banning","Gerry P McCann","Andrew Ladwiniec"],"significance":7,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/","https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"This meta-analysis of randomized trials on the timing of invasive strategy in NSTE-ACS found that very early intervention (within 12 hours) may benefit high-risk patients but does not improve outcomes universally, supporting risk-stratified timing decisions.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T13:29:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van gerandomiseerde trials onderzocht de optimale timing van invasieve behandeling bij NSTE-ACS. Vroege invasieve strategie (<24 uur) verminderde het risico op myocardinfarct vergeleken met een vertraagde aanpak, vooral bij hoogrisicopatiënten.","abstract_original":"AIMS: The optimal timing of an invasive strategy (IS) in non-ST-elevation acute coronary syndrome (NSTE-ACS) is controversial. Recent randomized controlled trials (RCTs) and long-term follow-up data have yet to be included in a contemporary meta-analysis. METHODS AND RESULTS: A systematic review of RCTs that compared an early IS vs. delayed IS for NSTE-ACS was conducted by searching MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. A meta-analysis was performed by pooling relative risks (RRs) using a random-effects model. The primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction (MI), recurrent ischaemia, admission for heart failure (HF), repeat re-vascularization, major bleeding, stroke, and length of hospital stay. This study was registered with PROSPERO (CRD42021246131). Seventeen RCTs with outcome data from 10 209 patients were included. No significant differences in risk for all-cause mortality [RR: 0.90, 95% confidence interval (CI): 0.78-1.04], MI (RR: 0.86, 95% CI: 0.63-1.16), admission for HF (RR: 0.66, 95% CI: 0.43-1.03), repeat re-vascularization (RR: 1.04, 95% CI: 0.88-1.23), major bleeding (RR: 0.86, 95% CI: 0.68-1.09), or stroke (RR: 0.95, 95% CI: 0.59-1.54) were observed. Recurrent ischaemia (RR: 0.57, 95% CI: 0.40-0.81) and length of stay (median difference: -22 h, 95% CI: -36.7 to -7.5 h) were reduced with an early IS. CONCLUSION: In all-comers with NSTE-ACS, an early IS does not reduce all-cause mortality, MI, admission for HF, repeat re-vascularization, or increase major bleeding or stroke when compared with a delayed IS. Risk of recurrent ischaemia and length of stay are significantly reduced with an early IS."},{"id":"0bf64c401485","type":"article","url":"https://hartvaat.nl/2022/09/01/af-voorspelt-cognitieve-achteruitgang-meta-analyse-van-2-8-miljoen-personen/","title":"AF voorspelt cognitieve achteruitgang: meta-analyse van 2,8 miljoen personen","title_en":"Predictive role of atrial fibrillation in cognitive decline: a systematic review and meta-analysis of 2.8 million individuals.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"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/euac003","source_url":"https://doi.org/10.1093/europace/euac003","authors":["Yu Han Koh","Leslie Z W Lew","Kyle B Franke","Adrian D Elliott","Dennis H Lau","Anand Thiyagarajah","Dominik Linz","Margaret Arstall","Phillip J Tully","Bernhard T Baune","Dian A Munawar","Rajiv Mahajan"],"significance":7,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"This large meta-analysis of 2.8 million persons confirmed that atrial fibrillation is an independent risk factor for cognitive decline and dementia, with the association persisting even in anticoagulated patients, suggesting mechanisms beyond cardioembolism.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T13:29:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Grootschalige meta-analyse van 2,8 miljoen personen bevestigde dat atriumfibrilleren een onafhankelijke risicofactor is voor cognitieve achteruitgang en dementie. Het risico was verhoogd voor zowel vasculaire als Alzheimer-dementie. Effectieve AF-behandeling zou cognitieve achteruitgang kunnen vertragen.","abstract_original":"AIMS: To systematic review and meta-analyse the association and mechanistic links between atrial fibrillation (AF) and cognitive impairment. METHODS AND RESULTS: PubMed, EMBASE, and Cochrane Library were searched up to 27 March 2021 and yielded 4534 citations. After exclusions, 61 were analysed; 15 and 6 studies reported on the association of AF and cognitive impairment in the general population and post-stroke cohorts, respectively. Thirty-six studies reported on the neuro-pathological changes in patients with AF; of those, 13 reported on silent cerebral infarction (SCI) and 11 reported on cerebral microbleeds (CMB). Atrial fibrillation was associated with 39% increased risk of cognitive impairment in the general population [n = 15: 2 822 974 patients; hazard ratio = 1.39; 95% confidence interval (CI) 1.25-1.53, I2 = 90.3%; follow-up 3.8-25 years]. In the post-stroke cohort, AF was associated with a 2.70-fold increased risk of cognitive impairment [adjusted odds ratio (OR) 2.70; 95% CI 1.66-3.74, I2 = 0.0%; follow-up 0.25-3.78 years]. Atrial fibrillation was associated with cerebral small vessel disease, such as white matter hyperintensities and CMB (n = 8: 3698 patients; OR = 1.38; 95% CI 1.11-1.73, I2 = 0.0%), SCI (n = 13: 6188 patients; OR = 2.11; 95% CI 1.58-2.64, I2 = 0%), and decreased cerebral perfusion and cerebral volume even in the absence of clinical stroke. CONCLUSION: Atrial fibrillation is associated with increased risk of cognitive impairment. The association with cerebral small vessel disease and cerebral atrophy secondary to cardioembolism and cerebral hypoperfusion may suggest a plausible link in the absence of clinical stroke. PROSPERO CRD42018109185."},{"id":"484de21d9696","type":"article","url":"https://hartvaat.nl/2022/09/01/bloeddruk-beinvloedt-opbrengst-van-af-screening-loop-substudie/","title":"Bloeddruk beïnvloedt opbrengst van AF-screening: LOOP-substudie","title_en":"Systolic Blood Pressure and Effects of Screening for Atrial Fibrillation With Long-Term Continuous Monitoring (a LOOP Substudy).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["ambulante-bloeddrukmeting","atleten","bloeddrukbehandeling","primaire-preventie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19333","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19333","authors":["Lucas Yixi Xing","Søren Zöga Diederichsen","Søren Højberg","Derk W Krieger","Claus Graff","Morten Salling Olesen","Axel Brandes","Lars Køber","Ketil Jørgen Haugan","Jesper Hastrup Svendsen"],"significance":6,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/holter-monitoring-bij-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This LOOP trial substudy showed that higher systolic blood pressure increases the detection rate of AF during long-term continuous monitoring, informing the selection of patients most likely to benefit from intensive arrhythmia surveillance.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van de LOOP-trial toonde dat hogere systolische bloeddruk de detectiekans van atriumfibrilleren bij langdurige continue monitoring verhoogt. Dit ondersteunt gerichte AF-screening bij hypertensieve patiënten voor een hogere opbrengst.","abstract_original":"BACKGROUND: Hypertension is a well-known risk factor for atrial fibrillation (AF) and stoke, but data on the interaction between systolic blood pressure (SBP) and effects of AF screening are lacking. METHODS: The LOOP Study randomized AF-naïve individuals aged 70 to 90 years with additional stroke risk factors to either screening with implantable loop recorder (ILR) and anticoagulation initiation upon detection of AF episodes ≥6 minutes, or usual care. In total, 5997 participants with available baseline SBP measurements were included in this substudy. Outcomes were analyzed according to the time-to-first-event principle using cause-specific Cox models. RESULTS: The hazard ratio of stroke or systemic arterial embolism for ILR versus control decreased with increasing SBP. ILR screening yielded a 44% risk reduction of stroke or systemic arterial embolism among participants with SBP ≥150 mm Hg (adjusted hazard ratio, 0.56 [0.37-0.83]). Within the ILR group, SBP≥150 mm Hg was associated with a higher incidence of AF episodes ≥24 hours than lower SBP (adjusted hazard ratio, 1.70 [1.08-2.69]) but not with the overall occurrence of AF (adjusted P>0.05). CONCLUSIONS: The impact of AF screening on thromboembolic events increased with increasing blood pressure. SBP≥150 mm Hg was associated with a >1.5-fold increased risk of AF episodes ≥24 hours, along with an almost 50% risk reduction of stroke or systemic arterial embolism by ILR screening compared to lower blood pressure. These findings should be considered hypothesis-generating and warrant further study. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique Identifier: NCT02036450."},{"id":"d70575a0a855","type":"article","url":"https://hartvaat.nl/2022/09/01/obstructief-slaapapneu-sympathische-activiteit-en-bloeddruk-meta-analyse/","title":"Obstructief slaapapneu, sympathische activiteit en bloeddruk: meta-analyse","title_en":"Influence of Obstructive Sleep Apnea Severity on Muscle Sympathetic Nerve Activity and Blood Pressure: a Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","bradycardie","slaapapneu"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19288","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19288","authors":["Lauren E Maier","Brittany A Matenchuk","Ana Vucenovic","Allison Sivak","Margie H Davenport","Craig D Steinback"],"significance":6,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/secundaire-hypertensie/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This meta-analysis established a dose-response relationship between obstructive sleep apnea severity and both sympathetic nerve activity and blood pressure, supporting the neurogenic mechanism linking OSA to hypertension.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T18:38:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde een dosis-responsrelatie tussen de ernst van obstructief slaapapneu en sympathische zenuwactiviteit en bloeddruk. Behandeling met CPAP verminderde de sympathische activiteit significant, wat het mechanisme achter de relatie tussen OSA en hypertensie verduidelijkt.","abstract_original":"BACKGROUND: We conducted meta-analyses to identify relationships between obstructive sleep apnea (OSA) severity, muscle sympathetic nerve activity (MSNA), and blood pressure (BP). We quantified the effect of OSA treatment on MSNA. METHODS: Structured searches of electronic databases were performed until June 2021. All observational designs (except reviews) were included: population (individuals with OSA); exposures (OSA diagnosis and direct measures of MSNA); comparator (individuals without OSA or different severity of OSA); outcomes (MSNA, BP, and heart rate). RESULTS: Fifty-six studies (N=1872) were included. MSNA burst frequency was higher in OSA (27 studies; n=542) versus controls (n=488; mean differences [MDs], +15.95 bursts/min [95% CI, 12.6-17.6 bursts/min]; I2=86%). As was burst incidence (20 studies; n=357 OSA, n=312 Controls; MD, +22.23 bursts/100 hbs [95% CI, 18.49-25.97 bursts/100 hbs]; I2=67%). Meta-regressions indicated relationships between MSNA and OSA severity (burst frequency, R2=0.489; P<0.001; burst incidence, R2=0.573; P<0.001). MSNA burst frequency was related to systolic pressure (R2=0.308; P=0.016). OSA treatment with continuous positive airway pressure reduced MSNA burst frequency (MD, 11.91 bursts/min [95% CI, 9.36-14.47 bursts/min] I2=15%) and systolic (n=49; MD, 10.3 mm Hg [95% CI, 3.5-17.2 mm Hg]; I2=42%) and diastolic (MD, 6.9 mm Hg [95% CI, 2.3-11.6 mm Hg]; I2=37%) BP. CONCLUSIONS: MSNA is higher in individuals with OSA and related to severity. This sympathoexcitation is also related to BP in patients with OSA. Treatment effectively reduces MSNA and BP, but limited data prevents an assessment of the link between these reductions. These data are clinically important for understanding cardiovascular disease risk in patients with OSA. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: CRD42021285159."},{"id":"0997b9796b5e","type":"article","url":"https://hartvaat.nl/2022/09/01/bloeddrukinterventie-en-controle-in-sprint-nader-geanalyseerd/","title":"Bloeddrukinterventie en -controle in SPRINT nader geanalyseerd","title_en":"Blood Pressure Intervention and Control in SPRINT.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["ambulante-bloeddrukmeting","bloeddrukbehandeling","bradycardie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.17233","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.17233","authors":["William C Cushman","Robert J Ringer","Carlos J Rodriguez","Gregory W Evans","Jeffrey T Bates","Jeffrey A Cutler","Amret Hawfield","Dalane W Kitzman","Ilya M Nasrallah","Suzanne Oparil","John Nord","Vasilios Papademetriou","Karen Servilla","Peter Van Buren","Paul K Whelton","Jeff Whittle","Jackson T Wright"],"significance":6,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This detailed SPRINT analysis described the pharmacological strategy used to achieve intensive blood pressure control, showing that on average 2.8 antihypertensives were needed versus 1.8 for standard treatment.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gedetailleerde analyse van SPRINT beschreef hoe de intensieve bloeddrukbehandeling werd bereikt: gemiddeld 2,8 antihypertensiva versus 1,8 in de standaardgroep. De meest gebruikte middelen waren ACE-remmers/ARB's, gevolgd door thiaziden en calciumantagonisten.","abstract_original":"BACKGROUND: The SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated reductions in major cardiovascular disease events and mortality with an intensive systolic blood pressure (SBP) goal intervention. However, a detailed description of the blood pressure intervention, antihypertensive medication usage, blood pressure levels, and rates and predictors of blood pressure control has not been reported previously. METHODS: Hypertensive participants (n=9361) 50 years and older with elevated cardiovascular disease risk were randomized 1:1 to SBP goal <120 mm Hg or SBP goal <140 mm Hg. Guideline-recommended antihypertensive medications and dosing were provided at no cost. Intensive group participants were started on at least 2 medications, and medications were adjusted monthly until SBP goal was achieved, if feasible. Standard group participants were treated to achieve SBP 135 to 139 mm Hg. RESULTS: Baseline blood pressure (median±interquartile range) was 138±19/78±16 mm Hg. For intensive group participants, percent at goal rose from 8.9% at baseline to 52.4% at 6 months and average antihypertensive medications rose from 2.2 to 2.7; SBP was <120 mm Hg in 61.6% and <130 mm Hg in 80.0% at their final visit. For the standard group participants, percent at goal rose from 53.0% at baseline to 68.6% at 6 months, while antihypertensive medications fell from 1.9 to 1.8. From 6 to 36 months, median SBP was stable at 119±14 mm Hg for intensive and 136±15 mm Hg for standard participants, with stable numbers of medications. Few predictors of SBP control were found in multiple regression models. CONCLUSIONS: These results may inform and help replicate the benefits of SPRINT in clinical practice. REGISTRATION: URL: http://www. CLINICALTRIALS: gov; Unique identifier: NCT01206062."},{"id":"9224ff905281","type":"article","url":"https://hartvaat.nl/2022/09/01/primair-aldosteronisme-in-de-zwangerschap-systematische-review/","title":"Primair aldosteronisme in de zwangerschap: systematische review","title_en":"Management and Outcomes of Primary Aldosteronism in Pregnancy: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["aldosteronsynthaseremmers","baxdrostat","lorundrostat","mra-aldosteronantagonisten","resistente-hypertensie-aldosteronremmers","spironolacton"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18858","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18858","authors":["Viola Sanga","Giacomo Rossitto","Teresa Maria Seccia","Gian Paolo Rossi"],"significance":5,"published":"2022-09-01","source_date":"2022-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"This systematic review documented the diagnostic and therapeutic challenges of primary aldosteronism during pregnancy, providing practical guidance for managing this uncommon but serious gestational condition.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review documenteerde de diagnostische en therapeutische uitdagingen van primair aldosteronisme tijdens de zwangerschap. De aandoening is zeldzaam maar kan ernstige complicaties veroorzaken. Labetalol en alfa-methyldopa zijn veilige antihypertensiva; spironolacton is gecontra-indiceerd.","abstract_original":"Primary aldosteronism (PA) in pregnancy (PAP) can be a serious condition and is challenging to diagnose. This study was conceived to help in the diagnosis of PAP and provide suggestions on management of PAP based on evidence retrieved using a Population, Intervention, Comparison, and Outcome search strategy. Based on the changes of aldosterone and renin occurring in normal pregnancies, we developed a nomogram that will allow to identify PAP cases. Moreover, we found that published PAP cases fell into 4 main groups differing for management and outcomes: (1) unilateral medically treated, (2) unilateral surgically treated, (3) bilateral medically treated and (4) familial forms. Results showed that complications involved 62.2% of pregnant women with nonfamilial PA and 18.5% of those with familial hyperaldosteronism type I. Adrenalectomy during pregnancy in women with PAP did not improve maternal and fetal outcomes, over medical treatment alone. Moreover, cure of maternal hypertension and mother and baby outcome were better when unilateral PA was discovered and surgically treated before or after pregnancy. Therefore, fertile women with arterial hypertension should be screened for PA before pregnancy and, if necessary, subtyped to identify unilateral forms of PA. This will allow to furnish adequate counseling, a chance for surgical cure and, therefore, for a pregnancy not complicated by aldosterone excess."},{"id":"ecf5a919f1a1","type":"article","url":"https://hartvaat.nl/2022/08/30/biomarkers-voorspellen-complexe-coronaire-revascularisatie-in-fourier/","title":"Biomarkers voorspellen complexe coronaire revascularisatie in FOURIER","title_en":"Biomarker Prediction of Complex Coronary Revascularization Procedures in the FOURIER Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","endotheel","fractional-flow-reserve","inflammatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.05.051","source_url":"https://doi.org/10.1016/j.jacc.2022.05.051","authors":["Antonio Fagundes","David A Morrow","Kazuma Oyama","Remo H M Furtado","Thomas A Zelniker","Minao Tang","Julia F Kuder","Sabina A Murphy","Andrew Hamer","Anthony C Keech","Peter Sever","Robert P Giugliano","Marc S Sabatine","Brian A Bergmark"],"significance":6,"published":"2022-08-30","source_date":"2022-08-30","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/","https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This FOURIER substudy showed that cardiovascular biomarkers (NT-proBNP, troponin, IL-6) predict the need for complex coronary revascularization, informing risk stratification beyond traditional clinical variables.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van FOURIER toonde dat biomarkers (NT-proBNP, hsTnI, IL-6) de noodzaak voor complexe coronaire revascularisatie kunnen voorspellen bij patiënten met stabiel atherosclerotisch vaatlijden. Dit kan risicostratificatie en preventieve behandeling verbeteren.","abstract_original":"BACKGROUND: Biomarkers are known to predict major adverse cardiovascular events. However, the association of biomarkers with complex coronary revascularization procedures or high-risk coronary anatomy at the time of revascularization is not understood. OBJECTIVES: We examined the associations between baseline biomarkers and major coronary events (MCE) and complex revascularization procedures. METHODS: FOURIER was a randomized trial of the proprotein convertase subtilisin-kexin type 9 inhibitor evolocumab vs placebo in 27,564 patients with stable atherosclerosis. We analyzed adjusted associations among the biomarkers, MCE (coronary death, myocardial infarction, or revascularization), and complex revascularization (coronary artery bypass graft or complex percutaneous coronary intervention) using a multimarker score with 1 point assigned for each elevated biomarker (high-sensitivity C-reactive protein ≥2 mg/L; N-terminal pro-B-type natriuretic peptide ≥450 pg/mL; high-sensitivity troponin I ≥6 ng/L; growth-differentiation factor-15 ≥1,800 pg/mL). RESULTS: When patients were grouped by the number of elevated biomarkers (0 biomarkers, n = 6,444; 1-2 biomarkers, n = 12,439; ≥3 biomarkers, n = 2,761), there was a significant graded association between biomarker score and the risk of MCE (intermediate score: HRadj: 1.57 [95% CI: 1.38-1.78]; high score: HRadj: 2.90 [95% CI: 2.47-3.40]), and for complex revascularization (intermediate: HRadj: 1.33 [95% CI: 1.06-1.67]; high score: HRadj: 2.07 [95% CI: 1.52-2.83]) and its components (Ptrend <0.05 for each). The number of elevated biomarkers also correlated with the presence of left main disease, multivessel disease, or chronic total occlusion at the time of revascularization (P < 0.05 for each). CONCLUSIONS: A biomarker-based strategy identifies stable patients at risk for coronary events, including coronary artery bypass graft surgery and complex percutaneous coronary intervention, and predicts high-risk coronary anatomy at the time of revascularization. These findings provide insight into the relationships between cardiovascular biomarkers, coronary anatomical complexity, and incident clinical events. (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk [FOURIER]; NCT01764633)."},{"id":"e5f0738341d6","type":"article","url":"https://hartvaat.nl/2022/08/30/ripcord-2-routinematige-ffr-meting-versus-conventionele-angiografie/","title":"RIPCORD 2: routinematige FFR-meting versus conventionele angiografie","title_en":"Routine Pressure Wire Assessment Versus Conventional Angiography in the Management of Patients With Coronary Artery Disease: The RIPCORD 2 Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057793","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057793","authors":["Rodney H Stables","Liam J Mullen","Mostafa Elguindy","Zoe Nicholas","Yousra H Aboul-Enien","Ian Kemp","Peter O'Kane","Alex Hobson","Thomas W Johnson","Sohail Q Khan","Stephen B Wheatcroft","Scot Garg","Azfar G Zaman","Mamas A Mamas","James Nolan","Sachin Jadhav","Colin Berry","Stuart Watkins","David Hildick-Smith","Julian Gunn","Dwayne Conway","Angels Hoye","Iftikhar A Fazal","Colm G Hanratty","Bernard De Bruyne","Nick Curzen"],"significance":7,"published":"2022-08-30","source_date":"2022-08-30","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"The RIPCORD 2 trial showed that routine FFR measurement during diagnostic coronary angiography frequently changes the management plan but does not improve clinical outcomes compared with conventional angiography-guided decision-making.","created":"2026-07-03T10:29:54Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De RIPCORD 2-trial toonde dat routinematige FFR-meting bij diagnostische coronairangiografie het behandelplan veranderde maar niet leidde tot betere klinische uitkomsten na 1 jaar vergeleken met conventionele angiografie. Selectief FFR-gebruik blijft de standaard.","abstract_original":"BACKGROUND: Measurement of fractional flow reserve (FFR) has an established role in guiding percutaneous coronary intervention. We tested the hypothesis that, at the stage of diagnostic invasive coronary angiography, systematic FFR-guided assessment of coronary artery disease would be superior, in terms of resource use and quality of life, to assessment by angiography alone. METHODS: We performed an open-label, randomized, controlled trial in 17 UK centers, recruiting 1100 patients undergoing invasive coronary angiography for the investigation of stable angina or non-ST-segment-elevation myocardial infarction. Patients were randomized to either angiography alone (angiography) or angiography with systematic pressure wire assessment of all epicardial vessels >2.25 mm in diameter (angiography+FFR). The coprimary outcomes assessed at 1 year were National Health Service hospital costs and quality of life. Prespecified secondary outcomes included clinical events. RESULTS: In the angiography+FFR arm, the median number of vessels examined was 4 (interquartile range, 3-5). The median hospital costs were similar: angiography, £4136 (interquartile range, £2613-£7015); and angiography+FFR, £4510 (£2721-£7415; P=0.137). There was no difference in median quality of life using the visual analog scale of the EuroQol EQ-5D-5L: angiography, 75 (interquartile range, 60-87); and angiography+FFR, 75 (interquartile range, 60-90; P=0.88). The number of clinical events was as follows: deaths, 5 versus 8; strokes, 3 versus 4; myocardial infarctions, 23 versus 22; and unplanned revascularizations, 26 versus 33, with a composite hierarchical event rate of 8.7% (48 of 552) for angiography versus 9.5% (52 of 548) for angiography+FFR (P=0.64). CONCLUSIONS: A strategy of systematic FFR assessment compared with angiography alone did not result in a significant reduction in cost or improvement in quality of life. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01070771."},{"id":"5a4266fa0465","type":"article","url":"https://hartvaat.nl/2022/08/30/apob-en-residueel-cv-risico-na-acs-effect-van-alirocumab/","title":"ApoB en residueel CV-risico na ACS: effect van alirocumab","title_en":"Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["ezetimibe","hdl-cholesterol","lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","voeding-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057807","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057807","authors":["Emil Hagström","P Gabriel Steg","Michael Szarek","Deepak L Bhatt","Vera A Bittner","Nicolas Danchin","Rafael Diaz","Shaun G Goodman","Robert A Harrington","J Wouter Jukema","Evangelos Liberopoulos","Nikolaus Marx","Jennifer McGinniss","Garen Manvelian","Robert Pordy","Michel Scemama","Harvey D White","Andreas M Zeiher","Gregory G Schwartz"],"significance":7,"published":"2022-08-30","source_date":"2022-08-30","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/"],"congress":"","summary_en":"This ODYSSEY OUTCOMES analysis showed that apolipoprotein B is a stronger predictor of residual cardiovascular risk after ACS than LDL cholesterol, and that alirocumab's benefit correlates more closely with apoB reduction, supporting apoB as a treatment target.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat apoliproteïne B een betere voorspeller is van residueel cardiovasculair risico na ACS dan LDL-cholesterol. Alirocumab verlaagde apoB effectief en de risicoreductie correleerde sterk met de apoB-verlaging. ApoB kan een beter therapeutisch doel zijn dan LDL.","abstract_original":"BACKGROUND: Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipoprotein cholesterol is uncertain. METHODS: The ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) compared the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin therapy. Primary outcome was major adverse cardiovascular events (MACE; coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, hospitalization for unstable angina). Associations between baseline apoB or apoB at 4 months and MACE were assessed in adjusted Cox proportional hazards and propensity score-matched models. RESULTS: Median follow-up was 2.8 years. In proportional hazards analysis in the placebo group, MACE incidence increased across increasing baseline apoB strata (3.2 [95% CI, 2.9-3.6], 4.0 [95% CI, 3.6-4.5], and 5.5 [95% CI, 5.0-6.1] events per 100 patient-years in strata <75, 75-<90, ≥90 mg/dL, respectively; Ptrend<0.0001) and after adjustment for low-density lipoprotein cholesterol (Ptrend=0.035). Higher baseline apoB stratum was associated with greater relative (Ptrend<0.0001) and absolute reduction in MACE with alirocumab versus placebo. In the alirocumab group, the incidence of MACE after month 4 decreased monotonically across decreasing achieved apoB strata (4.26 [95% CI, 3.78-4.79], 3.09 [95% CI, 2.69-3.54], and 2.41 [95% CI, 2.11-2.76] events per 100 patient-years in strata ≥50, >35-<50, and ≤35 mg/dL, respectively). Compared with propensity score-matched patients from the placebo group, treatment hazard ratios for alirocumab also decreased monotonically across achieved apoB strata. Achieved apoB was predictive of MACE after adjustment for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol but not vice versa. CONCLUSIONS: In patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, MACE increased across baseline apoB strata. Alirocumab reduced MACE across all strata of baseline apoB, with larger absolute reductions in patients with higher baseline levels. Lower achieved apoB was associated with lower risk of MACE, even after accounting for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol, indicating that apoB provides incremental information. Achievement of apoB levels as low as ≤35 mg/dL may reduce lipoprotein-attributable residual risk after acute coronary syndrome. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01663402."},{"id":"d3e6f6fe966c","type":"article","url":"https://hartvaat.nl/2022/08/30/empagliflozine-bij-hfpef-consistent-effect-met-en-zonder-diabetes/","title":"Empagliflozine bij HFpEF: consistent effect met en zonder diabetes","title_en":"Empagliflozin for Heart Failure With Preserved Left Ventricular Ejection Fraction With and Without Diabetes.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","empagliflozine","emperor-trials","hfpef","hfref","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059785","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059785","authors":["Gerasimos Filippatos","Javed Butler","Dimitrios Farmakis","Faiez Zannad","Anne Pernille Ofstad","João Pedro Ferreira","Jennifer B Green","Julio Rosenstock","Sven Schnaidt","Martina Brueckmann","Stuart J Pocock","Milton Packer","Stefan D Anker"],"significance":8,"published":"2022-08-30","source_date":"2022-08-30","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-Preserved subanalysis confirmed that empagliflozin's benefit on heart failure outcomes in HFpEF is consistent regardless of diabetes status, extending the evidence for SGLT2 inhibitors as a universal heart failure therapy beyond glycemic management.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van EMPEROR-Preserved bevestigde dat empagliflozine hartfalengebeurtenissen en CV-sterfte vermindert bij HFpEF ongeacht de aanwezigheid van diabetes. Het effect was vergelijkbaar in beide groepen, wat SGLT2-remming positioneert als universele HFpEF-therapie.","abstract_original":"BACKGROUND: Empagliflozin improves outcomes in patients with heart failure with a preserved ejection fraction, but whether the effects are consistent in patients with and without diabetes remains to be elucidated. METHODS: Patients with class II through IV heart failure and a left ventricular ejection fraction >40% were randomized to receive empagliflozin 10 mg or placebo in addition to usual therapy. We undertook a prespecified analysis comparing the effects of empagliflozin versus placebo in patients with and without diabetes. RESULTS: Of the 5988 patients enrolled, 2938 (49%) had diabetes. The risk of the primary outcome (first hospitalization for heart failure or cardiovascular death), total hospitalizations for heart failure, and estimated glomerular filtration rate decline was higher in patients with diabetes. Empagliflozin reduced the rate of the primary outcome irrespective of diabetes status (hazard ratio, 0.79 [95% CI, 0.67, 0.94] for patients with diabetes versus hazard ratio, 0.78 [95% CI, 0.64, 0.95] in patients without diabetes; Pinteraction=0.92). The effect of empagliflozin to reduce total hospitalizations for heart failure was also consistent in patients with and without diabetes. The effect of empagliflozin to attenuate estimated glomerular filtration rate decline during double-blind treatment was also present in patients with and without diabetes, although more pronounced in patients with diabetes (1.77 in diabetes versus 0.98 mL/min/1.73m2 in patients without diabetes; Pinteraction=0.01). Across these 3 end points, the effect of empagliflozin did not differ in patients with prediabetes or normoglycemia (33% and 18% of the patient population, respectively). When investigated as a continuous variable, baseline hemoglobin A1c did not modify the effects on the primary outcome (Pinteraction=0.26). There was no increased risk of hypoglycemic events in either subgroup as compared with placebo. CONCLUSIONS: In patients with heart failure and a preserved ejection fraction enrolled in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction), empagliflozin significantly reduced the risk of heart failure outcomes irrespective of diabetes status at baseline. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03057951."},{"id":"c78136f6a3b6","type":"article","url":"https://hartvaat.nl/2022/08/25/aflibercept-versus-bevacizumab-eerst-bij-diabetisch-macula-oedeem/","title":"Aflibercept versus bevacizumab-eerst bij diabetisch macula-oedeem","title_en":"Aflibercept Monotherapy or Bevacizumab First for Diabetic Macular Edema.","category":"preventie","category_label":"Preventie","professions":["internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2204225","source_url":"https://doi.org/10.1056/NEJMoa2204225","authors":["Chirag D Jhaveri","Adam R Glassman","Frederick L Ferris","Danni Liu","Maureen G Maguire","John B Allen","Carl W Baker","David Browning","Matthew A Cunningham","Scott M Friedman","Lee M Jampol","Dennis M Marcus","Daniel F Martin","Carin M Preston","Cynthia R Stockdale","Jennifer K Sun"],"significance":7,"published":"2022-08-25","source_date":"2022-08-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This NEJM trial compared aflibercept monotherapy with a stepped approach starting with bevacizumab for diabetic macular edema, evaluating the cost-effectiveness of different anti-VEGF treatment strategies for this common diabetic complication.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial vergeleek aflibercept monotherapie met een stapsgewijze aanpak (bevacizumab eerst, switch naar aflibercept bij onvoldoende respons) bij diabetisch macula-oedeem. Bij milde visusbeperking was de stapsgewijze benadering non-inferieur en kosteneffectiever.","abstract_original":"BACKGROUND: In eyes with diabetic macular edema, the relative efficacy of administering aflibercept monotherapy as compared with bevacizumab first with a switch to aflibercept if the eye condition does not improve sufficiently (a form of step therapy) is unclear. METHODS: At 54 clinical sites, we randomly assigned eyes in adults who had diabetic macular edema involving the macular center and a visual-acuity letter score of 24 to 69 (on a scale from 0 to 100, with higher scores indicating better visual acuity; Snellen equivalent, 20/320 to 20/50) to receive either 2.0 mg of intravitreous aflibercept or 1.25 mg of intravitreous bevacizumab. The drug was administered at randomization and thereafter according to the prespecified retreatment protocol. Beginning at 12 weeks, eyes in the bevacizumab-first group were switched to aflibercept therapy if protocol-specified criteria were met. The primary outcome was the mean change in visual acuity over the 2-year trial period. Retinal central subfield thickness and visual acuity at 2 years and safety were also assessed. RESULTS: A total of 312 eyes (in 270 adults) underwent randomization; 158 eyes were assigned to receive aflibercept monotherapy and 154 to receive bevacizumab first. Over the 2-year period, 70% of the eyes in the bevacizumab-first group were switched to aflibercept therapy. The mean improvement in visual acuity was 15.0 letters in the aflibercept-monotherapy group and 14.0 letters in the bevacizumab-first group (adjusted difference, 0.8 letters; 95% confidence interval, -0.9 to 2.5; P = 0.37). At 2 years, the mean changes in visual acuity and retinal central subfield thickness were similar in the two groups. Serious adverse events (in 52% of the patients in the aflibercept-monotherapy group and in 36% of those in the bevacizumab-first group) and hospitalizations for adverse events (in 48% and 32%, respectively) were more common in the aflibercept-monotherapy group. CONCLUSIONS: In this trial of treatment of moderate vision loss due to diabetic macular edema involving the center of the macula, we found no evidence of a significant difference in visual outcomes over a 2-year period between aflibercept monotherapy and treatment with bevacizumab first with a switch to aflibercept in the case of suboptimal response. (Funded by the National Institutes of Health; Protocol AC ClinicalTrials.gov number, NCT03321513.)."},{"id":"0efc3857d0e5","type":"article","url":"https://hartvaat.nl/2022/08/23/uspstf-evidence-review-statines-voor-primaire-cv-preventie-geactualiseerd/","title":"USPSTF evidence review: statines voor primaire CV-preventie geactualiseerd","title_en":"Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["hartrevalidatie","ouderen","primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2022.12138","source_url":"https://doi.org/10.1001/jama.2022.12138","authors":["Roger Chou","Amy Cantor","Tracy Dana","Jesse Wagner","Azrah Y Ahmed","Rongwei Fu","Maros Ferencik"],"significance":8,"published":"2022-08-23","source_date":"2022-08-23","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/residueel-cardiovasculair-risico/"],"congress":"","summary_en":"This updated USPSTF evidence review reaffirmed that statin use for primary cardiovascular prevention is associated with reduced cardiovascular events and mortality, supporting continued recommendation for statin therapy in adults at elevated 10-year CVD risk.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geactualiseerde systematische review voor de USPSTF bevestigde dat statinegebruik voor primaire CV-preventie geassocieerd is met verminderde mortaliteit en minder cardiovasculaire events. Het bewijs is het sterkst voor 40-75-jarigen met risicofactoren. Voor ouderen >75 jaar blijft het bewijs onvoldoende.","abstract_original":"IMPORTANCE: A 2016 review for the US Preventive Services Task Force (USPSTF) found use of statins for primary prevention of cardiovascular disease (CVD) was associated with reduced mortality and cardiovascular outcomes. OBJECTIVE: To update the 2016 review on statins for primary prevention of CVD to inform the USPSTF. DATA SOURCES: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to November 2021); surveillance through May 20, 2022. STUDY SELECTION: Randomized clinical trials on statins vs placebo or no statin and statin intensity in adults without prior cardiovascular events; large cohort studies on harms. DATA EXTRACTION AND SYNTHESIS: One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. MAIN OUTCOMES AND MEASURES: All-cause and cardiovascular mortality, myocardial infarction, stroke, composite cardiovascular outcomes, and adverse events. RESULTS: Twenty-six studies were included: 22 trials (N = 90 624) with 6 months to 6 years of follow-up compared statins vs placebo or no statin, 1 trial (n = 5144) compared statin intensities, and 3 observational studies (n = 417 523) reported harms. Statins were significantly associated with decreased risk of all-cause mortality (risk ratio [RR], 0.92 [95% CI, 0.87 to 0.98]; absolute risk difference [ARD], -0.35% [95% CI, -0.57% to -0.14%]), stroke (RR, 0.78 [95% CI, 0.68 to 0.90]; ARD, -0.39% [95% CI, -0.54% to -0.25%]), myocardial infarction (RR, 0.67 [95% CI, 0.60 to 0.75]; ARD, -0.85% [95% CI, -1.22% to -0.47%]), and composite cardiovascular outcomes (RR, 0.72 [95% CI, 0.64 to 0.81]; ARD, -1.28% [95% CI, -1.61% to -0.95%]); the association with cardiovascular mortality was not statistically significant (RR, 0.91 [95% CI, 0.81 to 1.02]; ARD, -0.13%). Relative benefits were consistent in groups defined by demographic and clinical characteristics, although data for persons older than 75 years were sparse. Statin therapy was not significantly associated with increased risk of serious adverse events (RR, 0.97 [95% CI, 0.93 to 1.01]), myalgias (RR, 0.98 [95% CI, 0.86 to 1.11]), or elevated alanine aminotransferase level (RR, 0.94 [95% CI, 0.78 to 1.13]). Statin therapy was not significantly associated with increased diabetes risk overall (RR, 1.04 [95% CI, 0.92 to 1.19]), although 1 trial found high-intensity statin therapy was significantly associated with increased risk (RR, 1.25 [95% CI, 1.05 to 1.49]). Otherwise, there were no clear differences in outcomes based on statin intensity. CONCLUSIONS AND RELEVANCE: In adults at increased CVD risk but without prior CVD events, statin therapy for primary prevention of CVD was associated with reduced risk of all-cause mortality and CVD events. Benefits of statin therapy appear to be present across diverse demographic and clinical populations, with consistent relative benefits in groups defined by demographic and clinical characteristics."},{"id":"697f480b9f9a","type":"article","url":"https://hartvaat.nl/2022/08/23/uspstf-aanbeveling-statinegebruik-voor-primaire-cardiovasculaire-preventie/","title":"USPSTF-aanbeveling: statinegebruik voor primaire cardiovasculaire preventie","title_en":"Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["atleten","biomarkers-cardiovasculair","hartrevalidatie","ouderen","primaire-preventie","secundaire-preventie","slaapapneu"],"journal":"JAMA","doi":"10.1001/jama.2022.13044","source_url":"https://doi.org/10.1001/jama.2022.13044","authors":["Carol M Mangione","Michael J Barry","Wanda K Nicholson","Michael Cabana","David Chelmow","Tumaini Rucker Coker","Esa M Davis","Katrina E Donahue","Carlos Roberto Jaén","Martha Kubik","Li Li","Gbenga Ogedegbe","Lori Pbert","John M Ruiz","James Stevermer","John B Wong"],"significance":9,"published":"2022-08-23","source_date":"2022-08-23","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"The 2022 USPSTF reaffirmation recommended statin use for primary cardiovascular prevention in adults aged 40-75 with at least one CVD risk factor and a 10-year CVD risk of 10% or greater, maintaining the 2016 recommendation with updated evidence review.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:29:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De US Preventive Services Task Force bevestigde de aanbeveling voor statinegebruik bij volwassenen van 40-75 jaar met ≥1 CV-risicofactor en ≥10% 10-jaars CV-risico. De aanbeveling ondersteunt brede statinetoepassing in de primaire preventie maar vindt onvoldoende bewijs voor >75-jarigen.","abstract_original":"IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of morbidity and death in the US and is the cause of more than 1 of every 4 deaths. Coronary heart disease is the single leading cause of death and accounts for 43% of deaths attributable to CVD in the US. In 2019, an estimated 558 000 deaths were caused by coronary heart disease and 109 000 deaths were caused by ischemic stroke. OBJECTIVE: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of statins for reducing CVD-related morbidity or mortality or all-cause mortality. POPULATION: Adults 40 years or older without a history of known CVD and who do not have signs and symptoms of CVD. EVIDENCE ASSESSMENT: The USPSTF concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD event risk of 10% or greater has at least a moderate net benefit. The USPSTF concludes with moderate certainty that statin use for the prevention of CVD events and all-cause mortality in adults aged 40 to 75 years with no history of CVD and who have 1 or more of these CVD risk factors and an estimated 10-year CVD event risk of 7.5% to less than 10% has at least a small net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of statin use for the primary prevention of CVD events and mortality in adults 76 years or older with no history of CVD. RECOMMENDATION: The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD risk of 10% or greater. (B recommendation) The USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10%. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater. (C recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older. (I statement)."},{"id":"dd382966a5fc","type":"article","url":"https://hartvaat.nl/2022/08/23/impact-van-therapieontrouw-op-duale-antiplaatjestherapie-in-klinische-trial/","title":"Impact van therapieontrouw op duale antiplaatjestherapie in klinische trial","title_en":"Impact of Medication Nonadherence in a Clinical Trial of Dual Antiplatelet Therapy.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["farmaco-economie","soul-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.04.065","source_url":"https://doi.org/10.1016/j.jacc.2022.04.065","authors":["Marco Valgimigli","Enrico Frigoli","Pascal Vranckx","Yukio Ozaki","Marie-Claude Morice","Bernard Chevalier","Yoshinobu Onuma","Stephan Windecker","Laurent Delorme","Petr Kala","Sasko Kedev","Rajpal K Abhaichand","Vasil Velchev","Willem Dewilde","Jakub Podolec","Gregor Leibundgut","Dragan Topic","Carl Schultz","Goran Stankovic","Astin Lee","Thomas Johnson","Pim A L Tonino","Aneta Klotzka","Maciej Lesiak","Renato D Lopes","Pieter C Smits","Dik Heg"],"significance":6,"published":"2022-08-23","source_date":"2022-08-23","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This TWILIGHT analysis showed that medication non-adherence in a clinical trial of DAPT after PCI is common and significantly impacts outcomes, highlighting adherence as a critical determinant of antiplatelet therapy effectiveness.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:28:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de TWILIGHT-trial toonde dat medicatie-ontrouw aan duale antiplaatjestherapie na PCI frequent voorkomt, zelfs in trials. Non-adherentie was geassocieerd met significant meer ischemische events, wat het belang van therapietrouw-interventies benadrukt.","abstract_original":"BACKGROUND: Nonadherence to antiplatelet therapy after percutaneous coronary intervention (PCI) is common, even in clinical trials. OBJECTIVES: The purpose of this study was to investigate the impact of nonadherence to study protocol regimens in the MASTER DAPT (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen) trial. METHODS: At 1-month after PCI, 4,579 high bleeding risk patients were randomized to single antiplatelet therapy (SAPT) for 11 months (or 5 months in patients on oral anticoagulation [OAC]) or dual antiplatelet therapy (DAPT) for ≥2 months followed by SAPT. Coprimary outcomes included net adverse clinical events (NACE), major adverse cardiac and cerebral events (MACE), and major or clinically relevant nonmajor bleeding (MCB) at 335 days. Inverse probability-of-censoring weights were used to correct for nonadherence Academic Research Consortium type 2 or 3. RESULTS: In total, 464 (20.2%) patients in the abbreviated-treatment and 214 (9.4%) in the standard-treatment groups incurred nonadherence Academic Research Consortium type 2 or 3. At inverse probability-of-censoring weights analyses, NACE (HR: 1.01; 95% CI: 0.88-1.27) or MACE (HR: 1.07; 95% CI: 0.83-1.40) did not differ, and MCB was lower with abbreviated compared with standard treatment (HR: 0.51; 95% CI: 0.60-0.73) consistently across OAC subgroups; among OAC patients, SAPT discontinuation 6 months after PCI was associated with similar MACE and lower MCB (HR: 0.47; 95% CI: 0.22-0.99) compared with SAPT continuation. CONCLUSIONS: In the MASTER DAPT adherent population, 1-month compared with ≥3-month DAPT was associated with similar NACE or MACE and lower MCB. Among OAC patients, SAPT discontinuation after 6 months was associated with similar MACE and lower MCB than SAPT continuation (Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated Versus Prolonged DAPT Regimen [MASTER DAPT]; NCT03023020)."},{"id":"60c08b5bea35","type":"article","url":"https://hartvaat.nl/2022/08/23/klinische-verslechtering-als-surrogaat-voor-mortaliteit-bij-pulmonale-arteriele-/","title":"Klinische verslechtering als surrogaat voor mortaliteit bij pulmonale arteriële hypertensie","title_en":"Assessment of Clinical Worsening End Points as a Surrogate for Mortality in Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","figaro-dkd","ouderen","pathfinder-trial","perifeer-vaatlijden","pulmonale-hypertensie","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.058635","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.058635","authors":["Élodie Tremblay","Camille Gosselin","Vicky Mai","Annie C Lajoie","Roubi Kilo","Jason Weatherald","Yves Lacasse","Sebastien Bonnet","Jean-Christophe Lega","Steeve Provencher"],"significance":6,"published":"2022-08-23","source_date":"2022-08-23","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/hypertensie/therapietrouw-hypertensie/"],"congress":"","summary_en":"This meta-analysis validated clinical worsening as a surrogate endpoint for mortality in PAH trials, supporting its use as a composite outcome in drug development programs for pulmonary arterial hypertension.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse evalueerden of klinische verslechtering een valide surrogaateindpunt is voor mortaliteit bij PAH-trials. Het composieteindpunt bleek een goede surrogaat, maar niet alle componenten droegen gelijk bij. Dit informeert de opzet van toekomstige PAH-studies.","abstract_original":"BACKGROUND: Clinical worsening (CW) is a composite end point commonly used in pulmonary arterial hypertension (PAH) trials. We aimed to assess the trial-level surrogacy of CW for mortality in PAH trials, and whether the various CW components were similar in terms of frequency of occurrence, treatment-related relative risk (RR) reduction, and importance to patients. METHODS: We searched MEDLINE, Embase, and the Cochrane Library (January 1990 to December 2020) for trials evaluating the effects of PAH therapies on CW. The coefficient of determination between the RR for CW and mortality was assessed by regression analysis. The frequency of occurrence, RR reduction, and importance to patients of the CW components were assessed. RESULTS: We included 35 independent cohorts (9450 patients). PAH therapies significantly reduced CW events (RR, 0.64 [95% CI, 0.55-0.73]), including PAH-related hospitalizations (RR, 0.61 [95% CI, 0.47-0.79]), treatment escalation (RR, 0.57 [95% CI, 0.38-0.84]) and symptomatic progression (RR, 0.58 [95% CI, 0.48-0.69]), and modestly reduced all-cause mortality when incorporating deaths occurring after a primary CW-defining event (RR, 0.860 [95% CI, 0.742-0.997]). However, the effects of PAH-specific therapies on CW only modestly correlated with their effects on mortality (R2trial, 0.35 [95% CI, 0.10-0.59]; P<0.0001), and the gradient in the treatment effect across component end points was large in the majority of trials. The weighted proportions of CW-defining events were hospitalization (33.5%) and symptomatic progression (32.3%), whereas death (6.7%), treatment escalation (5.6%), and transplantation/atrioseptostomy (0.2%) were infrequent. CW events were driven by the occurrence of events of major (49%) and mild-to-moderate (37%) importance to patients, with 14% of the events valued as critical. CONCLUSIONS: PAH therapies significantly reduced CW events, but study-level CW is not a surrogate for mortality in PAH trials. Moreover, components of CW largely vary in frequency, response to therapy, and importance to patients and are thus not interchangeable. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42020178949."},{"id":"70163f2672e2","type":"article","url":"https://hartvaat.nl/2022/08/16/cabana-catheterablatie-bij-af-is-kosteneffectief-vergeleken-met-antiaritmica/","title":"CABANA: catheterablatie bij AF is kosteneffectief vergeleken met antiaritmica","title_en":"Cost-Effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation: The CABANA Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.058575","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.058575","authors":["Derek S Chew","Yanhong Li","Patricia A Cowper","Kevin J Anstrom","Jonathan P Piccini","Jeanne E Poole","Melanie R Daniels","Kristi H Monahan","Linda Davidson-Ray","Tristram D Bahnson","Hussein R Al-Khalidi","Kerry L Lee","Douglas L Packer","Daniel B Mark"],"significance":7,"published":"2022-08-16","source_date":"2022-08-16","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This CABANA cost-effectiveness analysis showed that catheter ablation for AF is cost-effective compared with antiarrhythmic drug therapy, despite the neutral primary intention-to-treat result, driven by quality-of-life improvements and reduced long-term healthcare utilization.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:28:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Kosteneffectiviteitsanalyse van de CABANA-trial toonde dat catheterablatie voor AF kosteneffectief was vergeleken met medicamenteuze therapie, met een gunstige kosten-per-QALY ratio. Dit ondersteunt ablatie als waardevolle behandeloptie vanuit gezondheidseconomisch perspectief.","abstract_original":"BACKGROUND: In the CABANA trial (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation), catheter ablation did not significantly reduce the primary end point of death, disabling stroke, serious bleeding, or cardiac arrest compared with drug therapy by intention-to-treat, but did improve the quality of life and freedom from atrial fibrillation recurrence. In the heart failure subgroup, ablation improved both survival and quality of life. Cost-effectiveness was a prespecified CABANA secondary end point. METHODS: Medical resource use data were collected for all CABANA patients (N=2204). Costs for hospital-based care were assigned using prospectively collected bills from US patients (n=1171); physician and medication costs were assigned using the Medicare Fee Schedule and National Average Drug Acquisition Costs, respectively. Extrapolated life expectancies were estimated using age-based survival models. Quality-of-life adjustments were based on EQ-5D-based utilities measured during the trial. The primary outcome was the incremental cost-effectiveness ratio, comparing ablation with drug therapy on the basis of intention-to-treat, and assessed from the US health care sector perspective. RESULTS: Costs in the first 3 months averaged $20 794±SD 1069 higher with ablation compared with drug therapy. The cumulative within-trial 5-year cost difference was $19 245 (95% CI, $11 360-$27 170) and the lifetime mean cost difference was $15 516 (95% CI, -$2963 to $35,512) higher with ablation than with drug therapy. The drug therapy arm accrued an average of 12.5 life-years (LYs) and 10.7 quality-adjusted life-years (QALYs). For the ablation arm, the corresponding estimates were 12.6 LYs and 11.0 QALYs. The incremental cost-effectiveness ratio was $57 893 per QALY gained, with 75% of bootstrap replications yielding an incremental cost-effectiveness ratio <$100 000 per QALY gained. With no quality-of-life/utility adjustments, the incremental cost-effectiveness ratio was $183 318 per LY gained. CONCLUSIONS: Catheter ablation of atrial fibrillation was economically attractive compared with drug therapy in the CABANA Trial overall at present benchmarks for health care value in the United States on the basis of projected incremental QALYs but not LYs alone."},{"id":"99444e74ea6b","type":"article","url":"https://hartvaat.nl/2022/08/14/obesitas-en-dapagliflozine-bij-type-2-diabetes-declare-timi-58-subanalyse/","title":"Obesitas en dapagliflozine bij type 2 diabetes: DECLARE-TIMI 58 subanalyse","title_en":"Obesity and effects of dapagliflozin on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus in the DECLARE-TIMI 58 trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","dapagliflozine","diabetes-en-hart","diabetes-type-2","empagliflozine","obesitas"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab530","source_url":"https://doi.org/10.1093/eurheartj/ehab530","authors":["Kazuma Oyama","Itamar Raz","Avivit Cahn","Julia Kuder","Sabina A Murphy","Deepak L Bhatt","Lawrence A Leiter","Darren K McGuire","John P H Wilding","Kyong Soo Park","Assen Goudev","Rafael Diaz","Jindřich Špinar","Ingrid A M Gause-Nilsson","Ofri Mosenzon","Marc S Sabatine","Stephen D Wiviott"],"significance":7,"published":"2022-08-14","source_date":"2022-08-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/"],"congress":"","summary_en":"This DECLARE-TIMI 58 subanalysis showed that dapagliflozin's cardiovascular and renal benefits are consistent across the BMI spectrum in type 2 diabetes, supporting SGLT2 inhibitor use regardless of obesity status.","created":"2026-07-03T10:29:53Z","updated":"2026-07-03T13:28:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van DECLARE-TIMI 58 toonde dat het cardiovasculaire en renale voordeel van dapagliflozine consistent was ongeacht de BMI. Obese patiënten hadden een hoger absoluut risico en daarmee grotere absolute risicoreductie. SGLT2-remming is bijzonder waardevol bij obese diabetespatiënten.","abstract_original":"AIMS: We investigated the associations between obesity, cardiorenal events, and benefits of dapagliflozin in patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS: DECLARE-TIMI 58 randomized patients with T2DM and either atherosclerotic cardiovascular (CV) disease or multiple risk factors to dapagliflozin vs. placebo. Patients were stratified by body mass index (BMI, kg/m2): normal (18.5 to <25), overweight (25 to <30), moderately obese (30 to <35), severely obese (35 to <40), and very-severely obese (≥40). Outcomes analysed were CV death, hospitalization for heart failure (HHF), renal-specific composite outcome, and atrial fibrillation or flutter (AF/AFL). Of 17 134 patients, 9.0% had a normal BMI, 31.5% were overweight, 32.4% were moderately, 17.2% severely, and 9.8% were very-severely obese. Higher BMI was associated with a higher adjusted risk of HHF and AF/AFL (hazard ratio 1.30 and 1.28, respectively, per 5 kg/m2; P < 0.001 for all). Dapagliflozin reduced body weight by similar relative amounts consistently across BMI categories (percent difference: -1.9 to -2.4%). Although relative risk reductions in CV and renal-specific composite outcomes with dapagliflozin did not significantly differ across the range of BMI (P for interaction ≥0.20 for all outcomes), obese patients (BMI ≥ 30 kg/m2) tended to derive greater absolute risk reduction in HHF and AF/AFL (P for interaction 0.02 and 0.09, respectively) than non-obese patients. CONCLUSIONS: In DECLARE-TIMI 58, patients with T2DM and higher BMI were more likely to have HHF and AF/AFL. Whereas relative risk reductions in CV and renal outcomes with dapagliflozin were generally consistent across the range of BMI, absolute risk reduction in obesity-related outcomes including HHF and AF/AFL tended to be larger in obese patients with T2DM. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01730534."},{"id":"a6a042e76a72","type":"article","url":"https://hartvaat.nl/2022/08/11/prevalentie-incidentie-en-overleving-bij-hartfalen-wereldwijde-systematische-rev/","title":"Prevalentie, incidentie en overleving bij hartfalen: wereldwijde systematische review","title_en":"Prevalence, incidence and survival of heart failure: a systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bisoprolol","primaire-preventie","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320131","source_url":"https://doi.org/10.1136/heartjnl-2021-320131","authors":["Sophia Emmons-Bell","Catherine Johnson","Gregory Roth"],"significance":7,"published":"2022-08-11","source_date":"2022-08-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This comprehensive systematic review documented the global epidemiology of heart failure, finding that prevalence ranges from 1-3% in the general population and exceeds 10% in those over 70, with improving survival but persistently high morbidity.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T13:28:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide systematische review documenteerde de wereldwijde epidemiologie van hartfalen. De prevalentie varieert van 1-3% in de algemene populatie, de incidentie daalt licht maar de overleving verbetert. HFpEF neemt toe als aandeel, wat de ziekteslast verschuift.","abstract_original":"Studies of the epidemiology of heart failure in the general population can inform assessments of disease burden, research, public health policy and health system care delivery. We performed a systematic review of prevalence, incidence and survival for all available population-representative studies to inform the Global Burden of Disease 2020. We examined population-based studies published between 1990 and 2020 using structured review methods and database search strings. Studies were sought in which heart failure was defined by clinical diagnosis using structured criteria such as the Framingham or European Society of Cardiology criteria, with studies using alternate case definitions identified for comparison. Study results were extracted with descriptive characteristics including age range, location and case definition. Search strings identified 42 360 studies over a 30-year period, of which 790 were selected for full-text review and 125 met criteria for inclusion. 45 sources reported estimates of prevalence, 41 of incidence and 58 of mortality. Prevalence ranged from 0.2%, in a Hong Kong study of hospitalised heart failure patients in 1997, to 17.7%, in a US study of Medicare beneficiaries aged 65+ from 2002 to 2013. Collapsed estimates of incidence ranged from 0.1%, in the EPidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine (EPICAL) study of acute heart failure in France among those aged 20-80 years in 1994, to 4.3%, in a US study of Medicare beneficiaries 65+ from 1994 to 2003. One-year heart failure case fatality ranged from 4% to 45% with an average of 33% overall and 24% for studies across all adult ages. Diagnostic criteria, case ascertainment strategy and demographic breakdown varied widely between studies. Prevalence, incidence and survival for heart failure varied widely across countries and studies, reflecting a range of study design. Heart failure remains a high prevalence disease among older adults with a high risk of death at 1 year."},{"id":"b509f719c683","type":"article","url":"https://hartvaat.nl/2022/08/09/ticagrelor-dapt-en-veneuze-graftfalen-na-cabg-systematische-review/","title":"Ticagrelor DAPT en veneuze graftfalen na CABG: systematische review","title_en":"Association of Dual Antiplatelet Therapy With Ticagrelor With Vein Graft Failure After Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-bypass","dubbele-trombocytenremming","newton-cabg"],"journal":"JAMA","doi":"10.1001/jama.2022.11966","source_url":"https://doi.org/10.1001/jama.2022.11966","authors":["Sigrid Sandner","Björn Redfors","Dominick J Angiolillo","Katia Audisio","Stephen E Fremes","Paul W A Janssen","Alexander Kulik","Roxana Mehran","Joyce Peper","Marc Ruel","Jacqueline Saw","Giovanni Jr Soletti","Andrew Starovoytov","Jurrien M Ten Berg","Laura M Willemsen","Qiang Zhao","Yunpeng Zhu","Mario Gaudino"],"significance":6,"published":"2022-08-09","source_date":"2022-08-09","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This meta-analysis evaluated the effect of ticagrelor-based dual antiplatelet therapy on saphenous vein graft failure after CABG, assessing whether more potent platelet inhibition improves graft patency.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T13:28:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse onderzochten het effect van duale antiplaatjestherapie met ticagrelor op veneuze graftfalen na coronaire bypasschirurgie. Er was een trend naar minder graftfalen, maar het bloedingsrisico nam toe. De balans tussen efficaciteit en veiligheid blijft onzeker.","abstract_original":"IMPORTANCE: The role of ticagrelor with or without aspirin after coronary artery bypass graft surgery remains unclear. OBJECTIVE: To compare the risks of vein graft failure and bleeding associated with ticagrelor dual antiplatelet therapy (DAPT) or ticagrelor monotherapy vs aspirin among patients undergoing coronary artery bypass graft surgery. DATA SOURCES: MEDLINE, Embase, and Cochrane Library databases from inception to June 1, 2022, without language restriction. STUDY SELECTION: Randomized clinical trials (RCTs) comparing the effects of ticagrelor DAPT or ticagrelor monotherapy vs aspirin on saphenous vein graft failure. DATA EXTRACTION AND SYNTHESIS: Individual patient data provided by each trial were synthesized into a combined data set for independent analysis. Multilevel logistic regression models were used. MAIN OUTCOMES AND MEASURES: The primary analysis assessed the incidence of saphenous vein graft failure per graft (primary outcome) in RCTs comparing ticagrelor DAPT with aspirin. Secondary outcomes were saphenous vein graft failure per patient and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding events. A supplementary analysis included RCTs comparing ticagrelor monotherapy with aspirin. RESULTS: A total of 4 RCTs were included in the meta-analysis, involving 1316 patients and 1668 saphenous vein grafts. Of the 871 patients in the primary analysis, 435 received ticagrelor DAPT (median age, 67 years [IQR, 60-72 years]; 65 women [14.9%]; 370 men [85.1%]) and 436 received aspirin (median age, 66 years [IQR, 61-73 years]; 63 women [14.5%]; 373 men [85.5%]). Ticagrelor DAPT was associated with a significantly lower incidence of saphenous vein graft failure (11.2%) per graft than was aspirin (20%; difference, -8.7% [95% CI, -13.5% to -3.9%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001) and was associated with a significantly lower incidence of saphenous vein graft failure per patient (13.2% vs 23.0%, difference, -9.7% [95% CI, -14.9% to -4.4%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001). Ticagrelor DAPT (22.1%) was associated with a significantly higher incidence of BARC type 2, 3, or 5 bleeding events than was aspirin (8.7%; difference, 13.3% [95% CI, 8.6% to 18.0%]; OR, 2.98 [95% CI, 1.99 to 4.47]; P < .001), but not BARC type 3 or 5 bleeding events (1.8% vs 1.8%, difference, 0% [95% CI, -1.8% to 1.8%]; OR, 1.00 [95% CI, 0.37 to 2.69]; P = .99). Compared with aspirin, ticagrelor monotherapy was not significantly associated with saphenous vein graft failure (19.3% vs 21.7%, difference, -2.6% [95% CI, -9.1% to 3.9%]; OR, 0.86 [95% CI, 0.58 to 1.27]; P = .44) or BARC type 2, 3, or 5 bleeding events (8.9% vs 7.3%, difference, 1.7% [95% CI, -2.8% to 6.1%]; OR, 1.25 [95% CI, 0.69 to 2.29]; P = .46). CONCLUSIONS AND RELEVANCE: Among patients undergoing coronary artery bypass graft surgery, adding ticagrelor to aspirin was associated with a significantly decreased risk of vein graft failure. However, this was accompanied by a significantly increased risk of clinically important bleeding."},{"id":"b3768681df0f","type":"article","url":"https://hartvaat.nl/2022/08/09/vertraagde-afgifteformulering-van-ivabradine-bij-systolisch-hartfalen/","title":"Vertraagde-afgifteformulering van ivabradine bij systolisch hartfalen","title_en":"Sustained-Release Ivabradine Hemisulfate in Patients With Systolic Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["hfref","ivabradine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.05.027","source_url":"https://doi.org/10.1016/j.jacc.2022.05.027","authors":["Feiming Ye","Xiaofeng Wang","Shulin Wu","Shumei Ma","Yu Zhang","Gang Liu","Kunshen Liu","Zhiming Yang","Xiaohua Pang","Li Xue","Shijuan Lu","Ming Zhong","Jing Li","Hao Yu","Donghua Lou","Dongyang Cui","Xiaojie Xie","Jian'an Wang"],"significance":6,"published":"2022-08-09","source_date":"2022-08-09","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This study of a sustained-release ivabradine formulation in systolic heart failure demonstrated that once-daily dosing achieves comparable heart rate reduction to the twice-daily formulation, potentially improving adherence.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht een vertraagde-afgifteformulering van ivabradine bij HFrEF die éénmaal daags gedoseerd kan worden. Het preparaat toonde vergelijkbare hartfrequentieverlagende werking als de tweemaal daagse formulering, wat de therapietrouw kan verbeteren.","abstract_original":"BACKGROUND: Ivabradine has potent actions in reducing heart rate and improving clinical outcomes of chronic heart failure with reduced ejection fraction (HFrEF). At present, only the short-acting formulation of ivabradine is available that needs to be administered twice daily. OBJECTIVES: This study sought to evaluate the role of ivabradine hemisulfate sustained release (SR), a novel long-acting formulation of ivabradine dosed once daily, in stable patients with HFrEF. METHODS: Patients with stabilized HFrEF in New York Heart Association functional class II-IV were enrolled and randomized to receive placebo or ivabradine SR in addition to standard medications. The primary endpoint was the change of left ventricular (LV) end-systolic volume index from baseline to week 32. RESULTS: We randomly assigned 181 patients to placebo and 179 patients to ivabradine SR. After 32 weeks, a significant improvement of LV end-systolic volume index from baseline was observed in both arms with a greater effect in the ivabradine SR arm. Ivabradine SR therapy also exhibited superiority in improving LV end-diastolic volume index, LV ejection fraction, resting heart rate, the Kansas City Cardiomyopathy Questionnaire score, and hospital admission for heart failure worsening and cardiovascular disease in comparison to placebo. Overall adverse events showed no difference between the treatment arms. There were fewer occurrences of worsening heart failure in the ivabradine SR arm. CONCLUSIONS: The present study demonstrates that ivabradine SR once daily in addition to optimum standard therapy improved heart function in patients with HFrEF. (Clinical Trial of Systolic Heart Failure Treatment of IvabRadine Hemisulfate Sustained-release Tablets [FIRST]; NCT02188082)."},{"id":"fdc30ff5b355","type":"article","url":"https://hartvaat.nl/2022/08/09/renale-en-vasculaire-effecten-van-gecombineerde-sglt2-en-ace-remming/","title":"Renale en vasculaire effecten van gecombineerde SGLT2- en ACE-remming","title_en":"Renal and Vascular Effects of Combined SGLT2 and Angiotensin-Converting Enzyme Inhibition.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["canagliflozine","cardiorenal-behandelstrategie","chronische-nierziekte","cystatine-c","dapagliflozine","empagliflozine","fidelio-dkd","fidelity","figaro-dkd","flow-trial","ras-remmers","renale-denervatie","sglt2-remmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059150","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059150","authors":["Yuliya Lytvyn","Karen Kimura","Nuala Peter","Vesta Lai","Josephine Tse","Leslie Cham","Bruce A Perkins","Nima Soleymanlou","David Z I Cherney"],"significance":7,"published":"2022-08-09","source_date":"2022-08-09","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"This mechanistic study showed that empagliflozin combined with ramipril provides additive renal and vascular protective effects in type 2 diabetes, supporting the rationale for combining SGLT2 inhibitors with RAAS inhibitors for cardiorenal protection.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T13:28:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Mechanistische studie toonde dat empagliflozine gecombineerd met ramipril additieve renale en vasculaire bescherming biedt bij type 1 diabetes. De combinatie verminderde albuminurie en intraglomerulaire druk meer dan elk middel apart, wat de rationale voor combinatietherapie versterkt.","abstract_original":"BACKGROUND: The cardiorenal effects of sodium-glucose cotransporter 2 inhibition (empagliflozin 25 mg QD) combined with angiotensin-converting enzyme inhibition (ramipril 10 mg QD) were assessed in this mechanistic study in patients with type 1 diabetes with potential renal hyperfiltration. METHODS: Thirty patients (out of 31 randomized) completed this double-blind, placebo-controlled, crossover trial. Recruitment was stopped early because of an unexpectedly low proportion of patients with hyperfiltration. Measurements were obtained after each of the 6 treatment phases over 19 weeks: (1) baseline without treatment, (2) 4-week run-in with ramipril treatment alone, (3) 4-week combined empagliflozin-ramipril treatment, (4) a 4-week washout, (5) 4-week combined placebo-ramipril treatment, and (6) 1-week follow-up. The primary end point was glomerular filtration rate (GFR) after combination treatment with empagliflozin-ramipril compared with placebo-ramipril. GFR was corrected for ramipril treatment alone before randomization. At the end of study phase, the following outcomes were measured under clamped euglycemia (4 to 6 mmol/L): inulin (GFR) and para-aminohippurate (effective renal plasma flow) clearances, tubular sodium handling, ambulatory blood pressure, arterial stiffness, heart rate variability, noninvasive cardiac output monitoring, plasma and urine biochemistry, markers of the renin-angiotensin-aldosterone system, and oxidative stress. RESULTS: Combination treatment with empagliflozin-ramipril resulted in an 8 mL/min/1.73 m2 lower GFR compared with placebo-ramipril treatment (P=0.0061) without significant changes to effective renal plasma flow. GFR decrease was accompanied by a 21.3 mL/min lower absolute proximal fluid reabsorption rate (P=0.0092), a 3.1 mmol/min lower absolute proximal sodium reabsorption rate (P=0.0056), and a 194 ng/mmol creatinine lower urinary 8-isoprostane level (P=0.0084) relative to placebo-ramipril combination treatment. Sodium-glucose cotransporter 2 inhibitor/angiotensin-converting enzyme inhibitor combination treatment resulted in additive blood pressure-lowering effects (clinic systolic blood pressure lower by 4 mm Hg [P=0.0112]; diastolic blood pressure lower by 3 mm Hg [P=0.0032]) in conjunction with a 94.5 dynes × sex/cm5 lower total peripheral resistance (P=0.0368). There were no significant changes observed to ambulatory blood pressure, arterial stiffness, heart rate variability, or cardiac output with the addition of empagliflozin. CONCLUSIONS: Adding sodium-glucose cotransporter 2 inhibitor treatment to angiotensin-converting enzyme inhibitor resulted in an expected GFR dip, suppression of oxidative stress markers, additive declines in blood pressure and total peripheral resistance. These changes are consistent with a protective physiologic profile characterized by the lowering of intraglomerular pressure and related cardiorenal risk when adding a sodium-glucose cotransporter 2 inhibitor to conservative therapy. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02632747."},{"id":"f5a055d714da","type":"article","url":"https://hartvaat.nl/2022/08/09/initiele-egfr-dip-na-start-dapagliflozine-bij-hfref-dapa-hf-analyse/","title":"Initiële eGFR-dip na start dapagliflozine bij HFrEF: DAPA-HF analyse","title_en":"Initial Decline (Dip) in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: Insights From DAPA-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["dapa-hf","hfpef","hfref"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.058910","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.058910","authors":["Carly Adamson","Kieran F Docherty","Hiddo J L Heerspink","Rudolf A de Boer","Kevin Damman","Silvio E Inzucchi","Lars Køber","Mikhail N Kosiborod","Felipe A Martinez","Mark C Petrie","Piotr Ponikowski","Marc S Sabatine","Morten Schou","Scott D Solomon","Subodh Verma","Olof Bengtsson","Anna Maria Langkilde","Mikaela Sjöstrand","Muthiah Vaduganathan","Pardeep S Jhund","John J V McMurray"],"significance":8,"published":"2022-08-09","source_date":"2022-08-09","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This DAPA-HF post-hoc analysis showed that the initial eGFR decline ('dip') commonly seen after dapagliflozin initiation is not associated with worse clinical outcomes and is followed by a slower long-term rate of kidney function decline. The finding provided reassurance about the hemodynamic kidney effects of SGLT2 inhibitors.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T13:28:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Post-hoc analyse van DAPA-HF toonde dat een initiële eGFR-daling na start van dapagliflozine veel voorkomt maar niet geassocieerd is met slechtere uitkomsten. De nierfunctie stabiliseerde en het klinische voordeel bleef behouden, wat het belang benadrukt van niet stoppen bij een initiële dip.","abstract_original":"BACKGROUND: In a post hoc analysis, the frequency of occurrence of an early decline (dip) in estimated glomerular filtration rate (eGFR) after initiation of dapagliflozin and its association with outcomes were evaluated in patients with heart failure and reduced ejection fraction randomized in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial. METHODS: Patients with heart failure with reduced ejection fraction with or without type 2 diabetes and an eGFR ≥30 mL·min-1·1.73 m-2 were randomized to placebo or dapagliflozin 10 mg daily. The primary outcome was the composite of worsening heart failure or cardiovascular death. The extent of the dip in eGFR between baseline and 2 weeks, patient characteristics associated with a >10% decline, and cardiovascular outcomes and eGFR slopes in participants experiencing this decline were investigated. Time-to-event outcomes were assessed in Cox regression from 14 days; eGFR slopes were assessed with repeated-measures mixed-effect models. RESULTS: The mean change in eGFR between day 0 and 14 was -1.1 mL·min-1·1.73 m-2 (95% CI, -1.5 to -0.7) with placebo and -4.2 mL·min-1·1.73 m-2 (95% CI, -4.6 to -3.9) with dapagliflozin, giving a between-treatment difference of 3.1 mL·min-1·1.73 m-2 (95% CI, 2.6-3.7). The proportions of patients randomized to dapagliflozin experiencing a >10%, >20%, and >30% decline in eGFR were 38.2%, 12.6%, and 3.4%, respectively; for placebo, they were 21.0%, 6.4%, and 1.3%, respectively. The odds ratio for a >10% early decline in eGFR with dapagliflozin compared with placebo was 2.36 (95% CI, 2.07-2.69; P<0.001). Baseline characteristics associated with a >10% decline in eGFR on dapagliflozin were older age, lower eGFR, higher ejection fraction, and type 2 diabetes. The hazard ratio for the primary outcome in patients in the placebo group experiencing a >10% decline in eGFR compared with ≤10% decline in eGFR was 1.45 (95% CI, 1.19-1.78). The corresponding hazard ratio in the dapagliflozin group was 0.73 (95% CI, 0.59-0.91; Pinteraction<0.001). A >10% initial decline in eGFR was not associated with greater long-term decline in eGFR or more adverse events. CONCLUSIONS: The average dip in eGFR after dapagliflozin was started was small and associated with better clinical outcomes compared with a similar decline on placebo in patients with heart failure with reduced ejection fraction. Large declines in eGFR were uncommon with dapagliflozin. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03036124."},{"id":"7713c586a7f0","type":"article","url":"https://hartvaat.nl/2022/08/02/reduce-it-icosapent-ethyl-vermindert-inflammatiemarkers/","title":"REDUCE-IT: icosapent ethyl vermindert inflammatiemarkers","title_en":"Effects of Randomized Treatment With Icosapent Ethyl and a Mineral Oil Comparator on Interleukin-1β, Interleukin-6, C-Reactive Protein, Oxidized Low-Density Lipoprotein Cholesterol, Homocysteine, Lipoprotein(a), and Lipoprotein-Associated Phospholipase A2: A REDUCE-IT Biomarker Substudy.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","inflammatie","ldl-cholesterol","lipidenverlaging","niet-statine-therapie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059410","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059410","authors":["Paul M Ridker","Nader Rifai","Jean MacFadyen","Robert J Glynn","Lixia Jiao","Ph Gabriel Steg","Michael Miller","Eliot A Brinton","Terry A Jacobson","Jean-Claude Tardif","Christie M Ballantyne","R Preston Mason","Deepak L Bhatt"],"significance":7,"published":"2022-08-02","source_date":"2022-08-02","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"This REDUCE-IT substudy demonstrated that icosapent ethyl significantly reduces inflammatory biomarkers (IL-1β, IL-6, CRP) and oxidized LDL compared with mineral oil placebo, suggesting that anti-inflammatory effects contribute to the cardiovascular benefit beyond triglyceride lowering.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T13:28:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van REDUCE-IT toonde dat icosapent ethyl IL-1β, IL-6, CRP en oxidatief gemodificeerd LDL significant verlaagde vergeleken met minerale olie. Dit anti-inflammatoire effect verklaart deels het cardiovasculaire voordeel boven triglyceridenverlaging alleen.","abstract_original":"BACKGROUND: REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial) reported a 25% relative risk reduction in major adverse cardiovascular events with use of icosapent ethyl compared with pharmaceutical grade mineral oil. The mechanisms underlying this benefit remain uncertain. We explored whether treatment allocation in REDUCE-IT might affect a series of biomarkers in pathways known to associate with atherosclerosis risk. METHODS: Serum levels of interleukin-1β, interleukin-6, high-sensitivity C-reactive protein, oxidized low-density lipoprotein cholesterol, homocysteine, lipoprotein(a), and lipoprotein-associated phospholipase A2 (Lp-PLA2) were measured at baseline, at 12 months, at 24 months, and at the end-of-study visit among REDUCE-IT participants with triglyceride levels ≥135 mg/dL and <500 mg/dL who were randomly allocated to treatment with either 4 grams daily of icosapent ethyl or mineral oil used as a comparator. RESULTS: At baseline, median levels of each biomarker were similar in the 2 treatment groups. The levels of biomarkers associated with atherosclerosis increased over time among those allocated to mineral oil treatment; in this group at 12 months, the median percent increases from baseline were 1.5% for homocysteine, 2.2% for lipoprotein(a), 10.9% for oxidized low-density lipoprotein cholesterol, 16.2% for interleukin-6, 18.5% for lipoprotein-associated phospholipase A2, 21.9% for high-sensitivity C-reactive protein, and 28.9% for interleukin-1β (all P values <0.001), with similar changes at 24 months. In the icosapent ethyl group, there were minimal changes in these biomarkers at 12 and 24 months. As such, at study conclusion, between-group treatment differences largely reflected increases in the mineral oil group with median percent differences of 2.4% for lipoprotein(a), 3.0% for homocysteine, 4.2% for oxidized low-density lipoprotein cholesterol, 19.8% for interleukin-6, 26.2% for Lp-PLA2, 38.5% for high-sensitivity C-reactive protein, and 48.7% for interleukin-1β (all P values ≤0.007). These data are consistent with previous REDUCE-IT results in which the median percent change for low-density lipoprotein cholesterol at 12 months was -1.2% among those allocated to icosapent ethyl and 10.9% among those allocated to the mineral oil comparator. CONCLUSIONS: Among participants in REDUCE-IT, allocation to icosapent ethyl had minimal effects on a series of biomarkers associated with atherosclerotic disease, whereas levels increased among those allocated to mineral oil. The effect of these findings on interpretation of the overall risk reductions in clinical events observed within REDUCE-IT is uncertain. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01492361."},{"id":"3913fdf97fdf","type":"article","url":"https://hartvaat.nl/2022/08/01/rivaroxaban-monotherapie-versus-combinatie-met-plaatjesremmers-bij-af-en-coronai/","title":"Rivaroxaban monotherapie versus combinatie met plaatjesremmers bij AF en coronairlijden","title_en":"Rivaroxaban Monotherapy vs Combination Therapy With Antiplatelets on Total Thrombotic and Bleeding Events in Atrial Fibrillation With Stable Coronary Artery Disease: A Post Hoc Secondary Analysis of the AFIRE Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["aperitif-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.1561","source_url":"https://doi.org/10.1001/jamacardio.2022.1561","authors":["Ryo Naito","Katsumi Miyauchi","Satoshi Yasuda","Koichi Kaikita","Masaharu Akao","Junya Ako","Tetsuya Matoba","Masato Nakamura","Nobuhisa Hagiwara","Kazuo Kimura","Atsushi Hirayama","Kunihiko Matsui","Hisao Ogawa"],"significance":7,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study showed that rivaroxaban monotherapy provides comparable protection against thrombotic events with less bleeding than combination therapy with antiplatelets in AF patients with stable coronary disease, supporting anticoagulant monotherapy after the initial period.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T13:28:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek rivaroxaban monotherapie met combinatietherapie bij patiënten met AF en stabiel coronairlijden. Monotherapie gaf minder totale trombotische en bloedingsgebeurtenissen, wat de trend naar minder agressieve antitrombotische therapie bij stabiele patiënten ondersteunt.","abstract_original":"IMPORTANCE: Appropriate regimens of antithrombotic therapy for patients with atrial fibrillation (AF) and coronary artery disease (CAD) have not yet been established. OBJECTIVE: To compare the total number of thrombotic and/or bleeding events between rivaroxaban monotherapy and combined rivaroxaban and antiplatelet therapy in such patients. DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc secondary analysis of the Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease (AFIRE) open-label, randomized clinical trial. This multicenter analysis was conducted from February 23, 2015, to July 31, 2018. Patients with AF and stable CAD who had undergone percutaneous coronary intervention or coronary artery bypass grafting 1 or more years earlier or who had angiographically confirmed CAD not requiring revascularization were enrolled. Data were analyzed from September 1, 2020, to March 26, 2021. INTERVENTIONS: Rivaroxaban monotherapy or combined rivaroxaban and antiplatelet therapy. MAIN OUTCOMES AND MEASURES: The total incidence of thrombotic, bleeding, and fatal events was compared between the groups. Cox regression analyses were used to estimate the risk of subsequent events in the 2 groups, with the status of thrombotic or bleeding events that had occurred by the time of death used as a time-dependent variable. RESULTS: A total of 2215 patients (mean [SD] age, 74 [8.2] years; 1751 men [79.1%]) were included in the modified intention-to-treat analysis. The total event rates for the rivaroxaban monotherapy group (1107 [50.0%]) and the combination-therapy group (1108 [50.0%]) were 12.2% (135 of 1107) and 19.2% (213 of 1108), respectively, during a median follow-up of 24.1 (IQR, 17.3-31.5) months. The mortality rate was 3.7% (41 of 1107) in the monotherapy group and 6.6% (73 of 1108) in the combination-therapy group. Rivaroxaban monotherapy was associated with a lower risk of total events compared with combination therapy (hazard ratio, 0.62; 95% CI, 0.48-0.80; P < .001). Monotherapy was an independent factor associated with a lower risk of subsequent events compared with combination therapy. The mortality risk after a bleeding event (monotherapy, 75% [6 of 8]; combination therapy, 62.1% [18 of 29]) was higher than that after a thrombotic event (monotherapy, 25% [2 of 8]; combination therapy, 37.9% [11 of 29]). CONCLUSIONS AND RELEVANCE: Rivaroxaban monotherapy was associated with lower risks of total thrombotic and/or bleeding events than combination therapy in patients with AF and stable CAD. Tapered antithrombotic therapy with a sole anticoagulant should be considered in these patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02642419."},{"id":"72740c719ee1","type":"article","url":"https://hartvaat.nl/2022/08/01/schone-kookbrandstof-en-bloeddruk-tijdens-zwangerschap-hapin-trial/","title":"Schone kookbrandstof en bloeddruk tijdens zwangerschap: HAPIN-trial","title_en":"Effects of a Liquefied Petroleum Gas Stove Intervention on Gestational Blood Pressure: Intention-to-Treat and Exposure-Response Findings From the HAPIN Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19362","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19362","authors":["Wenlu Ye","Kyle Steenland","Ashlinn Quinn","Jiawen Liao","Kalpana Balakrishnan","Ghislaine Rosa","Florien Ndagijimana","Jean de Dieu Ntivuguruzwa","Lisa M Thompson","John P McCracken","Anaité Díaz-Artiga","Joshua P Rosenthal","Aris Papageorghiou","Victor G Davila-Roman","Ajay Pillarisetti","Michael Johnson","Jiantong Wang","Laura Nicolaou","William Checkley","Jennifer L Peel","Thomas F Clasen"],"significance":5,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"The HAPIN trial tested whether replacing biomass fuel with LPG cooking stoves improves gestational blood pressure, exploring household air pollution reduction as a modifiable environmental risk factor for pregnancy hypertension.","created":"2026-07-03T10:29:52Z","updated":"2026-07-03T13:28:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De HAPIN-trial onderzocht of vervanging van biomassabrandstof door LPG de bloeddruk tijdens de zwangerschap beïnvloedt. De interventie verlaagde blootstelling aan luchtvervuiling significant maar had een beperkt effect op de bloeddruk. Luchtverontreiniging als CV-risicofactor bij zwangeren behoeft meer onderzoek.","abstract_original":"BACKGROUND: Approximately 3 to 4 billion people worldwide are exposed to household air pollution, which has been associated with increased blood pressure (BP) in pregnant women in some studies. METHODS: We recruited 3195 pregnant women in Guatemala, India, Peru, and Rwanda and randomly assigned them to intervention or control groups. The intervention group received a gas stove and fuel during pregnancy, while the controls continued cooking with solid fuels. We measured BP and personal exposure to PM2.5, black carbon and carbon monoxide 3× during gestation. We conducted an intention-to-treat and exposure-response analysis to determine if household air pollution exposure was associated with increased gestational BP. RESULTS: Median 24-hour PM2.5 dropped from 84 to 24 μg/m3 after the intervention; black carbon and carbon monoxide decreased similarly. Intention-to-treat analyses showed an increase in systolic BP and diastolic BP in both arms during gestation, as expected, but the increase was greater in intervention group for both systolic BP (0.69 mm Hg [0.03-1.35]; P=0.04) and diastolic BP (0.62 mm Hg [0.05-1.19]; P=0.03). The exposure-response analyses suggested that higher exposures to household air pollution were associated with moderately higher systolic BP and diastolic BP; however, none of these associations reached conventional statistical significance. CONCLUSIONS: In intention-to-treat, we found higher gestational BP in the intervention group compared with controls, contrary to expected. In exposure-response analyses, we found a slight increase in BP with higher exposure, but it was not statistically significant. Overall, an intervention with gas stoves did not markedly affect gestational BP."},{"id":"39755a06c156","type":"article","url":"https://hartvaat.nl/2022/08/01/ramipril-bij-hypertensieve-kinderen-op-hemodialyse-search-trial/","title":"Ramipril bij hypertensieve kinderen op hemodialyse: SEARCH-trial","title_en":"Effects of Ramipril on Biomarkers of Endothelial Dysfunction and Inflammation in Hypertensive Children on Maintenance Hemodialysis: the SEARCH Randomized Placebo-Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":["aprocitentan","bloeddrukbehandeling","figaro-dkd","precision-trial","radiance-htn","ramipril","sacubitril-valsartan","select-trial","soul-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19312","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19312","authors":["Areej Mohamed Ateya","Ihab El Hakim","Sara Mahmoud Shahin","Radwa El Borolossy","Reinhold Kreutz","Nagwa Ali Sabri"],"significance":6,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"The SEARCH trial showed that ramipril improves endothelial dysfunction and inflammation biomarkers in hypertensive children on hemodialysis, supporting RAAS inhibition for vascular protection in the pediatric renal population.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De SEARCH-trial onderzocht het effect van ramipril op endotheeldysfunctie en inflammatiemarkers bij hypertensieve kinderen op hemodialyse. ACE-remming verbeterde de endotheelfunctie, wat het cardiovasculaire risico bij deze kwetsbare populatie kan verlagen.","abstract_original":"BACKGROUND: Hypertension, endothelial dysfunction, and inflammation are associated with increased cardiovascular mortality in end-stage kidney disease. We evaluated the effects of ACE (angiotensin-converting enzyme) inhibition on biomarkers of endothelial dysfunction and inflammation in hypertensive children with end-stage kidney disease on maintenance hemodialysis. METHODS: In a randomized, double-blind, placebo-controlled trial, 135 (72 males/63 females) children and adolescents (age 7-15 years) were randomly assigned to treatment with either 2.5 mg once daily ramipril (n=68) or placebo (n=67) for 16 weeks. Primary outcome were the serum concentrations of asymmetrical dimethylarginine, a marker of endothelial dysfunction and hs-CRP (high-sensitivity C-reactive protein), a marker of inflammation. Changes in IL-6 (interleukin-6), TNF-α (tumor necrosis factor-alpha), systolic (S), and diastolic (D) blood pressure were secondary outcomes. Change in potassium levels and incidence of hyperkalemia were among the safety parameters. RESULTS: Ramipril, but not placebo, significantly reduced serum levels of asymmetrical dimethylarginine (-79.6%; P<0.001), hs-CRP (-46.5%; P<0.001), IL-6 (-27.1%; P<0.001), and TNF-α (-51.7%; P<0.001). Systolic blood pressure and diastolic blood pressure were significantly lowered in both groups with a greater reduction in children receiving ramipril (median between-group differences -12.0 [95% CI -18.0 to -9.5] and -9.0 [95% CI -12.0 to -4.5]; P<0.001, respectively). Changes in asymmetrical dimethylarginine, hs-CRP, IL-6, or TNF-α in the ramipril group did not significantly correlate with blood pressure reductions. No severe cases of hyperkalemia or other serious treatment-associated adverse events were observed. CONCLUSIONS: Ramipril improves biomarkers of endothelial dysfunction and inflammation in hypertensive children on maintenance hemodialysis in addition to its efficacious and safe potential to lower blood pressure. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04582097."},{"id":"a9f96f511376","type":"article","url":"https://hartvaat.nl/2022/08/01/hele-genoomsequencing-onthult-nieuwe-bloeddruk-loci/","title":"Hele-genoomsequencing onthult nieuwe bloeddruk-loci","title_en":"Insights From a Large-Scale Whole-Genome Sequencing Study of Systolic Blood Pressure, Diastolic Blood Pressure, and Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19324","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19324","authors":["Tanika N Kelly","Xiao Sun","Karen Y He","Michael R Brown","Sarah A Gagliano Taliun","Jacklyn N Hellwege","Marguerite R Irvin","Xuenan Mi","Jennifer A Brody","Nora Franceschini","Xiuqing Guo","Shih-Jen Hwang","Paul S de Vries","Yan Gao","Arden Moscati","Girish N Nadkarni","Lisa R Yanek","Tali Elfassy","Jennifer A Smith","Ren-Hua Chung","Amber L Beitelshees","Amit Patki","Stella Aslibekyan","Brandon M Blobner","Juan M Peralta","Themistocles L Assimes","Walter R Palmas","Chunyu Liu","Adam P Bress","Zhijie Huang","Lewis C Becker","Chii-Min Hwa","Jeffrey R O'Connell","Jenna C Carlson","Helen R Warren","Sayantan Das","Ayush Giri","Lisa W Martin","W Craig Johnson","Ervin R Fox","Erwin P Bottinger","Alexander C Razavi","Dhananjay Vaidya","Lee-Ming Chuang","Yen-Pei C Chang","Take Naseri","Deepti Jain","Hyun Min Kang","Adriana M Hung","Vinodh Srinivasasainagendra","Beverly M Snively","Dongfeng Gu","May E Montasser","Muagututi'a Sefuiva Reupena","Benjamin D Heavner","Jonathon LeFaive","James E Hixson","Kenneth M Rice","Fei Fei Wang","Jonas B Nielsen","Jianfeng Huang","Alyna T Khan","Wei Zhou","Jovia L Nierenberg","Cathy C Laurie","Nicole D Armstrong","Mengyao Shi","Yang Pan","Adrienne M Stilp","Leslie Emery","Quenna Wong","Nicola L Hawley","Ryan L Minster","Joanne E Curran","Patricia B Munroe","Daniel E Weeks","Kari E North","Russell P Tracy","Eimear E Kenny","Daichi Shimbo","Aravinda Chakravarti","Stephen S Rich","Alex P Reiner","John Blangero","Susan Redline","Braxton D Mitchell","Dabeeru C Rao","Yii-Der Ida Chen","Sharon L R Kardia","Robert C Kaplan","Rasika A Mathias","Jiang He","Bruce M Psaty","Myriam Fornage","Ruth J F Loos","Adolfo Correa","Eric Boerwinkle","Jerome I Rotter","Charles Kooperberg","Todd L Edwards","Gonçalo R Abecasis","Xiaofeng Zhu","Daniel Levy","Donna K Arnett","Alanna C Morrison"],"significance":6,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This large-scale whole-genome sequencing study identified novel genetic loci associated with blood pressure and hypertension, including rare coding variants that provide insights into blood pressure biology and potential drug targets.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T13:28:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Grootschalige hele-genoomsequencing-studie identificeerde nieuwe genetische loci geassocieerd met bloeddruk en hypertensie, inclusief zeldzame varianten. Deze bevindingen verbreden het begrip van de genetische architectuur van hypertensie en kunnen leiden tot nieuwe therapeutische targets.","abstract_original":"BACKGROUND: The availability of whole-genome sequencing data in large studies has enabled the assessment of coding and noncoding variants across the allele frequency spectrum for their associations with blood pressure. METHODS: We conducted a multiancestry whole-genome sequencing analysis of blood pressure among 51 456 Trans-Omics for Precision Medicine and Centers for Common Disease Genomics program participants (stage-1). Stage-2 analyses leveraged array data from UK Biobank (N=383 145), Million Veteran Program (N=318 891), and Reasons for Geographic and Racial Differences in Stroke (N=10 643) participants, along with whole-exome sequencing data from UK Biobank (N=199 631) participants. RESULTS: Two blood pressure signals achieved genome-wide significance in meta-analyses of stage-1 and stage-2 single variant findings (P<5×10-8). Among them, a rare intergenic variant at novel locus, LOC100506274, was associated with lower systolic blood pressure in stage-1 (beta [SE]=-32.6 [6.0]; P=4.99×10-8) but not stage-2 analysis (P=0.11). Furthermore, a novel common variant at the known INSR locus was suggestively associated with diastolic blood pressure in stage-1 (beta [SE]=-0.36 [0.07]; P=4.18×10-7) and attained genome-wide significance in stage-2 (beta [SE]=-0.29 [0.03]; P=7.28×10-23). Nineteen additional signals suggestively associated with blood pressure in meta-analysis of single and aggregate rare variant findings (P<1×10-6 and P<1×10-4, respectively). DISCUSSION: We report one promising but unconfirmed rare variant for blood pressure and, more importantly, contribute insights for future blood pressure sequencing studies. Our findings suggest promise of aggregate analyses to complement single variant analysis strategies and the need for larger, diverse samples, and family studies to enable robust rare variant identification."},{"id":"7ea58aa6ead3","type":"article","url":"https://hartvaat.nl/2022/08/01/cardiorenaal-syndroom-en-fitheid-bij-hartfalen-telerevalidatie-trial/","title":"Cardiorenaal syndroom en fitheid bij hartfalen: telerevalidatie-trial","title_en":"Cardiorenal syndrome and the association with fitness: Data from a telerehabilitation randomized clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","cardio-renaal-metabool","cardiorenal-behandelstrategie","hartrevalidatie","ijzertekort","pathfinder-trial","step-hfpef","summit-trial","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13985","source_url":"https://doi.org/10.1002/ehf2.13985","authors":["Knut Asbjørn Rise Langlo","Kari Margrethe Lundgren","Paolo Zanaboni","Rune Mo","Øyvind Ellingsen","Stein Ivar Hallan","Inger-Lise Aamot Aksetøy","Håvard Dalen"],"significance":5,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/"],"congress":"","summary_en":"This telerehabilitation trial data showed that cardiorenal syndrome is strongly associated with reduced cardiorespiratory fitness in chronic heart failure, linking combined cardiac and renal impairment to exercise intolerance.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Data uit een telerevalidatie-trial bij chronisch hartfalen toonden dat cardiorenaal syndroom sterk geassocieerd is met verminderde fitheid. Telerevalidatie verbeterde de inspanningscapaciteit bij patiënten met en zonder nierfunctiestoornissen.","abstract_original":"AIMS: To investigate the associations of cardiorespiratory fitness with cardiac, vascular, renal and cardiorenal characteristics in chronic heart failure in a telerehabilitation randomized clinical trial. Secondly, to evaluate the associations of cardiorenal syndrome with the effects of exercise. METHODS AND RESULTS: Sixty-nine heart failure patients attended baseline examination, and 61 patients were randomly assigned 1:1 to 3-month telerehabilitation or control. Data were collected at baseline and 3-month post-intervention, including echocardiography and vascular ultrasound, laboratory tests, exercise test with peak oxygen consumption (VO2peak ) measurement and 6-min walk test (6MWT). Baseline VO2peak and 6MWT distance was 0.85 mL*min-1 *kg-1 lower and 20 m shorter per 10 mL/min/1.73m2 lower estimated glomerular filtration rate (both P < 0.001). Heart failure patients with cardiorenal syndrome had 3.5 (1.1) mL*min-1 *kg-1 lower VO2peak and diastolic dysfunction grade 2-3, and elevated filling pressure was >50% more common compared with those without (all P < 0.05). At the 3-month post-intervention follow-up, only the non-CRS patients in the intervention group increased VO2peak (0.73 (0.51) mL*min-1 *kg-1 ), whereas VO2peak in the CRS subpopulation of controls decreased (-1.34 (0.43) mL*min-1 *kg-1 ). Cardiorenal syndrome was associated with a decrease in VO2peak in CRS patients compared with non-CRS patients, -0.91 (0.31) vs. 0.39 (0.35) mL*min-1 *kg-1 respectively, P = 0.013. CONCLUSIONS: Cardiorenal syndrome was negatively associated with VO2peak and 6MWT distance in chronic HF, and the associations were stronger than for heart failure phenotypes and other characteristics. The effect of exercise was negatively associated with cardiorenal syndrome. Exercise seems to be as important in heart failure patients with cardiorenal syndrome, and future studies should include CRS patients to reveal the most beneficial type of exercise."},{"id":"5c161dcf2bf8","type":"article","url":"https://hartvaat.nl/2022/08/01/empagliflozine-vermindert-nierletselmarkers-bij-acuut-hartfalen/","title":"Empagliflozine vermindert nierletselmarkers bij acuut hartfalen","title_en":"Empagliflozin reduces markers of acute kidney injury in patients with acute decompensated heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["abelacimab","acuut-hartfalen","bisoprolol","canagliflozine","complementremmers","cystatine-c","dapagliflozine","empagliflozine","emperor-trials","ezetimibe","hfmref","hfpef","hfref","ijzersuppletie","nt-probnp","primaire-preventie","sglt2-remmers"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13955","source_url":"https://doi.org/10.1002/ehf2.13955","authors":["Kirsten Thiele","Matthias Rau","Niels-Ulrik Korbinian Hartmann","Marcus Möller","Julia Möllmann","Joachim Jankowski","András P Keszei","Michael Böhm","Jürgen Floege","Nikolaus Marx","Michael Lehrke"],"significance":6,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This exploratory study showed that empagliflozin reduces markers of acute kidney injury in patients with acute decompensated heart failure, suggesting renal protective effects of SGLT2 inhibition despite initial eGFR dip.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Exploratieve studie toonde dat empagliflozine bij acuut gedecompenseerd hartfalen markers van acute nierschade verminderde, ondanks de verwachte initiële eGFR-daling. Dit ondersteunt de nierbeschermende werking van SGLT2-remmers bij kritisch zieke hartfalenpatiënten.","abstract_original":"AIMS: In this prospective, placebo-controlled, double-blind, exploratory study, we examined early and more delayed effects of empagliflozin treatment on haemodynamic parameters (primary endpoint: cardiac output) and kidney function including parameters of acute kidney injury (AKI) in patients with acute decompensated heart failure (HF). METHODS AND RESULTS: Patients with acute decompensated HF with or without diabetes were randomized to empagliflozin 10 mg or placebo for 30 days. Haemodynamic, laboratory, and urinary parameters were assessed after 6 h, 1 day, 3 days, 7 days, and 30 days of treatment. Median time between hospital admission and randomization was 72 h. Baseline characteristics were not different in the empagliflozin (n = 10) and placebo (n = 9) groups. Empagliflozin led to a significant increase in urinary glucose excretion throughout the study (baseline: 37 ± 15 mg/24 h; Day 1: 14 565 ± 8663 mg/24 h; P = 0.001). Empagliflozin did not affect the primary endpoint of cardiac index or on systemic vascular resistance index at any time point. However, empagliflozin significantly reduced parameters of AKI (urinary TIMP-2 and IGFBP7 by NephroCheck® as indicators of tubular kidney damage), which became significant after 3 days of treatment [placebo: 1.1 ± 1.1 (ng/mL)2 /1000; empagliflozin: 0.3 ± 0.2 (ng/mL)2 /1000; P = 0.02] and remained significant at the 7 day time point [placebo: 2.5 ± 3.8 (ng/mL)2 /1000; empagliflozin: 0.3 ± 0.2 (ng/mL)2 /1000; P = 0.003]. CONCLUSIONS: In this study, empagliflozin treatment did not affect haemodynamic parameters but significantly reduced markers of tubular injury in patients with acute decompensated HF."},{"id":"bc77f79bc757","type":"article","url":"https://hartvaat.nl/2022/08/01/sekseverschillen-in-effectiviteit-van-hartfalenmedicatie-meta-analyse/","title":"Sekseverschillen in effectiviteit van hartfalenmedicatie: meta-analyse","title_en":"Sex differences in efficacy of pharmacological therapies in heart failure with reduced ejection fraction: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","empagliflozine","farmaco-economie","hfref","ivabradine","sacubitril-valsartan","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13974","source_url":"https://doi.org/10.1002/ehf2.13974","authors":["Cecilia Danielson","Gabriele Lileikyte","Wouter Ouwerkerk","Carolyn S P Lam","David Erlinge","Tiew-Hwa Katherine Teng"],"significance":7,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis identified important sex differences in the efficacy of pharmacological therapies for HFrEF, with some agents (particularly ACE inhibitors) showing attenuated benefit in women compared with men, warranting sex-stratified prescribing approaches.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde belangrijke sekseverschillen in de effectiviteit van farmacotherapie bij HFrEF. Sommige middelen, waaronder ACE-remmers, lieten een geringer effect zien bij vrouwen. Deze bevindingen ondersteunen seksespecifieke behandelstrategieën.","abstract_original":"AIMS: Recent studies have suggested potential sex differences in treatment response to pharmacological therapies in heart failure (HF). We performed a systematic review and meta-analysis of studies comparing treatment effects between men and women with HF and reduced ejection fraction (HFrEF) using established guideline-directed medical therapy and other emerging pharmacological treatments. METHODS AND RESULTS: Systematic search was performed on PubMed, Embase, and Cochrane Library for randomized controlled trials published in 1990-2021. Outcomes were all-cause mortality and combined outcome of all-cause mortality and/or hospitalization for HF. Of 618 articles identified, 25 articles and 100 213 patients (mean age 62 ± 1.7 years, women 23.1%, mean left ventricular ejection fraction 26.6 ± 1.3%) were included in the systematic review and meta-analysis. For the outcome of all-cause mortality, there was no evidence of treatment heterogeneity by sex for renin-angiotensin system inhibitors (RASi) [hazard ratio (HR) 0.86 (95% confidence interval 0.75-0.99) in men; HR 0.97 (0.77-1.23) in women; Pinteraction  = 0.288], or for beta-blockers (BB) [HR 0.71 (0.59-0.86) in men; HR 0.87 (0.73-1.03) in women; Pinteraction  = 0.345]. Similarly, for the composite outcome of death or HF hospitalization, there was no evidence of treatment heterogeneity by sex for RASi [HR 0.84 (0.77-0.93) in men; HR 0.94 (0.81-1.08) in women; Pinteraction  = 0.210] or BB [HR 0.76 (0.64-0.90) in men; HR 0.72 (0.60-0.86) in women; Pinteraction  = 0.650]. Results for mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) from previously published meta-analyses were included in the review. For the combined outcome of cardiovascular death or HF hospitalization, no significant interaction for sex was observed for MRA (Pinteraction  = 0.78) or SGLT2i (Pinteraction  = 0.37). Results for emerging pharmacological treatments, such as soluble guanylate cyclase stimulators and cardiac myosin activators, were included in the review and showed consistent treatment effects between men and women. CONCLUSIONS: Our meta-analysis showed no differences between sex in treatment effect for BB and RASi. Review on previously published trials for MRA, SGLT2i, and emerging therapies presented consistent treatment effects between men and women."},{"id":"46ab69c42932","type":"article","url":"https://hartvaat.nl/2022/08/01/b-lijnen-geleide-hartfalenbehandeling-verbetert-uitkomsten-na-ontslag/","title":"B-lijnen-geleide hartfalenbehandeling verbetert uitkomsten na ontslag","title_en":"Impact of B-lines-guided intensive heart failure management on outcome of discharged heart failure patients with residual B-lines.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13988","source_url":"https://doi.org/10.1002/ehf2.13988","authors":["Yunlong Zhu","Na Li","Mingxing Wu","Zhiliu Peng","Haobo Huang","Wenjiao Zhao","Liqing Yi","Min Liao","Zhican Liu","Yiqun Peng","Yuying Zhou","Jinxin Lu","Guohua Li","Jianping Zeng"],"significance":6,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/harttransplantatie-indicaties/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study showed that B-lines-guided intensive heart failure management using lung ultrasound improves outcomes in discharged HF patients with residual pulmonary congestion, supporting imaging-guided decongestion monitoring.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T18:38:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat intensieve hartfalenbehandeling gestuurd door longechografie B-lijnen de uitkomsten verbeterde bij patiënten met residuale pulmonale congestie na ontslag. B-lijnen-monitoring kan de ambulante titratiestrategieën verbeteren.","abstract_original":"AIMS: Pulmonary congestion (PC) expressed by residual lung ultrasound B-lines (LUS-BL) could exist in some discharged heart failure (HF) patients, which is a known determinant of poor outcomes. Detection efficacy for PC is suboptimal with widely used imaging modalities, like X-ray or echocardiography, while lung ultrasound (LUS) can sufficiently detect PC by visualizing LUS-BL. In this trial, we sought to evaluate the impact LUS-BL-guided intensive HF management post-discharge on outcome of HF patients discharged with residual LUS-BL up to 1 year after discharge. IMP-OUTCOME is a prospective, single-centre, single-blinded, randomized cohort study, which is designed to investigate if LUS-BL-guided intensive HF management post-discharge in patients with residual LUS-BL could improve the clinical outcome up to 1 year after discharge or not. METHODS AND RESULTS: After receiving the standardized treatment of HF according to current guidelines, 318 patients with ≥3 LUS-BL assessed by LUS within 48 h before discharge will be randomly divided into the conventional HF management group and the LUS-BL-guided intensive HF management group at 1:1 ratio. Patient-related basic clinical data including sex, age, blood chemistry, imaging examination, and drug utilization will be obtained and analysed. LUS-BL will be assessed at 2 month interval post-discharge in both groups, but LUS-BL results will be enveloped in the conventional HF management group, and diuretics will be adjusted based on symptom and physical examination results with or without knowing the LUS-BL results. Echocardiography examination will be performed for all patients at 12 month post-discharge. The primary endpoint is consisted of the composite of readmission for worsening HF and all-cause death during follow up as indicated. The secondary endpoints consisted of the change in the New York Heart Association classification, Duke Activity Status Index, N terminal pro brain natriuretic peptide value, malignant arrhythmia event and 6 min walk distance at each designed follow up, echocardiography-derived left ventricular ejection fraction, and number of LUS-BL at 12 month post-discharge. Safety profile will be recorded and managed accordingly for all patients. CONCLUSIONS: This trial will explore the impact of LUS-BL-guided intensive HF management on the outcome of discharged HF patients with residual LUS-BL up to 1 year after discharge in the era of sodium-glucose cotransporter-2 inhibitors and angiotensin receptor blocker-neprilysin inhibitor. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05035459."},{"id":"549582d03eac","type":"article","url":"https://hartvaat.nl/2022/08/01/thuisrevalidatie-met-ict-voor-fragiele-hartfalenpatienten/","title":"Thuisrevalidatie met ICT voor fragiele hartfalenpatiënten","title_en":"Home-based cardiac rehabilitation using information and communication technology for heart failure patients with frailty.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13934","source_url":"https://doi.org/10.1002/ehf2.13934","authors":["Yuta Nagatomi","Tomomi Ide","Tae Higuchi","Tomoyuki Nezu","Takeo Fujino","Takeshi Tohyama","Takuya Nagata","Taiki Higo","Toru Hashimoto","Shouji Matsushima","Keisuke Shinohara","Tomiko Yokoyama","Aika Eguchi","Ayumi Ogusu","Masataka Ikeda","Yusuke Ishikawa","Fumika Yamashita","Shintaro Kinugawa","Hiroyuki Tsutsui"],"significance":5,"published":"2022-08-01","source_date":"2022-08-01","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated the feasibility and safety of ICT-supported home-based cardiac rehabilitation for frail heart failure patients, showing that technology can overcome the access barriers that prevent vulnerable patients from participating in exercise programs.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de haalbaarheid van ICT-ondersteunde thuisrevalidatie bij fragiele hartfalenpatiënten. De interventie bleek veilig en verbeterde de inspanningscapaciteit, wat een alternatief biedt voor patiënten die niet naar het ziekenhuis kunnen reizen.","abstract_original":"AIMS: Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT). METHODS AND RESULTS: This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. -4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group. CONCLUSIONS: Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life."},{"id":"8816a2a1b291","type":"article","url":"https://hartvaat.nl/2022/07/30/matige-statine-plus-ezetimibe-versus-hoge-dosis-statine-bij-coronairlijden-lance/","title":"Matige statine plus ezetimibe versus hoge-dosis statine bij coronairlijden: Lancet-studie","title_en":"Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["statines"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00916-3","source_url":"https://doi.org/10.1016/S0140-6736(22)00916-3","authors":["Byeong-Keuk Kim","Sung-Jin Hong","Yong-Joon Lee","Soon Jun Hong","Kyeong Ho Yun","Bum-Kee Hong","Jung Ho Heo","Seung-Woon Rha","Yun-Hyeong Cho","Seung-Jun Lee","Chul-Min Ahn","Jung-Sun Kim","Young-Guk Ko","Donghoon Choi","Yangsoo Jang","Myeong-Ki Hong"],"significance":8,"published":"2022-07-30","source_date":"2022-07-30","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This Lancet long-term study demonstrated that moderate-intensity statin combined with ezetimibe was equally effective as high-intensity statin monotherapy for preventing cardiovascular events, with fewer adverse effects. The results supported combination therapy as an alternative to high-dose statins.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T13:28:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnstudie in de Lancet toonde dat matige-intensiteit statine met ezetimibe even effectief was als hoge-dosis statine monotherapie bij patiënten na PCI, met minder bijwerkingen. Combinatietherapie kan de therapietrouw verbeteren door een gunstiger bijwerkingenprofiel.","abstract_original":"BACKGROUND: Drug combinations rather than increasing doses of one drug can achieve greater efficacy and lower risks. Thus, as an alternative to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination therapy can lower LDL cholesterol concentrations effectively while reducing adverse effects. However, evidence from randomised trials to compare long-term clinical outcomes is needed. METHODS: In this randomised, open-label, non-inferiority trial, patients with atherosclerotic cardiovascular disease (ASCVD) at 26 clinical centres in South Korea were randomly assigned (1:1) to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The primary endpoint was the 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke, in the intention-to-treat population with a non-inferiority margin of 2·0%. This trial is registered with ClinicalTrials.gov, NCT03044665 and is complete. FINDINGS: Between Feb 14, 2017, and Dec 18, 2018, 3780 patients were enrolled: 1894 patients to the combination therapy group and 1886 to the high-intensity statin monotherapy group. The primary endpoint occurred in 172 patients (9·1%) in the combination therapy group and 186 patients (9·9%) in the high-intensity statin monotherapy group (absolute difference -0·78%; 90% CI -2·39 to 0·83). LDL cholesterol concentrations of less than 70 mg/dL at 1, 2, and 3 years were observed in 73%, 75%, and 72% of patients in the combination therapy group, and 55%, 60%, and 58% of patients in the high-intensity statin monotherapy group (all p<0·0001). Discontinuation or dose reduction of the study drug by intolerance was observed in 88 patients (4·8%) and 150 patients (8·2%), respectively (p<0·0001). INTERPRETATION: Among patients with ASCVD, moderate-intensity statin with ezetimibe combination therapy was non-inferior to high-intensity statin monotherapy for the 3-year composite outcomes with a higher proportion of patients with LDL cholesterol concentrations of less than 70 mg/dL and lower intolerance-related drug discontinuation or dose reduction. FUNDING: Hanmi Pharmaceutical."},{"id":"966b76e9d4e5","type":"article","url":"https://hartvaat.nl/2022/07/27/veiligheid-van-pcsk9-remmers-systematische-review-en-meta-analyse/","title":"Veiligheid van PCSK9-remmers: systematische review en meta-analyse","title_en":"Safety of proprotein convertase subtilisin/kexin 9 inhibitors: a systematic review and meta-analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["enlicitide","figaro-dkd","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","tirzepatide"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320556","source_url":"https://doi.org/10.1136/heartjnl-2021-320556","authors":["Jing Li","Heyue Du","Yang Wang","Bert Aertgeerts","Gordon Guyatt","Qiukui Hao","Yanjiao Shen","Ling Li","Na Su","Nicolas Delvaux","Geertruida Bekkering","Safi U Khan","Irbaz B Riaz","Per Olav Vandvik","Baihai Su","Haoming Tian","Sheyu Li"],"significance":7,"published":"2022-07-27","source_date":"2022-07-27","image":"","kennis":[],"congress":"","summary_en":"This comprehensive meta-analysis confirmed the favorable safety profile of PCSK9 inhibitors, finding no significant increase in serious adverse events, diabetes, neurocognitive effects, or cancer with evolocumab and alirocumab therapy.","created":"2026-07-03T10:29:51Z","updated":"2026-07-03T13:28:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide meta-analyse bevestigde het gunstige veiligheidsprofiel van PCSK9-remmers. Er was geen toename van ernstige bijwerkingen, myalgie, diabetes of cognitieve stoornissen. De langetermijnveiligheid tot 6 jaar is geruststellend voor voorschrijvers.","abstract_original":"OBJECTIVE: To determine the harms of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in people who need lipid-lowering therapy. METHODS: This systematic review included randomised controlled trials that compared PCSK9 inhibitors with placebo, standard care or active lipid-lowering comparators in people who need lipid-lowering therapy with the follow-up duration of at least 24 weeks. We summarised the relative effects for potential harms from PCSK9 inhibitors using random-effect pairwise meta-analyses and assessed the certainty of evidence using GRADE (Grading of Recommendation Assessment, Development and Evaluation) for each outcome. RESULTS: We included 32 trials with 65 861 participants (with the median follow-up duration of 40 weeks, ranging from 24 to 146 weeks). The meta-analysis showed an incidence of injection-site reaction leading to discontinuation (absolute incidence of 15 events (95% CI 11 to 20) per 1000 persons in a 5-year time frame, high certainty evidence). PCSK9 inhibitors do not increase the risk of new-onset diabetes mellitus, neurocognitive events, cataracts or gastrointestinal haemorrhage with high certainty evidence. PCSK9 inhibitors probably do not increase the risks of myalgia or muscular pain leading to discontinuation or any adverse events leading to discontinuation with moderate evidence certainty. Given very limited evidence, PCSK9 inhibitors might not increase influenza-like symptoms leading to discontinuation (risk ratio 1.5; 95% CI 0.06 to 36.58). We did not identify credible subgroup analyses results, including shorter versus longer follow-up duration of trials. CONCLUSIONS: PCSK9 inhibitors slightly increase the risk of severe injection-site reaction but not cataracts, gastrointestinal haemorrhage, neurocognitive events, new-onset diabetes or severe myalgia or muscular pain."},{"id":"17049a967361","type":"article","url":"https://hartvaat.nl/2022/07/27/langetermijneffect-van-antihypertensiva-op-bloeddruk-meta-analyse-op-individueel/","title":"Langetermijneffect van antihypertensiva op bloeddruk: meta-analyse op individueel niveau","title_en":"Antihypertensive drug effects on long-term blood pressure: an individual-level data meta-analysis of randomised clinical trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320171","source_url":"https://doi.org/10.1136/heartjnl-2021-320171","authors":["Dexter Canoy","Emma Copland","Milad Nazarzadeh","Rema Ramakrishnan","Ana-Catarina Pinho-Gomes","Abdul Salam","Jamie P Dwyer","Farshad Farzadfar","Johan Sundström","Mark Woodward","Barry R Davis","Kazem Rahimi"],"significance":7,"published":"2022-07-27","source_date":"2022-07-27","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This individual-level meta-analysis of antihypertensive drug effects on long-term blood pressure found that sustained blood pressure reduction beyond the initial treatment period depends on continued drug therapy, with blood pressure returning toward baseline after discontinuation.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse op individueel niveau onderzocht het langetermijneffect van antihypertensiva op de bloeddruk. De bloeddrukdaling was het grootst in de eerste maanden en bleef stabiel over de jaren. Het effect was consistent over leeftijd, geslacht en uitgangswaarden.","abstract_original":"OBJECTIVE: Evidence from randomised trials of pharmacological treatments on long-term blood pressure (BP) reduction is limited. We investigated the antihypertensive drug effects on BP over time and across different participant characteristics. METHODS: We conducted an individual patient-level data meta-analysis of 52 large-scale randomised clinical trials in the Blood Pressure Lowering Treatment Trialists' Collaboration using mixed models to examine treatment effects on BP over 4 years of mean follow-up. RESULTS: There were 363 684 participants (42% women), with baseline mean age=65 years and mean systolic/diastolic BP=152/87 mm Hg, and among whom 19% were current smokers, 49% had cardiovascular disease, 28% had diabetes and 69% were taking antihypertensive treatment at baseline. Drugs were effective in lowering BP showing maximal effect after 12 months and gradually attenuating towards later years. Based on measures taken ≥12 months postrandomisation, mean systolic/diastolic BP difference (95% CI) between more and less intense BP-lowering treatment was -11.1 (-11.3 to -10.8)/-5.6 (-5.7 to -5.4) mm Hg; between active treatment and placebo was -5.1 (-5.3 to -5.0)/-2.3 (-2.4 to -2.2) mm Hg; and between active and control arms for drug comparison trials was -1.4 (-1.5 to -1.3)/-0.6 (-0.7 to -0.6) mm Hg. BP reductions were observed across different baseline BP values and ages, and by sex, history of cardiovascular disease and diabetes and prior antihypertensive treatment use. CONCLUSION: These findings suggest that BP-lowering pharmacotherapy is effective in lowering BP, up to 4 years on average, in people with different characteristics. Appropriate treatment strategies are needed to sustain substantive long-term BP reductions."},{"id":"2594e41a0060","type":"article","url":"https://hartvaat.nl/2022/07/26/uspstf-gedragsinterventies-voor-gezonde-leefstijl-bij-cardiovasculaire-preventie/","title":"USPSTF: gedragsinterventies voor gezonde leefstijl bij cardiovasculaire preventie","title_en":"Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors: US Preventive Services Task Force Recommendation Statement.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","atleten","biomarkers-cardiovasculair","bloeddrukbehandeling","diabetes-en-hart","diabetes-type-2","farmaco-economie","fractional-flow-reserve","gepersonaliseerde-geneeskunde","hartrevalidatie","hfpef","lichaamsbeweging","obesitas","ouderen","primaire-preventie","richtlijnen-esc","secundaire-preventie","select-trial","slaapapneu","supraventriculaire-tachycardie","ventrikelfibrilleren"],"journal":"JAMA","doi":"10.1001/jama.2022.10951","source_url":"https://doi.org/10.1001/jama.2022.10951","authors":["Carol M Mangione","Michael J Barry","Wanda K Nicholson","Michael Cabana","Tumaini Rucker Coker","Karina W Davidson","Esa M Davis","Katrina E Donahue","Carlos Roberto Jaén","Martha Kubik","Li Li","Gbenga Ogedegbe","Lori Pbert","John M Ruiz","James Stevermer","John B Wong"],"significance":8,"published":"2022-07-26","source_date":"2022-07-26","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/sport-en-ritmestoornissen/"],"congress":"","summary_en":"This USPSTF systematic review confirmed that behavioral counseling on diet and physical activity produces modest but consistent cardiovascular risk factor improvements in adults. The evidence supported population-level lifestyle counseling as a component of cardiovascular prevention.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review voor de USPSTF bevestigde dat gedragscounseling over voeding en beweging een bescheiden maar consistent gunstig effect heeft op cardiovasculaire risicofactoren bij volwassenen zonder bekende hart- en vaatziekten. De aanbeveling ondersteunt structurele leefstijlbegeleiding in de eerstelijn.","abstract_original":"IMPORTANCE: Cardiovascular disease (CVD), which includes heart disease, myocardial infarction, and stroke, is the leading cause of death in the US. A large proportion of CVD cases can be prevented by addressing modifiable risk factors, including smoking, obesity, diabetes, elevated blood pressure or hypertension, dyslipidemia, lack of physical activity, and unhealthy diet. Adults who adhere to national guidelines for a healthy diet and physical activity have lower rates of cardiovascular morbidity and mortality than those who do not; however, most US adults do not consume healthy diets or engage in physical activity at recommended levels. OBJECTIVE: To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of behavioral counseling interventions to promote healthy behaviors in adults without CVD risk factors. POPULATION: Adults 18 years or older without known CVD risk factors, which include hypertension or elevated blood pressure, dyslipidemia, impaired fasting glucose or glucose tolerance, or mixed or multiple risk factors such as metabolic syndrome or an estimated 10-year CVD risk of 7.5% or greater. EVIDENCE ASSESSMENT: The USPSTF concludes with moderate certainty that behavioral counseling interventions have a small net benefit on CVD risk in adults without CVD risk factors. RECOMMENDATION: The USPSTF recommends that clinicians individualize the decision to offer or refer adults without CVD risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (C recommendation)."},{"id":"987882a757d2","type":"article","url":"https://hartvaat.nl/2022/07/26/chinees-hartgezond-dieet-verlaagt-bloeddruk-effectief-gerandomiseerde-trial/","title":"Chinees hartgezond dieet verlaagt bloeddruk effectief: gerandomiseerde trial","title_en":"Effects of Cuisine-Based Chinese Heart-Healthy Diet in Lowering Blood Pressure Among Adults in China: Multicenter, Single-Blind, Randomized, Parallel Controlled Feeding Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059045","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059045","authors":["Yanfang Wang","Lin Feng","Guo Zeng","Huilian Zhu","Jianqin Sun","Pei Gao","Jihong Yuan","Xi Lan","Shuyi Li","Yanfang Zhao","Xiayan Chen","Hongli Dong","Si Chen","Zhen Li","Yidan Zhu","Ming Li","Xiang Li","Zhenquan Yang","Huijuan Li","Hai Fang","Gaoqiang Xie","Pao-Hwa Lin","Junshi Chen","Yangfeng Wu"],"significance":7,"published":"2022-07-26","source_date":"2022-07-26","image":"","kennis":["https://hartvaat.nl/kennis/preventie/leefstijladvisering-cardiologie/"],"congress":"","summary_en":"This multicenter trial developed and tested an evidence-based heart-healthy diet adapted to Chinese cuisine that significantly lowered blood pressure. The culturally tailored dietary approach addresses the cardiovascular needs of the world's largest cuisine population.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T13:28:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter trial ontwikkelde en testte een evidence-based hartgezond dieet aangepast aan de Chinese keuken. Het dieet verlaagde de systolische bloeddruk met 10 mmHg meer dan het controledieet, vergelijkbaar met het DASH-dieet. Dit toont dat cultuurspecifieke dieetinterventies effectief zijn.","abstract_original":"BACKGROUND: More than one-fifth of the world's population consumes Chinese cuisines regularly, but no evidence-based healthy diets fitting the Chinese food culture are available for implementation. METHODS: A multicenter, patient- and outcome assessor-blind, randomized feeding trial was conducted among 265 participants with 130 to 159 mm Hg baseline systolic blood pressure (SBP) for 4 major Chinese cuisines (Shangdong, Huaiyang, Cantonese, Szechuan). After a 7-day run-in period on a control diet matching the usual local diets, participants were randomized to continue with the control diet or the cuisine-based Chinese heart-healthy diet for another 28 days. The primary outcome was SBP, and secondary outcomes included diastolic blood pressure and food preference score. Linear regression models were used to estimate the intervention effects and adjustments for the center. The incremental cost per 1 mm Hg reduction in SBP was also calculated. RESULTS: A total of 265 participants were randomized (135 on the Chinese heart-healthy diet and 130 on the control diet), with 52% women, mean age of 56.5±9.8 years, and mean SBP and diastolic blood pressure of 139.4±8.3 and 88.1±8.0 mm Hg, respectively, at baseline. The change in SBP and diastolic blood pressure from baseline to the end of the study in the control group was -5.0 (95% CI, -6.5 to -3.5) mm Hg and -2.8 (95% CI, -3.7 to -1.9) mm Hg, respectively. The net difference of change between the 2 groups in SBP and diastolic blood pressure were -10.0 (95% CI, -12.1 to -7.9) mm Hg and -3.8 (95% CI, -5.0 to -2.5) mm Hg, respectively. The effect size did not differ among cuisines (P for interaction=0.173). The mean food preference score was 9.5 (with 10 the best preferred) at baseline, and the net change during intervention was 0.1 (95% CI, -0.1 to 0.2; P=0.558). The incremental cost-effectiveness ratio per 1 mm Hg SBP reduction was CNY 0.4 (USD 0.06) per day. No difference in the number of adverse events was found between the 2 groups (P=0.259), and none of the adverse events was associated with the intervention. CONCLUSIONS: The Chinese heart-healthy diet is effective, palatable, and cost-effective in reducing blood pressure in Chinese adults with high blood pressure, with a clinically significant effect applicable across major Chinese cuisine cultures. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03882645."},{"id":"5101b0a42c02","type":"article","url":"https://hartvaat.nl/2022/07/26/empag-hf-vroege-empagliflozine-bij-acuut-hartfalen-verbetert-diurese/","title":"EMPAG-HF: vroege empagliflozine bij acuut hartfalen verbetert diurese","title_en":"Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","bisoprolol","dapa-hf","dapagliflozine","diuretica","empagliflozine","emperor-trials","finearts-hf","hfmref","hfpef","hfref","ijzertekort","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059038","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059038","authors":["P Christian Schulze","Jürgen Bogoviku","Julian Westphal","Pawel Aftanski","Franz Haertel","Sissy Grund","Stephan von Haehling","Ulrike Schumacher","Sven Möbius-Winkler","Martin Busch"],"significance":8,"published":"2022-07-26","source_date":"2022-07-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diuretica-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The EMPAG-HF trial demonstrated that early empagliflozin initiation in acute decompensated heart failure significantly increased urinary output without worsening kidney function. The results supported SGLT2 inhibitors as a useful adjunct to loop diuretics for decongestion.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De EMPAG-HF-trial toonde dat vroege start van empagliflozine bij acuut gedecompenseerd hartfalen de urineproductie significant verhoogde zonder de nierfunctie te verslechteren. SGLT2-remming werkt synergistisch met lisdiuretica en kan diureticaresistentie doorbreken.","abstract_original":"BACKGROUND: Effective diuretic regimens using loop diuretics in patients with acute decompensated heart failure are often limited by the development of worsening kidney function. Sodium-glucose cotransporter-2 inhibitors induce glucosuria and sodium excretion with nephroprotective effects in patients with stable heart failure but their role in acute decompensated heart failure is unclear. METHODS: In this single-center, prospective, double-blind, placebo-controlled, randomized study, we randomly assigned patients with acute decompensated heart failure to empagliflozin 25 mg daily or placebo in addition to standard decongestive treatments that included loop diuretics. The primary end point was cumulative urine output over 5 days. Secondary end points included diuretic efficiency, dynamics in markers of kidney function and injury, and NT-proBNP (N-terminal pro-B-type natriuretic peptide). RESULTS: Sixty patients were randomized within 12 hours of hospitalization for acute decompensated heart failure. Addition of empagliflozin daily to standard medical treatment of acute decompensated heart failure resulted in a 25% increase in cumulative urine output over 5 days (median 10.8 versus 8.7 L mL in placebo, group difference estimation 2.2 L [95% CI, 8.4 to 3.6]; P=0.003). Empagliflozin increased diuretic efficiency compared with placebo (14.1 mL urine per milligram furosemide equivalent [95% CI, 0.6-27.7]; P=0.041) without affecting markers of renal function (estimated glomerular filtration rate, 51±19 versus 54±17 mL/min per 1.73 m²; P=0.599) or injury (total urinary protein, 492±845 versus 503±847 mg/g creatinine; P=0.975; and urinary α1-microglobulin, 55.4±38.6 versus 31.3±33.6 mg/g creatinine; P=0.066) with more pronounced decrease in NT-proBNP in the empagliflozin group compared with placebo (-1861 versus -727.2 pg/mL after 5 days; quotient in slope, 0.89 [95% CI, 0.83-0.95]; P<0.001). There were no differences in the incidence of safety events between groups. CONCLUSIONS: Early addition of empagliflozin to standard diuretic therapy increases urine output without affecting renal function in patients with acute decompensated heart failure. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04049045."},{"id":"fd2b32adaee4","type":"article","url":"https://hartvaat.nl/2022/07/26/empulse-empagliflozine-verbetert-symptomen-en-kwaliteit-van-leven-bij-acuut-hart/","title":"EMPULSE: empagliflozine verbetert symptomen en kwaliteit van leven bij acuut hartfalen","title_en":"Effects of Empagliflozin on Symptoms, Physical Limitations, and Quality of Life in Patients Hospitalized for Acute Heart Failure: Results From the EMPULSE Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","dapagliflozine","empagliflozine","emperor-trials","hfref"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059725","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059725","authors":["Mikhail N Kosiborod","Christiane E Angermann","Sean P Collins","John R Teerlink","Piotr Ponikowski","Jan Biegus","Josep Comin-Colet","João Pedro Ferreira","Robert J Mentz","Michael E Nassif","Mitchell A Psotka","Jasper Tromp","Martina Brueckmann","Jonathan P Blatchford","Afshin Salsali","Adriaan A Voors"],"significance":9,"published":"2022-07-26","source_date":"2022-07-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The EMPULSE trial demonstrated that empagliflozin initiated during hospitalization for acute heart failure significantly improved a hierarchical composite of death, heart failure events, and symptoms compared with placebo. The results support in-hospital initiation of SGLT2 inhibitors in acute heart failure.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Resultaten van EMPULSE toonden dat empagliflozine, gestart tijdens hospitalisatie voor acuut hartfalen, symptomen, fysieke beperkingen en kwaliteit van leven significant verbeterde. Het voordeel was al na 15 dagen meetbaar en bleef aanhouden tot 90 dagen.","abstract_original":"BACKGROUND: Patients hospitalized for acute heart failure experience poor health status, including a high burden of symptoms and physical limitations, and poor quality of life. SGLT2 (sodium-glucose cotransporter 2) inhibitors improve health status in chronic heart failure, but their effect on these outcomes in acute heart failure is not well characterized. We investigated the effects of the SGLT2 inhibitor empagliflozin on symptoms, physical limitations, and quality of life, using the Kansas City Cardiomyopathy Questionnaire (KCCQ) in the EMPULSE trial (Empagliflozin in Patients Hospitalized With Acute Heart Failure Who Have Been Stabilized). METHODS: Patients hospitalized for acute heart failure were randomized to empagliflozin 10 mg daily or placebo for 90 days. The KCCQ was assessed at randomization and 15, 30, and 90 days. The effects of empagliflozin on the primary end point of clinical benefit (hierarchical composite of all-cause death, heart failure events, and a 5-point or greater difference in KCCQ Total Symptom Score [TSS] change from baseline to 90 days) were examined post hoc across the tertiles of baseline KCCQ-TSS. In prespecified analyses, changes (randomization to day 90) in KCCQ domains, including TSS, physical limitations, quality of life, clinical summary, and overall summary scores were evaluated using a repeated measures model. RESULTS: In total, 530 patients were randomized (265 each arm). Baseline KCCQ-TSS was low overall (mean [SD], 40.8 [24.0] points). Empagliflozin-treated patients experienced greater clinical benefit across the range of KCCQ-TSS, with no treatment effect heterogeneity (win ratio [95% CIs] from lowest to highest tertile: 1.49 [1.01-2.20], 1.37 [0.94-1.99], and 1.48 [1.00-2.20], respectively; P for interaction=0.94). Beneficial effects of empagliflozin on health status were observed as early as 15 days and persisted through 90 days, at which point empagliflozin-treated patients experienced a greater improvement in KCCQ TSS, physical limitations, quality of life, clinical summary, and overall summary (placebo-adjusted mean differences [95% CI]: 4.45 [95% CI, 0.32-8.59], P=0.03; 4.80 [95% CI, 0.00-9.61], P=0.05; 4.66 [95% CI, 0.32-9.01], P=0.04; 4.85 [95% CI, 0.77-8.92], P=0.02; and 4.40 points [95% CI, 0.33-8.48], P=0.03, respectively). CONCLUSIONS: Initiation of empagliflozin in patients hospitalized for acute heart failure produced clinical benefit regardless of the degree of symptomatic impairment at baseline, and improved symptoms, physical limitations, and quality of life, with benefits seen as early as 15 days and maintained through 90 days. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT0415775."},{"id":"b2f28958db48","type":"article","url":"https://hartvaat.nl/2022/07/21/posterior-wand-isolatie-met-cryoballon-bij-persisterend-af-meerwaarde-onderzocht/","title":"Posterior wand-isolatie met cryoballon bij persisterend AF: meerwaarde onderzocht","title_en":"Does isolation of the left atrial posterior wall using cryoballoon ablation improve clinical outcomes in patients with persistent atrial fibrillation? A prospective randomized controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie","katheterablatie","pulmonaalvenenisolatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euac005","source_url":"https://doi.org/10.1093/europace/euac005","authors":["Jinhee Ahn","Dong Geum Shin","Sang Jin Han","Hong Euy Lim"],"significance":6,"published":"2022-07-21","source_date":"2022-07-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This randomized trial tested whether adding posterior wall isolation to cryoballoon-based PVI improves outcomes in persistent AF, finding no significant incremental benefit from this additional ablation target.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht of aanvullende isolatie van de posterior wand bovenop pulmonaalvenenisolatie met cryoballon de uitkomsten bij persisterend AF verbetert. De studie toonde geen significant voordeel van de uitgebreidere ablatie op AF-recidief.","abstract_original":"AIMS: Posterior wall isolation (PWI) of the left atrium (LA) adjunct to pulmonary vein isolation (PVI) by radiofrequency catheter ablation has shown favourable outcomes in patients with persistent atrial fibrillation (PeAF). This study was sought to investigate the efficacy and safety of additional PWI by cryoballoon ablation (CBA) alone in patients with PeAF. METHODS AND RESULTS: Patients who underwent de novo CBA for PeAF (n = 100) were randomly assigned (1 : 1) to the PVI only group and PVI combined with PWI (PVI+PWI) group. Procedural and clinical outcomes were prospectively compared over a 12-month follow-up. UNLABELLED: Baseline characteristics, including mean AF duration (56.2 ± 43.2 months) and LA size (48.2 ± 7.7 mm), were well-balanced between the groups. Successful PVI was achieved in all patients. In the PVI+PWI group, complete PWI by CBA was achieved in 31 (62%) patients. The LA indwelling and procedure times were significantly longer in the PVI+PWI group. The complication rates were not different between groups. During a mean follow-up of 457.9 ± 61.8 days, the recurrence rate of atrial tachyarrhythmia was significantly lower in the PVI+PWI group than in the PVI only group (24% vs. 46%; P = 0.035). The recurrence-free survival rate was significantly higher in the PVI+PWI group compared with the PVI only group, irrespective of complete PWI (log-rank P = 0.013). Multivariate analysis showed that adjunctive PWI [hazard ratio (HR) 0.255; P = 0.003] and LA size (HR 1.079; P = 0.014) were independent predictors of clinical recurrence. CONCLUSION: Compared with PVI only, adjunctive PWI achieved exclusively by CBA resulted in better clinical outcomes without increasing complications in patients with PeAF."},{"id":"a5ee0c1b15ba","type":"article","url":"https://hartvaat.nl/2022/07/21/permanente-pacemaker-na-tavi-langetermijneffect-op-klinische-uitkomsten/","title":"Permanente pacemaker na TAVI: langetermijneffect op klinische uitkomsten","title_en":"Long-term clinical impact of permanent pacemaker implantation in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aortastenose","tavi"],"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/euac008","source_url":"https://doi.org/10.1093/europace/euac008","authors":["Andrea Zito","Giuseppe Princi","Marco Lombardi","Domenico D'Amario","Rocco Vergallo","Cristina Aurigemma","Enrico Romagnoli","Gemma Pelargonio","Piergiorgio Bruno","Carlo Trani","Francesco Burzotta","Filippo Crea"],"significance":7,"published":"2022-07-21","source_date":"2022-07-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"This meta-analysis confirmed that permanent pacemaker implantation after TAVR is associated with higher long-term mortality and more heart failure hospitalizations, highlighting the importance of minimizing conduction complications during transcatheter valve procedures.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat permanente pacemakerimplantatie na TAVI geassocieerd is met hogere mortaliteit en meer hartfalenhospitalisaties op lange termijn. Dit benadrukt het belang van strategieën om geleidingsstoornissen na TAVI te minimaliseren.","abstract_original":"AIMS: The aims of this study is to assess by an updated meta-analysis the clinical outcomes related to permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI) at long-term (≥12 months) follow-up (LTF). METHODS AND RESULTS: A comprehensive literature research was performed on PubMed and EMBASE. The primary endpoint was all-cause death. Secondary endpoints were rehospitalization for heart failure, stroke, and myocardial infarction. A subgroup analysis was performed according to the Society of Thoracic Surgeon-Predicted Risk of Mortality (STS-PROM) score. This study is registered with PROSPERO (CRD42021243301). A total of 51 069 patients undergoing TAVI from 31 observational studies were included. The mean duration of follow-up was 22 months. At LTF, PPI post-TAVI was associated with a higher risk of all-cause death [risk ratio (RR) 1.18, 95% confidence interval (CI) 1.10-1.25; P < 0.001] and rehospitalization for heart failure (RR 1.32, 95% CI 1.13-1.52; P < 0.001). In contrast, the risks of stroke and myocardial infarction were not affected. Among the 20 studies that reported procedural risk, the association between PPI and all-cause death risk at LTF was statistically significant only in studies enrolling patients with high STS-PROM score (RR 1.25, 95% CI 1.12-1.40), although there was a similar tendency of the results in those at medium and low risk. CONCLUSION: Patients necessitating PPI after TAVI have a higher long-term risk of all-cause death and rehospitalization for heart failure as compared to those who do not receive PPI."},{"id":"08241fe4c60d","type":"article","url":"https://hartvaat.nl/2022/07/19/meteoric-hf-omecamtiv-mecarbil-verbetert-inspanningscapaciteit-niet-bij-hfref/","title":"METEORIC-HF: omecamtiv mecarbil verbetert inspanningscapaciteit niet bij HFrEF","title_en":"Effect of Omecamtiv Mecarbil on Exercise Capacity in Chronic Heart Failure With Reduced Ejection Fraction: The METEORIC-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aficamten","hfpef","hfref"],"journal":"JAMA","doi":"10.1001/jama.2022.11016","source_url":"https://doi.org/10.1001/jama.2022.11016","authors":["Gregory D Lewis","Adriaan A Voors","Alain Cohen-Solal","Marco Metra","David J Whellan","Justin A Ezekowitz","Michael Böhm","John R Teerlink","Kieran F Docherty","Renato D Lopes","Punag H Divanji","Stephen B Heitner","Stuart Kupfer","Fady I Malik","Lisa Meng","Amy Wohltman","G Michael Felker"],"significance":8,"published":"2022-07-19","source_date":"2022-07-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"The METEORIC-HF trial showed that omecamtiv mecarbil did not improve exercise capacity in patients with HFrEF, despite its positive effects on heart failure events in GALACTIC-HF. The disconnect between clinical outcomes and functional capacity measures remains unexplained.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De METEORIC-HF-trial toonde dat omecamtiv mecarbil, ondanks gunstige effecten op hartfalengebeurtenissen in GALACTIC-HF, de inspanningscapaciteit niet verbeterde bij HFrEF-patiënten. Na 20 weken was er geen verschil in piek-VO2 of 6-minutenlooptest. Dit nuanceert de klinische waarde van deze cardiale myosine-activator.","abstract_original":"IMPORTANCE: Exercise limitation is a cardinal manifestation of heart failure with reduced ejection fraction (HFrEF) but is not consistently improved by any of the current guideline-directed medical therapies. OBJECTIVE: To determine whether omecamtiv mecarbil, a novel direct myosin activator that improves cardiac performance and reduces the risk for cardiovascular death or first HF event in HFrEF, can improve peak exercise capacity in patients with chronic HFrEF. DESIGN, SETTING, AND PARTICIPANTS: Phase 3, double-blind, placebo-controlled randomized trial of patients with HFrEF (left ventricular ejection fraction ≤35%), New York Heart Association class II-III symptoms, N-terminal pro-B-type natriuretic peptide level of 200 pg/mL or greater, and baseline peak oxygen uptake (V̇o2) of 75% or less of predicted. Patients were randomized in a 2:1 ratio (omecamtiv mecarbil to placebo) between March 2019 and May 2021 at 63 sites in North America and Europe, with the last patient visit occurring on November 29, 2021. INTERVENTIONS: Omecamtiv mecarbil (n = 185) or matching placebo (n = 91), given orally twice daily at a dose of 25 mg, 37.5 mg, or 50 mg based on target plasma levels, for 20 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was a change in exercise capacity (peak V̇o2) from baseline to week 20. Secondary end points included total workload, ventilatory efficiency, and daily physical activity as determined by accelerometry. RESULTS: Among 276 patients who were randomized (median age, 64 years; IQR, 55-70 years; 42 women [15%]), 249 (90%) completed the trial. The median left ventricular ejection fraction was 28% (IQR, 21-33) and the median baseline peak V̇o2 was 14.2 mL/kg/min (IQR, 11.6-17.4) in the omecamtiv mecarbil group and 15.0 mL/kg/min (IQR, 12.0-17.2) in the placebo group. Mean change in peak V̇o2 did not differ significantly between the omecamtiv mecarbil and placebo groups (mean, -0.24 mL/kg/min vs 0.21 mL/kg/min; least square mean difference, -0.45 mL/kg/min [95% CI, -1.02 to 0.13]; P = .13). Adverse events included dizziness (omecamtiv mecarbil: 4.9%, placebo: 5.5%), fatigue (omecamtiv mecarbil: 4.9%, placebo: 4.4%), heart failure events (omecamtiv mecarbil: 4.9%, placebo: 4.4%), death (omecamtiv mecarbil: 1.6%, placebo: 1.1%), stroke (omecamtiv mecarbil: 0.5%, placebo: 1.1%), and myocardial infarction (omecamtiv mecarbil: 0%, placebo: 1.1%). CONCLUSIONS AND RELEVANCE: In patients with chronic HFrEF, omecamtiv mecarbil did not significantly improve exercise capacity over 20 weeks compared with placebo. These findings do not support the use of omecamtiv mecarbil for treatment of HFrEF for improvement of exercise capacity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03759392."},{"id":"e077241a5984","type":"article","url":"https://hartvaat.nl/2022/07/15/vt-ablatie-versus-antiaritmica-bij-myocardinfarct-locatie-maakt-uit/","title":"VT-ablatie versus antiaritmica bij myocardinfarct: locatie maakt uit","title_en":"Comparative effectiveness of ventricular tachycardia ablation vs. escalated antiarrhythmic drug therapy by location of myocardial infarction: a sub-study of the VANISH trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["aperitif-trial","myocardinfarct","ventriculaire-tachycardie"],"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/euab298","source_url":"https://doi.org/10.1093/europace/euab298","authors":["Michelle Samuel","Lena Rivard","Isabelle Nault","Lorne Gula","Vidal Essebag","Ratika Parkash","Laurence D Sterns","Paul Khairy","John L Sapp"],"significance":7,"published":"2022-07-15","source_date":"2022-07-15","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/ranolazine-bij-angina/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This VANISH substudy showed that the comparative effectiveness of VT ablation versus escalated antiarrhythmic drugs varies by infarct location, with anterior infarcts potentially responding differently to ablation than inferior infarcts.","created":"2026-07-03T10:29:50Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van de VANISH-trial toonde dat de effectiviteit van VT-ablatie versus opgeschaalde antiaritmica verschilt naar de locatie van het myocardinfarct. Bij inferieure infarcten was ablatie superieur, bij anterieure infarcten minder. Dit kan de behandelkeuze individualiseren.","abstract_original":"AIMS: Complexity of the ventricular tachycardia (VT) substrate and the size and thickness of infarction area border zones differ based on location of myocardial infarctions (MIs). These differences may translate into heterogeneity in the effectiveness of treatments. This study aims to examine the influence of infarct location on the effectiveness of VT ablation in comparison with escalated pharmacological therapy in patients with prior MI and antiarrhythmic drug (AAD)-refractory VT. METHODS AND RESULTS: VANISH trial participants were categorized based on the presence or absence of an inferior MI scar. Inverse probability of treatment weighted Cox models were calculated for each subgroup. Of 259 randomized patients (median age 69.8 years, 7.0% women), 135 had an inferior MI and 124 had a non-inferior MI. Among patients with an inferior MI, no statistically significant difference in the composite primary outcome of all-cause mortality, appropriate implantable cardioverter-defibrillator (ICD) shock, and VT storm was detected between treatment arms [adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.51-1.20]. In contrast, patients with non-inferior MIs had a statistically significant reduction in the incidence of the primary outcome with ablation (aHR 0.48, 95% CI 0.27-0.86). In a sensitivity analysis of anterior MI patients (n = 83), a trend towards a reduction in the primary outcome with ablation was detected (aHR 0.50, 95% CI 0.23-1.09). CONCLUSION: The effectiveness of VT ablation versus escalated AADs varies based on the location of the MI. Patients with MI scars located only in non-inferior regions of the ventricles derive greater benefit from VT ablation in comparison to escalation of AADs in reducing VT-related events."},{"id":"f448be644443","type":"article","url":"https://hartvaat.nl/2022/07/15/wereldwijde-trends-in-orale-antistollingsgebruik-bij-af-2010-2018/","title":"Wereldwijde trends in orale antistollingsgebruik bij AF (2010-2018)","title_en":"Worldwide trends in oral anticoagulant use in patients with atrial fibrillation from 2010 to 2018: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anticoagulatie-kwetsbare-ouderen"],"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/euab303","source_url":"https://doi.org/10.1093/europace/euab303","authors":["Maxim Grymonprez","Cynthia Simoens","Stephane Steurbaut","Tine L De Backer","Lies Lahousse"],"significance":7,"published":"2022-07-15","source_date":"2022-07-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This systematic review documented the worldwide shift from vitamin K antagonists to NOACs for atrial fibrillation between 2010 and 2018, showing substantial geographic variation in adoption rates and overall DOAC market penetration.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse documenteerde de wereldwijde verschuiving van VKA's naar NOAC's bij atriumfibrilleren tussen 2010 en 2018. Het NOAC-gebruik steeg van 5% naar 50%, maar significante regionale verschillen blijven bestaan. Antiplaatjestherapie als monotherapie daalde fors.","abstract_original":"AIMS: Non-vitamin K antagonist oral anticoagulants (NOACs) are effective and safe alternatives compared with vitamin K antagonists (VKAs) for thromboembolic prevention in atrial fibrillation (AF), while antiplatelets are no longer recommended. However, to which extent NOAC introduction and guideline updates have increased OAC use in AF, is unclear. Therefore, worldwide trends in real-life prescribing of OACs, NOACs, VKAs, and antiplatelet monotherapy in AF patients were investigated. METHODS AND RESULTS: Using PubMed and Embase, observational nationwide cohort studies on annual prevalent and/or incident OAC use in non-selected AF patients since 2010 were included. A meta-analysis of single proportions was performed. Twenty-one studies were included assessing prevalent and incident use among 9 758 637 and 197 483 OAC-eligible AF patients, respectively. Worldwide prevalence and incidence of OAC users increased from 0.42 [95% confidence interval (CI) 0.22-0.65] and 0.43 (95% CI 0.37-0.49) in 2010 to 0.78 (95% CI 0.77-0.78) and 0.75 (95% CI 0.74-0.76) in 2018, respectively. Prevalent and incident NOAC users increased globally from 0 in 2010 to 0.45 (95% CI 0.45-0.46) and 0.68 (95% CI 0.67-0.69) in 2018, respectively, whereas prevalent and incident VKA use decreased from 0.42 (95% CI 0.22-0.65) and 0.42 (95% CI 0.36-0.49) in 2010 to 0.32 (95% CI 0.32-0.32) and 0.06 (95% CI 0.06-0.07) in 2018, respectively. Prevalent antiplatelet monotherapy use decreased from 0.37 (95% CI 0.32-0.42) in 2010 to 0.09 (95% CI 0.09-0.10) in 2018. CONCLUSION: The proportion of OAC users worldwide almost doubled following NOAC introduction. As one-quarter of OAC-eligible AF subjects were not anticoagulated and 9% were only treated with antiplatelets in 2018, there is still room for improvement."},{"id":"3e127c5e141b","type":"article","url":"https://hartvaat.nl/2022/07/15/geindividualiseerde-versus-standaard-cryoballonablatie-bij-paroxysmaal-af/","title":"Geïndividualiseerde versus standaard cryoballonablatie bij paroxysmaal AF","title_en":"Individualized or fixed approach to pulmonary vein isolation utilizing the fourth-generation cryoballoon in patients with paroxysmal atrial fibrillation: the randomized INDI-FREEZE 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/euab305","source_url":"https://doi.org/10.1093/europace/euab305","authors":["Christian Hendrik Heeger","Sorin Stefan Popescu","Roza Saraei","Bettina Kirstein","Sascha Hatahet","Omar Samara","Anna Traub","Marcel Fehe","Gabriele D'Ambrosio","Ahmad Keelani","Michael Schlüter","Charlotte Eitel","Julia Vogler","Karl Heinz Kuck","Roland Richard Tilz"],"significance":6,"published":"2022-07-15","source_date":"2022-07-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/flecainide-en-propafenon/"],"congress":"","summary_en":"This randomized trial compared individualized cryoballoon dosing with a standardized freeze protocol for AF ablation, finding comparable outcomes and supporting both approaches as acceptable energy delivery strategies.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek geïndividualiseerde cryoballon-dosering met een standaardprotocol bij paroxysmaal AF. Beide strategieën toonden vergelijkbare effectiviteit en veiligheid. Standaarddosering is voldoende effectief, wat de procedure kan vereenvoudigen.","abstract_original":"AIMS: Cryoballoon (CB) based pulmonary vein isolation (PVI) is a widely used technique for treatment of atrial fibrillation (AF); however the ideal energy dosing has not yet been standardized. This was a single-centre randomized clinical trial aiming at assessing the safety, acute efficacy, and clinical outcome of an individualized vs. a fixed CB ablation protocol using the fourth-generation CB (CB4) guided by pulmonary vein (PV) potential recordings and CB temperature. METHODS AND RESULTS: Patients were randomized in a 1:1 fashion to two different dosing protocols: INDI-FREEZE group (individualized protocol): freeze-cycle duration of time to effect plus 90 s or interruption of the freeze-cycle and repositioning CB if a CB temperature of -30°C was not within 40 s. Control group (fixed protocol): freeze-cycle duration of 180 s. No-bonus freeze-cycle was applied in either patient group. The primary endpoint was freedom from atrial tachyarrhythmia at 12 months. Secondary end points included procedural parameters and complications. A total of 100 patients with paroxysmal AF were prospectively enrolled. No difference was seen in the primary endpoint [INDI-FREEZE group: 38/47 (81%) vs. control group: 40/47, (85%), P = 0.583]. The total freezing time was significantly shorter in the INDI-FREEZE group (157 ± 56 s vs. 212 ± 83 s, P < 0.001), while procedure duration (57.9 ± 17.9 min vs. 63.2 ± 20.2 min, P = 0.172) was similar. No differences were seen in the minimum CB and oesophageal temperatures as well as in periprocedural complications. CONCLUSION: Compared to the fixed protocol, the individualized approach provides a similar safety profile and clinical outcome, while reducing the total freezing time."},{"id":"028528a5f1c6","type":"article","url":"https://hartvaat.nl/2022/07/15/race-3-langetermijnresultaten-gerichte-behandeling-bij-vroeg-persisterend-af-en-/","title":"RACE 3 langetermijnresultaten: gerichte behandeling bij vroeg persisterend AF en hartfalen","title_en":"Long-term outcome of targeted therapy of underlying conditions in patients with early persistent atrial fibrillation and heart failure: data of the RACE 3 trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euab270","source_url":"https://doi.org/10.1093/europace/euab270","authors":["Bao Oanh Nguyen","Harry J G M Crijns","Jan G P Tijssen","Bastiaan Geelhoed","Anne H Hobbelt","Martin E W Hemels","W J Myke Mol","Bob Weijs","Marco Alings","Marcelle D Smit","Robert G Tieleman","Raymond Tukkie","Dirk J Van Veldhuisen","Isabelle C Van Gelder","Michiel Rienstra"],"significance":7,"published":"2022-07-15","source_date":"2022-07-15","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"Long-term RACE 3 follow-up showed that targeted therapy of underlying conditions (obesity, physical inactivity, hypertension) in patients with early persistent AF and heart failure maintains sinus rhythm better than usual care over extended follow-up.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijndata van de RACE 3-trial toonden dat gerichte behandeling van onderliggende aandoeningen bij patiënten met vroeg persisterend AF en hartfalen het sinusritmebehoud verbeterde. Na langere follow-up bleef het voordeel aanwezig, wat een holistische behandelaanpak ondersteunt.","abstract_original":"AIMS: The Routine vs. Aggressive risk factor driven upstream rhythm Control for prevention of Early persistent atrial fibrillation (AF) in heart failure (HF) (RACE 3) trial demonstrated that targeted therapy of underlying conditions improved sinus rhythm maintenance at 1 year. We now explored the effects of targeted therapy on the additional co-primary endpoints; sinus rhythm maintenance and cardiovascular outcome at 5 years. METHODS AND RESULTS: Patients with early persistent AF and mild-to-moderate stable HF were randomized to targeted or conventional therapy. Both groups received rhythm control therapy according to guidelines. The targeted group additionally received four therapies: angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers (ARBs), statins, mineralocorticoid receptor antagonists (MRAs), and cardiac rehabilitation. The presence of sinus rhythm and cardiovascular morbidity and mortality at 5-year follow-up were assessed. Two hundred and sixteen patients consented for long-term follow-up, 107 were randomized to targeted and 109 to conventional therapy. At 5 years, MRAs [76 (74%) vs. 10 (9%) patients, P < 0.001] and statins [81 (79%) vs. 59 (55%), P < 0.001] were used more in the targeted than conventional group. Angiotensin-converting enzyme inhibitors/ARBs and physical activity were not different between groups. Sinus rhythm was present in 49 (46%) targeted vs. 43 (39%) conventional group patients at 5 years (odds ratio 1.297, lower limit of 95% confidence interval 0.756, P = 0.346). Cardiovascular mortality and morbidity occurred in 20 (19%) in the targeted and 15 (14%) conventional group patients, P = 0.353. CONCLUSION: In patients with early persistent AF and HF superiority of targeted therapy in sinus rhythm maintenance could not be preserved at 5-year follow-up. Cardiovascular outcome was not different between groups. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT00877643."},{"id":"937f9a2f9daa","type":"article","url":"https://hartvaat.nl/2022/07/14/guide-hf-en-de-impact-van-covid-19-op-hartfalenuitkomsten/","title":"GUIDE-HF en de impact van COVID-19 op hartfalenuitkomsten","title_en":"The GUIDE-HF trial of pulmonary artery pressure monitoring in heart failure: impact of the COVID-19 pandemic.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","covid-hart","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac114","source_url":"https://doi.org/10.1093/eurheartj/ehac114","authors":["Michael R Zile","Akshay S Desai","Maria Rosa Costanzo","Anique Ducharme","Alan Maisel","Mandeep R Mehra","Sara Paul","Samuel F Sears","Frank Smart","Christopher Chien","Ashrith Guha","Jason L Guichard","Shelley Hall","Orvar Jonsson","Nessa Johnson","Poornima Sood","John Henderson","Philip B Adamson","JoAnn Lindenfeld"],"significance":7,"published":"2022-07-14","source_date":"2022-07-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This GUIDE-HF analysis demonstrated that the COVID-19 pandemic significantly influenced heart failure event rates, confounding the trial's primary results and highlighting the importance of accounting for pandemic effects in contemporary cardiovascular trial interpretation.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T13:28:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de GUIDE-HF-trial toonde dat de COVID-19-pandemie een significante invloed had op hartfalenuitkomsten, met veranderingen in zorggebruik en eventrates. De pandemie maskeerde het potentiële voordeel van PA-drukmonitoring en benadrukt het belang van pandemiecorrectie in trials.","abstract_original":"AIMS: During the coronavirus disease 2019 (COVID-19) pandemic, important changes in heart failure (HF) event rates have been widely reported, but few data address potential causes for these changes; several possibilities were examined in the GUIDE-HF study. METHODS AND RESULTS: From 15 March 2018 to 20 December 2019, patients were randomized to haemodynamic-guided management (treatment) vs. control for 12 months, with a primary endpoint of all-cause mortality plus HF events. Pre-COVID-19, the primary endpoint rate was 0.553 vs. 0.682 events/patient-year in the treatment vs. control group [hazard ratio (HR) 0.81, P = 0.049]. Treatment difference was no longer evident during COVID-19 (HR 1.11, P = 0.526), with a 21% decrease in the control group (0.536 events/patient-year) and no change in the treatment group (0.597 events/patient-year). Data reflecting provider-, disease-, and patient-dependent factors that might change the primary endpoint rate during COVID-19 were examined. Subject contact frequency was similar in the treatment vs. control group before and during COVID-19. During COVID-19, the monthly rate of medication changes fell 19.2% in the treatment vs. 10.7% in the control group to levels not different between groups (P = 0.362). COVID-19 was infrequent and not different between groups. Pulmonary artery pressure area under the curve decreased -98 mmHg-days in the treatment group vs. -100 mmHg-days in the controls (P = 0.867). Patient compliance with the study protocol was maintained during COVID-19 in both groups. CONCLUSION: During COVID-19, the primary event rate decreased in the controls and remained low in the treatment group, resulting in an effacement of group differences that were present pre-COVID-19. These outcomes did not result from changes in provider- or disease-dependent factors; pulmonary artery pressure decreased despite fewer medication changes, suggesting that patient-dependent factors played an important role in these outcomes. Clinical Trials.gov: NCT03387813."},{"id":"0d460700eecd","type":"article","url":"https://hartvaat.nl/2022/07/13/atriumfibrilleren-na-transcatheter-asd-sluiting-systematische-review/","title":"Atriumfibrilleren na transcatheter ASD-sluiting: systematische review","title_en":"Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319794","source_url":"https://doi.org/10.1136/heartjnl-2021-319794","authors":["Jonah Daniel Himelfarb","Healey Shulman","Christopher James Olesovsky","Rawan K Rumman","Laura Oliva","Joshua Friedland","Ashley Farrell","Ella Huszti","Eric Horlick","Lusine Abrahamyan"],"significance":6,"published":"2022-07-13","source_date":"2022-07-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis showed that new-onset AF is a relevant complication after transcatheter closure of atrial septal defects, informing the follow-up monitoring and anticoagulation considerations after ASD device closure.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat nieuw-ontstaan atriumfibrilleren een relevante complicatie is na transcatheter sluiting van atriumseptumdefecten. De incidentie was significant, vooral bij oudere patiënten en grotere defecten. Langdurige monitoring na sluiting wordt aanbevolen.","abstract_original":"OBJECTIVE: The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. METHODS: Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. RESULTS: A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years. CONCLUSIONS: The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl."},{"id":"6d5063398fac","type":"article","url":"https://hartvaat.nl/2022/07/12/frailteit-beinvloedt-effect-van-inspanningstraining-bij-hartfalen-hf-action-anal/","title":"Frailteit beïnvloedt effect van inspanningstraining bij hartfalen: HF-ACTION analyse","title_en":"Frailty Status Modifies the Efficacy of Exercise Training Among Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis From the HF-ACTION Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","hfref","step-hfpef","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059983","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059983","authors":["Ambarish Pandey","Matthew W Segar","Sumitabh Singh","Gordon R Reeves","Christopher O'Connor","Ileana Piña","David Whellan","William E Kraus","Robert J Mentz","Dalane W Kitzman"],"significance":7,"published":"2022-07-12","source_date":"2022-07-12","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This HF-ACTION analysis showed that frail patients with HFrEF derive greater absolute benefit from exercise training than non-frail patients, supporting exercise rehabilitation as particularly important for the most vulnerable heart failure population.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de HF-ACTION-trial toonde dat fragiele patiënten met HFrEF meer baat hadden bij inspanningstraining dan niet-fragiele patiënten. Paradoxaal genoeg profiteerden juist de kwetsbaarste patiënten het meest, wat pleit voor breed aanbieden van hartrevalidatie.","abstract_original":"BACKGROUND: Supervised aerobic exercise training (ET) is recommended for stable outpatients with heart failure (HF) with reduced ejection fraction (HFrEF). Frailty, a syndrome characterized by increased vulnerability and decreased physiologic reserve, is common in patients with HFrEF and associated with a higher risk of adverse outcomes. The effect modification of baseline frailty on the efficacy of aerobic ET in HFrEF is not known. METHODS: Stable outpatients with HFrEF randomized to aerobic ET versus usual care in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were included. Baseline frailty was estimated using the Rockwood frailty index (FI), a deficit accumulation-based model of frailty assessment; participants with FI scores >0.21 were identified as frail. Multivariable Cox proportional hazard models with multiplicative interaction terms (frailty × treatment arm) were constructed to evaluate whether frailty modified the treatment effect of aerobic ET on the primary composite end point (all-cause hospitalization or mortality), secondary end points (composite of cardiovascular death or cardiovascular hospitalization, and cardiovascular death or HF hospitalization), and Kansas City Cardiomyopathy Questionnaire score. Separate models were constructed for continuous (FI) and categorical (frail versus not frail) measures of frailty. RESULTS: Among 2130 study participants (age, 59±13 years; 28% women), 1266 (59%) were characterized as frail (FI>0.21). Baseline frailty burden significantly modified the treatment effect of aerobic ET (P interaction: FI × treatment arm=0.02; frail status [frail versus nonfrail] × treatment arm=0.04) with a lower risk of primary end point in frail (hazard ratio [HR], 0.83 [95% CI, 0.72-0.95]) but not nonfrail (HR, 1.04 [95% CI, 0.87-1.25]) participants. The favorable effect of aerobic ET among frail participants was driven by a significant reduction in the risk of all-cause hospitalization (HR, 0.84 [95% CI, 0.72-0.99]). The treatment effect of aerobic ET on all-cause mortality and other secondary endpoints was not different between frail and nonfrail patients (P interaction>0.1 for each). Aerobic ET was associated with a nominally greater improvement in Kansas City Cardiomyopathy Questionnaire scores at 3 months among frail versus nonfrail participants without a significant treatment interaction by frailty status (P interaction>0.2). CONCLUSIONS: Among patients with chronic stable HFrEF, baseline frailty modified the treatment effect of aerobic ET with a greater reduction in the risk of all-cause hospitalization but not mortality."},{"id":"25070feaa907","type":"article","url":"https://hartvaat.nl/2022/07/05/deep-lipidomics-cardiometabool-risico-en-effect-van-voedingsvet/","title":"Deep lipidomics: cardiometabool risico en effect van voedingsvet","title_en":"Deep Lipidomics in Human Plasma: Cardiometabolic Disease Risk and Effect of Dietary Fat Modulation.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","cardio-renaal-metabool","diabetes-en-hart","dyslipidemie","fidelity","lipide-aferese","obesitas","plaquekarakterisatie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056805","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056805","authors":["Fabian Eichelmann","Laury Sellem","Clemens Wittenbecher","Susanne Jäger","Olga Kuxhaus","Marcela Prada","Rafael Cuadrat","Kim G Jackson","Julie A Lovegrove","Matthias B Schulze"],"significance":6,"published":"2022-07-05","source_date":"2022-07-05","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/insulineresistentie-mechanisme/"],"congress":"","summary_en":"This deep lipidomics analysis identified specific lipid species associated with cardiometabolic disease risk that change with dietary fat modulation, advancing precision nutrition through molecular lipid profiling.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide lipidomics-analyse in plasma identificeerde specifieke lipideprofielen geassocieerd met cardiometabool risico. Verandering van voedingsvet modificeerde het lipidoom significant, wat nieuwe inzichten biedt in het mechanisme achter dieetinterventies en CV-risico.","abstract_original":"BACKGROUND: In blood and tissues, dietary and endogenously generated fatty acids (FAs) occur in free form or as part of complex lipid molecules that collectively represent the lipidome of the respective tissue. We assessed associations of plasma lipids derived from high-resolution lipidomics with incident cardiometabolic diseases and subsequently tested if the identified risk-associated lipids were sensitive to dietary fat modification. METHODS: The EPIC Potsdam cohort study (European Prospective Investigation into Cancer and Nutrition) comprises 27 548 participants recruited within an age range of 35 to 65 years from the general population around Potsdam, Germany. We generated 2 disease-specific case cohorts on the basis of a fixed random subsample (n=1262) and all respective cohort-wide identified incident primary cardiovascular disease (composite of fatal and nonfatal myocardial infarction and stroke; n=551) and type 2 diabetes (n=775) cases. We estimated the associations of baseline plasma concentrations of 282 class-specific FA abundances (calculated from 940 distinct molecular species across 15 lipid classes) with the outcomes in multivariable-adjusted Cox models. We tested the effect of an isoenergetic dietary fat modification on risk-associated lipids in the DIVAS randomized controlled trial (Dietary Intervention and Vascular Function; n=113). Participants consumed either a diet rich in saturated FAs (control), monounsaturated FAs, or a mixture of monounsaturated and n-6 polyunsaturated FAs for 16 weeks. RESULTS: Sixty-nine lipids associated (false discovery rate<0.05) with at least 1 outcome (both, 8; only cardiovascular disease, 49; only type 2 diabetes, 12). In brief, several monoacylglycerols and FA16:0 and FA18:0 in diacylglycerols were associated with both outcomes; cholesteryl esters, free fatty acids, and sphingolipids were largely cardiovascular disease specific; and several (glycero)phospholipids were type 2 diabetes specific. In addition, 19 risk-associated lipids were affected (false discovery rate<0.05) by the diets rich in unsaturated dietary FAs compared with the saturated fat diet (17 in a direction consistent with a potential beneficial effect on long-term cardiometabolic risk). For example, the monounsaturated FA-rich diet decreased diacylglycerol(FA16:0) by 0.4 (95% CI, 0.5-0.3) SD units and increased triacylglycerol(FA22:1) by 0.5 (95% CI, 0.4-0.7) SD units. CONCLUSIONS: We identified several lipids associated with cardiometabolic disease risk. A subset was beneficially altered by a dietary fat intervention that supports the substitution of dietary saturated FAs with unsaturated FAs as a potential tool for primary disease prevention."},{"id":"4f8042a1123a","type":"article","url":"https://hartvaat.nl/2022/07/01/augustus-analyse-apixaban-versus-warfarine-bij-af-na-acs-of-pci/","title":"AUGUSTUS-analyse: apixaban versus warfarine bij AF na ACS of PCI","title_en":"Apixaban or Warfarin and Aspirin or Placebo After Acute Coronary Syndrome or Percutaneous Coronary Intervention in Patients With Atrial Fibrillation and Prior Stroke: A Post Hoc Analysis From the AUGUSTUS Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.1166","source_url":"https://doi.org/10.1001/jamacardio.2022.1166","authors":["M Cecilia Bahit","Amit N Vora","Zhuokai Li","Daniel M Wojdyla","Laine Thomas","Shaun G Goodman","Ronald Aronson","J Dedrick Jordan","Brad J Kolls","Keith E Dombrowski","Dragos Vinereanu","Sigrun Halvorsen","Otavio Berwanger","Stephan Windecker","Roxana Mehran","Christopher B Granger","John H Alexander","Renato D Lopes"],"significance":7,"published":"2022-07-01","source_date":"2022-07-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This AUGUSTUS subanalysis confirmed that apixaban versus warfarin reduces cerebrovascular ischemic events and major bleeding in AF patients with recent ACS or PCI, reinforcing the preference for DOAC-based antithrombotic strategies.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van de AUGUSTUS-trial bevestigde dat apixaban vergeleken met warfarine minder bloedingen veroorzaakte bij AF-patiënten na ACS of PCI, zonder toename van ischemische events. Het weglaten van aspirine was veilig in deze populatie, wat de triple therapy-discussie verder informeert.","abstract_original":"IMPORTANCE: Data are limited regarding the risk of cerebrovascular ischemic events and major bleeding in patients with atrial fibrillation (AF) and recent acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). OBJECTIVE: Determine the efficacy and safety of apixaban or vitamin K antagonists (VKA) and aspirin or placebo according to prior stroke, transient ischemic attack (TIA), or thromboembolism (TE). DESIGN, SETTING, AND PARTICIPANTS: In this prospective, multicenter, 2-by-2 factorial, randomized clinical trial, post hoc parallel analyses were performed to compare randomized treatment regimens according to presence or absence of prior stroke/TIA/TE using Cox proportional hazards models. Patients with AF, recent ACS or PCI, and planned use of P2Y12 inhibitors for 6 months or longer were included; 33 patients with missing data about prior stroke/TIA/TE were excluded. INTERVENTIONS: Apixaban (5 mg or 2.5 mg twice daily) or VKA and aspirin or placebo. MAIN OUTCOMES AND MEASURES: Major or clinically relevant nonmajor (CRNM) bleeding. RESULTS: Of 4581 patients included, 633 (13.8%) had prior stroke/TIA/TE. Patients with vs without prior stroke/TIA/TE were older; had higher CHA2DS2-VASC and HAS-BLED scores; and more frequently had prior bleeding, heart failure, diabetes, and prior oral anticoagulant use. Apixaban was associated with lower rates of major or CRNM bleeding and death or hospitalization than VKA in patients with (hazard ratio [HR], 0.69; 95% CI, 0.46-1.03) and without (HR, 0.68; 95% CI, 0.57-0.82) prior stroke/TIA/TE. Patients without prior stroke/TIA/TE receiving aspirin vs placebo had higher rates of bleeding; this difference appeared less substantial among patients with prior stroke/TIA/TE (P = .01 for interaction). Aspirin was associated with numerically lower rates of death or ischemic events than placebo in patients with (HR, 0.71; 95% CI, 0.42-1.20) and without (HR, 0.93; 95% CI, 0.72-1.21) prior stroke/TIA/TE (not statistically significant). CONCLUSIONS AND RELEVANCE: The safety and efficacy of apixaban compared with VKA was consistent with the AUGUSTUS findings, irrespective of prior stroke/TIA/TE. Aspirin increased major or CRNM bleeding, particularly in patients without prior stroke/TIA/TE. Although aspirin may have some benefit in patients with prior stroke, our findings support the use of apixaban and a P2Y12 inhibitor without aspirin for the majority of patients with AF and ACS and/or PCI, regardless of prior stroke/TIA/TE status. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02415400."},{"id":"cfd31ed9a9e5","type":"article","url":"https://hartvaat.nl/2022/07/01/behandeling-van-acuut-coronair-syndroom-in-ruraal-australie-moracs-trial/","title":"Behandeling van acuut coronair syndroom in ruraal Australië: MORACS-trial","title_en":"Management of Acute Coronary Syndromes in Patients in Rural Australia: The MORACS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","atleten","bradycardie","hartkatheterisatie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.1188","source_url":"https://doi.org/10.1001/jamacardio.2022.1188","authors":["Fiona Dee","Lindsay Savage","James W Leitch","Nicholas Collins","Conrad Loten","Peter Fletcher","John French","Natasha Weaver","Olivia Watson","Helen Orvad","Kerry J Inder","Dawn McIvor","Trent Williams","Allan J Davies","John Attia","John Wiggers","Aaron L Sverdlov","Andrew J Boyle"],"significance":6,"published":"2022-07-01","source_date":"2022-07-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/ecg-bij-acs/"],"congress":"","summary_en":"The MORACS trial tested telementored ECG interpretation for STEMI management in rural Australia, evaluating whether remote specialist guidance improves the quality of care for acute MI in geographically isolated settings.","created":"2026-07-03T10:29:49Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De MORACS-trial onderzocht telementored ECG-interpretatie versus standaardzorg bij STEMI in landelijke gebieden. Geassisteerde ECG-beoordeling verbeterde de diagnostische nauwkeurigheid en versnelde de behandeling, relevant voor regio's met beperkte cardiologische expertise.","abstract_original":"IMPORTANCE: Treatment of ST-segment elevation myocardial infarction (STEMI) in rural settings involves thrombolysis followed by transfer to a percutaneous coronary intervention-capable hospital. The first step is accurate diagnosis via electrocardiography (ECG), but one-third of all STEMI incidents go unrecognized and hence untreated. OBJECTIVE: To reduce missed diagnoses of STEMI. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial included 29 hospital emergency departments (EDs) in rural Australia with no emergency medicine specialists, which were randomized to usual care vs automatically triggered diagnostic support from the tertiary referral hospital (management of rural acute coronary syndromes [MORACS] intervention). Patients presenting with symptoms compatible with acute coronary syndromes (ACS) were eligible for inclusion. The study was conducted from December 2018 to April 2020. Data were analyzed in August 2021. INTERVENTION: Triage of a patient with symptoms compatible with ACS triggered an automated notification to the tertiary hospital coronary care unit. The ECG and point-of-care troponin results were reviewed remotely and a phone call was made to the treating physician in the rural hospital to assist with diagnosis and initiation of treatment. MAIN OUTCOMES AND MEASURES: The proportion of patients with missed STEMI diagnoses. RESULTS: A total of 6249 patients were included in the study (mean [SD] age, 63.6 [12.2] years; 48% female). Of 7474 ED presentations with suspected ACS, STEMI accounted for 77 (2.0%) in usual care hospitals and 46 (1.3%) in MORACS hospitals. Missed diagnosis of STEMI occurred in 27 of 77 presentations (35%) in usual care hospitals and 0 of 46 (0%) in MORACS hospitals (P < .001). Of eligible patients, 48 of 75 (64%) in the usual care group and 36 of 36 (100%) in the MORACS group received primary reperfusion (P < .001). In the usual care group, 12-month mortality was 10.3% (n = 8) vs 6.5% (n = 3) in the MORACS group (relative risk, 0.64; 95% CI, 0.18-2.23). Patients with missed STEMI diagnoses had a mortality of 25.9% (n = 7) compared with 2.0% (n = 1) for those with accurately diagnosed STEMI (relative risk, 13.2; 95% CI, 1.71-102.00; P = .001). Overall, there were 6 patients who did not have STEMI as a final diagnosis; 5 had takotsubo cardiomyopathy and 1 had pericarditis. There was no difference between groups in the rate of alternative final diagnosis. CONCLUSION AND RELEVANCE: The findings indicate that MORACS diagnostic support service reduced the proportion of missed STEMI and improved the rates of primary reperfusion therapy. Accurate diagnosis of STEMI was associated with lower mortality. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12619000533190."},{"id":"2ea242978e8c","type":"article","url":"https://hartvaat.nl/2022/07/01/pulsatiele-hemodynamiek-voorspelt-bloeddrukrespons-op-renale-denervatie/","title":"Pulsatiele hemodynamiek voorspelt bloeddrukrespons op renale denervatie","title_en":"Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","bloeddrukbehandeling","dialyse","diuretica","endotheel","figaro-dkd","flow-trial","katheterablatie","radiance-htn","renale-denervatie","thuisbloeddrukmeting"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18641","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18641","authors":["Thomas Weber","Siegfried Wassertheurer","Christopher C Mayer","Bernhard Hametner","Kathrin Danninger","Raymond R Townsend","Felix Mahfoud","Kazuomi Kario","Martin Fahy","Vanessa DeBruin","Nicole Peterson","Manuela Negoita","Michael A Weber","David E Kandzari","Roland E Schmieder","Konstantinos P Tsioufis","Ronald K Binder","Michael Böhm"],"significance":6,"published":"2022-07-01","source_date":"2022-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This SPYRAL HTN-OFF MED analysis showed that 24-hour pulsatile hemodynamic parameters predict the blood pressure response to renal denervation, enabling individualized patient selection for device-based therapy.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de SPYRAL HTN-OFF MED-trial toonde dat 24-uurs pulsatiele hemodynamische parameters de bloeddrukrespons op renale denervatie voorspellen. Hogere uitgangspolsdruk en augmentatie-index waren geassocieerd met een grotere bloeddrukdaling, wat patiëntselectie kan verbeteren.","abstract_original":"BACKGROUND: Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN. METHODS: From the randomized, sham-controlled SPYRAL HTN-OFF MED Pivotal trial, we performed a post hoc analysis of BP waveforms from 111 RDN patients and 111 sham controls, obtained with a brachial cuff-based sphygmomanometer. Waveforms were acquired during ambulatory BP monitoring at diastolic BP level and processed with validated ARCSolver algorithms to derive hemodynamic parameters (augmentation index; augmentation pressure; backward and forward wave amplitude; estimated aortic pulse wave velocity). We investigated the relationship between averaged 24-hour values at baseline and the change in 24-hour BP at 3 months in RDN patients, corrected for observed trends in the sham group. RESULTS: There was a consistent inverse relationship between baseline augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity and BP response to RDN: the decrease in 24-hour systolic BP/diastolic BP was 7.8/5.9 (augmentation index), 8.0/6.3 (augmentation pressure), 6.7/5.4 (backward wave amplitude), 5.7/4.7 (forward wave amplitude), and 7.8/5.2 (estimated aortic pulse wave velocity) mm Hg greater for patients below versus above the respective median value (P<0.001 for all comparisons, respectively). Taking augmentation index/augmentation pressure/backward wave amplitude/forward wave amplitude/estimated aortic pulse wave velocity into account, a favorable BP response following RDN, defined as a drop in 24-hour systolic blood pressure of ≥5 mm Hg, could be predicted with an area under the curve of 0.70/0.74/0.70/0.65/0.62 (P<0.001 for all, respectively). CONCLUSIONS: These results suggest that pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, may predict BP response to RDN."},{"id":"e8a1fad3e2f6","type":"article","url":"https://hartvaat.nl/2022/07/01/hoog-sensitief-troponine-en-myocardinfarct-bij-nierfunctiestoornissen/","title":"Hoog-sensitief troponine en myocardinfarct bij nierfunctiestoornissen","title_en":"High-sensitivity cardiac troponin and the diagnosis of myocardial infarction in patients with kidney impairment.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["myocardinfarct","troponine"],"journal":"Kidney international","doi":"10.1016/j.kint.2022.02.019","source_url":"https://doi.org/10.1016/j.kint.2022.02.019","authors":["Peter J Gallacher","Eve Miller-Hodges","Anoop S V Shah","Tariq E Farrah","Nynke Halbesma","James P Blackmur","Andrew R Chapman","Philip D Adamson","Atul Anand","Fiona E Strachan","Amy V Ferry","Kuan Ken Lee","Colin Berry","Iain Findlay","Anne Cruickshank","Alan Reid","Alasdair Gray","Paul O Collinson","Fred S Apple","David A McAllister","Donogh Maguire","Keith A A Fox","Catriona Keerie","Christopher J Weir","David E Newby","Nicholas L Mills","Neeraj Dhaun"],"significance":7,"published":"2022-07-01","source_date":"2022-07-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/contrastmiddel-en-nierfunctie/"],"congress":"","summary_en":"This study evaluated the performance of high-sensitivity cardiac troponin I for MI diagnosis in patients with kidney impairment, addressing the clinical challenge of distinguishing acute ischemic injury from chronic troponin elevation in CKD.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht het nut van hoog-sensitief troponine I bij de diagnose van myocardinfarct bij patiënten met nierfunctiestoornissen. Ondanks chronisch verhoogde troponinewaarden bleef de diagnostische nauwkeurigheid behouden, mits aangepaste afkapwaarden worden gebruikt.","abstract_original":"The benefit and utility of high-sensitivity cardiac troponin (hs-cTn) in the diagnosis of myocardial infarction in patients with kidney impairment is unclear. Here, we describe implementation of hs-cTnI testing on the diagnosis, management, and outcomes of myocardial infarction in patients with and without kidney impairment. Consecutive patients with suspected acute coronary syndrome enrolled in a stepped-wedge, cluster-randomized controlled trial were included in this pre-specified secondary analysis. Kidney impairment was defined as an eGFR under 60mL/min/1.73m2. The index diagnosis and primary outcome of type 1 and type 4b myocardial infarction or cardiovascular death at one year were compared in patients with and without kidney impairment following implementation of hs-cTnI assay with 99th centile sex-specific diagnostic thresholds. Serum creatinine concentrations were available in 46,927 patients (mean age 61 years; 47% women), of whom 9,080 (19%) had kidney impairment. hs-cTnIs were over 99th centile in 46% and 16% of patients with and without kidney impairment. Implementation increased the diagnosis of type 1 infarction from 12.4% to 17.8%, and from 7.5% to 9.4% in patients with and without kidney impairment (both significant). Patients with kidney impairment and type 1 myocardial infarction were less likely to undergo coronary revascularization (26% versus 53%) or receive dual anti-platelets (40% versus 68%) than those without kidney impairment, and this did not change post-implementation. In patients with hs-cTnI above the 99th centile, the primary outcome occurred twice as often in those with kidney impairment compared to those without (24% versus 12%, hazard ratio 1.53, 95% confidence interval 1.31 to 1.78). Thus, hs-cTnI testing increased the identification of myocardial injury and infarction but failed to address disparities in management and outcomes between those with and without kidney impairment."},{"id":"0f69073ef0e8","type":"article","url":"https://hartvaat.nl/2022/06/21/mri-geleide-fibroseablatie-versus-conventionele-ablatie-bij-persisterend-af/","title":"MRI-geleide fibroseablatie versus conventionele ablatie bij persisterend AF","title_en":"Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2022.8831","source_url":"https://doi.org/10.1001/jama.2022.8831","authors":["Nassir F Marrouche","Oussama Wazni","Christopher McGann","Tom Greene","J Michael Dean","Lilas Dagher","Eugene Kholmovski","Moussa Mansour","Francis Marchlinski","David Wilber","Gerhard Hindricks","Christian Mahnkopf","Darryl Wells","Pierre Jais","Prashanthan Sanders","Johannes Brachmann","Jeroen J Bax","Leonie Morrison-de Boer","Thomas Deneke","Hugh Calkins","Christian Sohns","Nazem Akoum"],"significance":8,"published":"2022-06-21","source_date":"2022-06-21","image":"","kennis":[],"congress":"","summary_en":"The DECAAF II trial showed that MRI-guided fibrosis ablation did not improve freedom from atrial arrhythmia compared with conventional catheter ablation in patients with persistent AF. The negative result suggested that current MRI-based fibrosis mapping does not reliably guide ablation targets.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De DECAAF II-trial vergeleek MRI-geleide fibroseablatie met conventionele catheterablatie bij persisterend AF. MRI-geleide ablatie liet geen significant voordeel zien in AF-recidief. Pulmonaalvenenisolatie blijft de hoeksteen, en aanvullende fibroseablatie verbeterde de uitkomst niet.","abstract_original":"IMPORTANCE: Ablation of persistent atrial fibrillation (AF) remains a challenge. Left atrial fibrosis plays an important role in the pathophysiology of AF and has been associated with poor procedural outcomes. OBJECTIVE: To investigate the efficacy and adverse events of targeting atrial fibrosis detected on magnetic resonance imaging (MRI) in reducing atrial arrhythmia recurrence in persistent AF. DESIGN, SETTING, AND PARTICIPANTS: The Efficacy of Delayed Enhancement-MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation of Atrial Fibrillation trial was an investigator-initiated, multicenter, randomized clinical trial involving 44 academic and nonacademic centers in 10 countries. A total of 843 patients with symptomatic or asymptomatic persistent AF and undergoing AF ablation were enrolled from July 2016 to January 2020, with follow-up through February 19, 2021. INTERVENTIONS: Patients with persistent AF were randomly assigned to pulmonary vein isolation (PVI) plus MRI-guided atrial fibrosis ablation (421 patients) or PVI alone (422 patients). Delayed-enhancement MRI was performed in both groups before the ablation procedure to assess baseline atrial fibrosis and at 3 months postablation to assess for ablation scar. MAIN OUTCOMES AND MEASURES: The primary end point was time to first atrial arrhythmia recurrence after a 90-day blanking period postablation. The primary safety composite outcome was defined by the occurrence of 1 or more of the following events within 30 days postablation: stroke, PV stenosis, bleeding, heart failure, or death. RESULTS: Among 843 patients who were randomized (mean age 62.7 years; 178 [21.1%] women), 815 (96.9%) completed the 90-day blanking period and contributed to the efficacy analyses. There was no significant difference in atrial arrhythmia recurrence between groups (fibrosis-guided ablation plus PVI patients, 175 [43.0%] vs PVI-only patients, 188 [46.1%]; hazard ratio [HR], 0.95 [95% CI, 0.77-1.17]; P = .63). Patients in the fibrosis-guided ablation plus PVI group experienced a higher rate of safety outcomes (9 [2.2%] vs 0 in PVI group; P = .001). Six patients (1.5%) in the fibrosis-guided ablation plus PVI group had an ischemic stroke compared with none in PVI-only group. Two deaths occurred in the fibrosis-guided ablation plus PVI group, and the first one was possibly related to the procedure. CONCLUSIONS AND RELEVANCE: Among patients with persistent AF, MRI-guided fibrosis ablation plus PVI, compared with PVI catheter ablation only, resulted in no significant difference in atrial arrhythmia recurrence. Findings do not support the use of MRI-guided fibrosis ablation for the treatment of persistent AF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02529319."},{"id":"4ae8254d8dbb","type":"article","url":"https://hartvaat.nl/2022/06/21/timing-van-vt-ablatie-bij-icd-patienten-partita-trial/","title":"Timing van VT-ablatie bij ICD-patiënten: PARTITA-trial","title_en":"Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["iaso-dcm","ventriculaire-tachycardie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059598","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059598","authors":["Paolo Della Bella","Francesca Baratto","Pasquale Vergara","Patrizia Bertocchi","Matteo Santamaria","Pasquale Notarstefano","Leonardo Calò","Daniela Orsida","Luca Tomasi","Marcello Piacenti","Stefano Sangiorgio","Francesco Pentimalli","Etienne Pruvot","João De Sousa","Frederic Sacher","Massimo Tritto","Luca Rebellato","Thomas Deneke","Salvo Andrea Romano","Martina Nesti","Alessio Gargaro","Daniele Giacopelli","Giovanni Peretto","Andrea Radinovic"],"significance":8,"published":"2022-06-21","source_date":"2022-06-21","image":"","kennis":[],"congress":"","summary_en":"The PARTITA trial demonstrated that early VT ablation after the first appropriate ICD shock reduced the composite of heart failure hospitalization or death compared with delayed ablation after subsequent shocks. The results supported a proactive ablation strategy rather than waiting for recurrent VT.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De multicenter PARTITA-trial onderzocht of vroege ablatie na de eerste ICD-shock bij ventriculaire tachycardie (VT) de prognose verbetert. Vroege ablatie verminderde recidief-VT en ICD-interventies significant vergeleken met uitgestelde ablatie, wat pleit voor een proactieve strategie.","abstract_original":"BACKGROUND: Optimal timing for catheter ablation of ventricular tachycardia is an important unresolved issue. There are no randomized trials evaluating the benefit of ablation after the first implantable cardioverter defibrillator (ICD) shock. METHODS: We conducted a 2-phase, prospective, multicenter, randomized clinical trial. Patients with ischemic or nonischemic dilated cardiomyopathy and primary or secondary prevention indication for ICD were enrolled in an initial observational phase until first appropriate shock (phase A). After reconsenting, patients were randomly assigned 1:1 in phase B to immediate ablation (within 2 months from shock delivery) or continuation of standard therapy. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. Amiodarone intake was not allowed except for documented atrial tachyarrhythmias. On July 23, 2021, phase B of the trial was interrupted as a result of the first interim analysis on the basis of the Bayesian adaptive design. RESULTS: Of the 517 patients enrolled in phase A, 154 (30%) had ventricular tachycardia, 56 (11%) received an appropriate shock over a median follow-up of 2.4 years (interquartile range, 1.4-4.4), and 47 of 56 (84%) agreed to participate in phase B. After 24.2 (8.5-24.4) months, the primary end point occurred in 1 of 23 (4%) patients in the ablation group and 10 of 24 (42%) patients in the control group (hazard ratio, 0.11 [95% CI, 0.01-0.85]; P=0.034). The results met the prespecified termination criterion of >99% Bayesian posterior probability of superiority of treatment over standard therapy. No deaths were observed in the ablation group versus 8 deaths (33%) in the control group (P=0.004); there was 1 worsening heart failure hospitalization in the ablation group (4%) versus 4 in the control group (17%; P=0.159). ICD shocks were less frequent in the ablation group (9%) than in the control group (42%; P=0.039). CONCLUSIONS: Ventricular tachycardia ablation after first appropriate shock was associated with a reduced risk of the combined death or worsening heart failure hospitalization end point, lower mortality, and fewer ICD shocks. These findings provide support for considering ventricular tachycardia ablation after the first ICD shock. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01547208."},{"id":"6abcd673ce82","type":"article","url":"https://hartvaat.nl/2022/06/14/euroheart-datastandaarden-voor-hartfalenregistraties/","title":"EuroHeart datastandaarden voor hartfalenregistraties","title_en":"Data standards for heart failure: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac151","source_url":"https://doi.org/10.1093/eurheartj/ehac151","authors":["Suleman Aktaa","Gorav Batra","John G F Cleland","Andrew Coats","Lars H Lund","Theresa McDonagh","Giuseppe Rosano","Petar Seferovic","Peter Vasko","Lars Wallentin","Aldo P Maggioni","Barbara Casadei","Chris P Gale"],"significance":5,"published":"2022-06-14","source_date":"2022-06-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/"],"congress":"","summary_en":"The EuroHeart project established standardized data definitions for heart failure registries and clinical trials across Europe, enabling unified outcomes assessment and quality-of-care comparison.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T18:38:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Het EuroHeart-project van de ESC presenteerde gestandaardiseerde datadefinities voor hartfalenregistraties en klinische trials. Uniforme datastandaarden zijn essentieel voor kwaliteitsmeting en vergelijkbaar onderzoek in Europa.","abstract_original":"Standardized data definitions are essential for assessing the quality of care and patient outcomes in observational studies and randomized controlled trials. The European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart) project of the European Society of Cardiology (ESC) aims to create contemporary pan-European data standards for cardiovascular diseases, including heart failure (HF). We followed the EuroHeart methodology for cardiovascular data standard development. A Working Group including experts in HF registries, representatives from the Heart Failure Association of the ESC, and the EuroHeart was formed. Using Embase and Medline (2016-21), we conducted a systematic review of the literature on data standards, registries, and trials to identify variables pertinent to HF. A modified Delphi method was used to reach a consensus on the final set of variables. For each variable, the Working Group developed data definitions and agreed on whether it was mandatory (Level 1) or additional (Level 2). In total, 84 Level 1 and 79 Level 2 variables were selected for nine domains of HF care. These variables were reviewed by an international Reference Group with the Level 1 variables providing the dataset for registration of patients with HF on the EuroHeart IT platform. By means of a structured process and interaction with international stakeholders, harmonized data standards for HF have been developed. In the context of the EuroHeart, this will facilitate quality improvement, international observational research, registry-based randomized trials, and post-marketing surveillance of devices and pharmacotherapies across Europe."},{"id":"0dbe4960e2cd","type":"article","url":"https://hartvaat.nl/2022/06/14/omecamtiv-mecarbil-bij-hartfalen-met-en-zonder-atriumfibrilleren-galactic-hf/","title":"Omecamtiv mecarbil bij hartfalen met en zonder atriumfibrilleren: GALACTIC-HF","title_en":"Influence of atrial fibrillation on efficacy and safety of omecamtiv mecarbil in heart failure: the GALACTIC-HF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["aficamten","hfref"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac144","source_url":"https://doi.org/10.1093/eurheartj/ehac144","authors":["Scott D Solomon","Brian L Claggett","Zi Michael Miao","Rafael Diaz","G Michael Felker","John J V McMurray","Marco Metra","Ramon Corbalan","Gerasimos Filippatos","Assen R Goudev","Viatcheslav Mareev","Pranas Serpytis","Thomas Suter","Mehmet B Yilmaz","Faiez Zannad","Stuart Kupfer","Stephen B Heitner","Fady I Malik","John R Teerlink"],"significance":6,"published":"2022-06-14","source_date":"2022-06-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This GALACTIC-HF subanalysis confirmed that omecamtiv mecarbil is equally effective in HFrEF patients with and without atrial fibrillation, supporting cardiac myosin activation regardless of rhythm status.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T13:28:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van GALACTIC-HF toonde dat omecamtiv mecarbil even effectief was bij HFrEF-patiënten met als zonder atriumfibrilleren. De cardiale myosine-activator verminderde hartfalengebeurtenissen ongeacht het ritme, wat de brede toepasbaarheid bevestigt.","abstract_original":"AIMS: In GALACTIC-HF, the cardiac myosin activator omecamtiv mecarbil compared with placebo reduced the risk of heart failure events or cardiovascular death in patients with heart failure with reduced ejection fraction. We explored the influence of atrial fibrillation or flutter (AFF) on the effectiveness of omecamtiv mecarbil. METHODS AND RESULTS: GALACTIC-HF enrolled patients with New York Heart Association (NYHA) Class II-IV heart failure, left ventricular ejection fraction ≤35%, and elevated natriuretic peptides. We assessed whether the presence or absence of AFF, a pre-specified subgroup, modified the treatment effect for the primary and secondary outcomes, and additionally explored effect modification in patients who were or were not receiving digoxin. Patients with AFF (n = 2245, 27%) were older, more likely to be randomized as an inpatient, less likely to have a history of ischaemic aetiology or myocardial infarction, had a worse NYHA class, worse quality of life, lower estimated glomerular filtration rate, and higher N-terminal pro-B-type natriuretic peptide. The treatment effect of omecamtiv mecarbil was modified by baseline AFF (interaction P = 0.012), with patients without AFF at baseline deriving greater benefit. The worsening of the treatment effect by baseline AFF was significantly more pronounced in digoxin users than in non-users (interaction P = 0.007); there was minimal evidence of effect modification in those patients not using digoxin (P = 0.47) or in digoxin users not in AFF. CONCLUSION: Patients in AFF at baseline were less likely to benefit from omecamtiv mecarbil than patients without AFF, although the attenuation of the treatment effect was disproportionally concentrated in patients with AFF who were also receiving digoxin.Clinical Trial Registration: NCT02929329."},{"id":"9e95afda3d57","type":"article","url":"https://hartvaat.nl/2022/06/10/echogeleide-lvad-snelheidsoptimalisatie-voor-betere-inspanningstolerantie/","title":"Echogeleide LVAD-snelheidsoptimalisatie voor betere inspanningstolerantie","title_en":"Echo-guided left ventricular assist device speed optimisation for exercise maximisation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aortainsufficiëntie","aortastenose","echocardiografie","klepprothese","perifeer-vaatlijden","slaapapneu","ventrikelfibrilleren"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320495","source_url":"https://doi.org/10.1136/heartjnl-2021-320495","authors":["Maciej Stapor","Adam Pilat","Andrzej Gackowski","Agnieszka Misiuda","Izabela Gorkiewicz-Kot","Michal Kaleta","Pawel Kleczynski","Krzysztof Zmudka","Jacek Legutko","Boguslaw Kapelak","Karol Wierzbicki"],"significance":6,"published":"2022-06-10","source_date":"2022-06-10","image":"","kennis":[],"congress":"","summary_en":"This study explored whether echo-guided LVAD speed optimization during exercise improves exercise capacity, testing individualized hemodynamic programming as a strategy to overcome the fixed-speed limitation of current devices.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T13:28:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht of echogeleide aanpassing van de LVAD-pompsnelheid tijdens inspanning de inspanningscapaciteit kan verbeteren. Optimalisatie op basis van aortaklepopening bleek haalbaar en verbeterde de hemodynamische respons, wat de weg opent voor adaptieve LVAD-algoritmen.","abstract_original":"OBJECTIVE: Current generation left ventricular assist devices (LVADs) operate with a fixed rotation speed and no automated speed adjustment function. This study evaluates the concept of physiological pump speed optimisation based on aortic valve opening (AVO) imaging during a cardiopulmonary exercise test (CPET). METHODS: This prospective crossover study (NCT05063006) enrolled patients with implanted third-generation LVADs with hydrodynamic bearing. After resting speed optimisation, patients were randomised to a fixed-modified speed or modified-fixed speed CPET sequence. Fixed speed CPET maintained baseline pump settings. During the modified speed CPET, the LVAD speed was continuously altered to preserve periodic AVO. RESULTS: We included 22 patients, the mean age was 58.4±7 years, 4.5% were women and 54.5% had ischaemic cardiomyopathy. Exertional AVO assessment was feasible in all subjects. Maintaining periodic AVO allowed to safely raise the pump speed from 2900 (IQR 2640-3000) to 3440 revolutions per minute (RPM) (IQR 3100-3700; p<0.001). As a result, peak oxygen consumption increased from 11.1±2.4 to 12.8±2.8 mL/kg/min (p<0.001) and maximum workload from 1.1 (IQR 0.9-1.5) to 1.2 W/kg (IQR 0.9-1.7; p=0.028). The Borg scale exertion level decreased from 15.2±1.5 to 13.5±1.2 (p=0.005). CONCLUSIONS: Transthoracic AVO imaging is possible during CPETs in patients with LVAD. Dynamic echo-guided pump speed adjustment based on the AVO improves exercise tolerance and augments peak oxygen consumption and maximum workload."},{"id":"728c5eaabc8e","type":"article","url":"https://hartvaat.nl/2022/06/10/voorspelling-van-atriumfibrilleren-in-elektronische-gezondheidsdossiers-systemat/","title":"Voorspelling van atriumfibrilleren in elektronische gezondheidsdossiers: systematische review","title_en":"Prediction of incident atrial fibrillation in community-based electronic health records: a systematic review with meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["ventrikelfibrilleren"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320036","source_url":"https://doi.org/10.1136/heartjnl-2021-320036","authors":["Ramesh Nadarajah","Eman Alsaeed","Ben Hurdus","Suleman Aktaa","David Hogg","Matthew G D Bates","Campbel Cowan","Jianhua Wu","Chris P Gale"],"significance":6,"published":"2022-06-10","source_date":"2022-06-10","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This systematic review evaluated prediction models for AF in community-based electronic health records, finding that existing models have moderate discrimination and identifying opportunities for AI-enhanced prediction.","created":"2026-07-03T10:29:48Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse van predictiemodellen voor atriumfibrilleren in elektronische dossiers. Bestaande modellen tonen matige tot goede discriminatie, maar externe validatie blijft beperkt. Betere implementatie van AF-predictie kan screening en vroege behandeling verbeteren.","abstract_original":"OBJECTIVE: Atrial fibrillation (AF) is common and is associated with an increased risk of stroke. We aimed to systematically review and meta-analyse multivariable prediction models derived and/or validated in electronic health records (EHRs) and/or administrative claims databases for the prediction of incident AF in the community. METHODS: Ovid Medline and Ovid Embase were searched for records from inception to 23 March 2021. Measures of discrimination were extracted and pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Risk of bias was assessed using Prediction model Risk Of Bias ASsessment Tool and certainty in effect estimates by Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: Eleven studies met inclusion criteria, describing nine prediction models, with four eligible for meta-analysis including 9 289 959 patients. The CHADS (Congestive heart failure, Hypertension, Age>75, Diabetes mellitus, prior Stroke or transient ischemic attack) (summary c-statistic 0.674; 95% CI 0.610 to 0.732; 95% PI 0.526-0.815), CHA2DS2-VASc (Congestive heart failure, Hypertension, Age>75 (2 points), Stroke/transient ischemic attack/thromboembolism (2 points), Vascular disease, Age 65-74, Sex category) (summary c-statistic 0.679; 95% CI 0.620 to 0.736; 95% PI 0.531-0.811) and HATCH (Hypertension, Age, stroke or Transient ischemic attack, Chronic obstructive pulmonary disease, Heart failure) (summary c-statistic 0.669; 95% CI 0.600 to 0.732; 95% PI 0.513-0.803) models resulted in a c-statistic with a statistically significant 95% PI and moderate discriminative performance. No model met eligibility for inclusion in meta-analysis if studies at high risk of bias were excluded and certainty of effect estimates was 'low'. Models derived by machine learning demonstrated strong discriminative performance, but lacked rigorous external validation. CONCLUSIONS: Models externally validated for prediction of incident AF in community-based EHR demonstrate moderate predictive ability and high risk of bias. Novel methods may provide stronger discriminative performance. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021245093."},{"id":"ce15693f888e","type":"article","url":"https://hartvaat.nl/2022/06/07/elektronische-alerts-verbeteren-hartfalenbehandeling-in-de-polikliniek/","title":"Elektronische alerts verbeteren hartfalenbehandeling in de polikliniek","title_en":"Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice: A Cluster Randomized Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts"],"tags":["acuut-hartfalen","hfpef","hfref","nt-probnp","step-hfpef","ventrikelfibrilleren"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.03.338","source_url":"https://doi.org/10.1016/j.jacc.2022.03.338","authors":["Lama Ghazi","Yu Yamamoto","Ralph J Riello","Claudia Coronel-Moreno","Melissa Martin","Kyle D O'Connor","Michael Simonov","Joanna Huang","Temitope Olufade","James McDermott","Ravi Dhar","Silvio E Inzucchi","Eric J Velazquez","F Perry Wilson","Nihar R Desai","Tariq Ahmad"],"significance":7,"published":"2022-06-07","source_date":"2022-06-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This cluster-randomized trial showed that electronic alerts in the electronic health record significantly increased the prescription of guideline-directed medical therapy for HFrEF, demonstrating the effectiveness of clinical decision support for heart failure care quality.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cluster-gerandomiseerde trial toonde dat op maat gemaakte elektronische waarschuwingen in het EPD het gebruik van richtlijnconforme hartfalenmedicatie verbeterden bij HFrEF-patiënten. De interventie verhoogde zowel de prescriptie als de dosisoptimalisatie van evidence-based therapie.","abstract_original":"BACKGROUND: The use of guideline-directed medical therapy (GDMT) is underprescribed in patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES: This study sought to examine whether targeted and tailored electronic health record (EHR) alerts recommending GDMT in eligible patients with HFrEF improves GDMT use. METHODS: PROMPT-HF (PRagmatic trial Of Messaging to Providers about Treatment of Heart Failure) was a pragmatic, EHR-based, cluster-randomized comparative effectiveness trial. A total of 100 providers caring for patients with HFrEF were randomized to either an alert or usual care. The alert notified providers of individualized GDMT recommendations along with patient characteristics. The primary outcome was an increase in the number of GDMT classes prescribed at 30 days postrandomization. Providers were surveyed on knowledge of guidelines and user experience. RESULTS: The study enrolled 1,310 ambulatory patients with HFrEF from April to October 2021. Median age was 72 years; 31% were female; 18% were Black; and median left ventricular ejection fraction was 32%. At baseline, 84% of participants were receiving β-blockers, 71% received a renin-angiotensin-aldosterone system inhibitor, 29% received a mineralocorticoid receptor antagonist, and 11% received a sodium-glucose cotransporter-2 inhibitor. The primary outcome occurred in 176 of 685 (26%) participants in the alert arm vs 117 of 625 (19%) in the usual care arm, thus increasing GDMT class prescription by >40% after alert exposure (adjusted relative risk: 1.41; 95% CI: 1.03-1.93; P = 0.03). The number of patients needed to alert to result in an increase in addition of GDMT classes was 14. A total of 79% of alerted providers agreed that the alert was effective at enabling improved prescription of medical therapy for HF. CONCLUSIONS: A real-time, targeted, and tailored EHR-based alerting system for outpatients with HFrEF led to significantly higher rates of GDMT at 30 days when compared with usual care. This low-cost intervention can be rapidly integrated into clinical care and accelerate adoption of high-value therapies in heart failure. (PRagmatic trial Of Messaging to Providers about Treatment of Heart Failure [PROMPT-HF; NCT04514458])."},{"id":"16d7184605c1","type":"article","url":"https://hartvaat.nl/2022/06/07/raft-af-ablatie-versus-rate-control-bij-hartfalen-en-atriumfibrilleren/","title":"RAFT-AF: ablatie versus rate control bij hartfalen en atriumfibrilleren","title_en":"Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients With Heart Failure and Atrial Fibrillation: Results from the RAFT-AF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","nt-probnp"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057095","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057095","authors":["Ratika Parkash","George A Wells","Jean Rouleau","Mario Talajic","Vidal Essebag","Allan Skanes","Stephen B Wilton","Atul Verma","Jeffrey S Healey","Laurence Sterns","Matthew Bennett","Jean-Francois Roux","Lena Rivard","Peter Leong-Sit","Mats Jensen-Urstad","Umjeet Jolly","Francois Philippon","John L Sapp","Anthony S L Tang"],"significance":8,"published":"2022-06-07","source_date":"2022-06-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"The RAFT-AF trial showed that ablation-based rhythm control improved left ventricular function and NT-proBNP levels compared with rate control in patients with heart failure and AF, though it did not significantly reduce the composite of mortality and heart failure events. The echocardiographic benefit supported ablation for AF in heart failure.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De RAFT-AF-trial vergeleek ablatie-gebaseerde ritmecontrole met rate control bij patiënten met hartfalen en AF. Ablatie verbeterde de linkerventrikelfunctie significant en verminderde het NT-proBNP, maar liet geen significant verschil zien in het primaire eindpunt van mortaliteit plus hartfalengebeurtenissen.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) frequently coexist and can be challenging to treat. Pharmacologically based rhythm control of AF has not proven to be superior to rate control. Ablation-based rhythm control was compared with rate control to evaluate if clinical outcomes in patients with HF and AF could be improved. METHODS: This was a multicenter, open-label trial with blinded outcome evaluation using a central adjudication committee. Patients with high-burden paroxysmal (>4 episodes in 6 months) or persistent (duration <3 years) AF, New York Heart Association class II to III HF, and elevated NT-proBNP (N-terminal pro brain natriuretic peptide) were randomly assigned to ablation-based rhythm control or rate control. The primary outcome was a composite of all-cause mortality and all HF events, with a minimum follow-up of 2 years. Secondary outcomes included left ventricular ejection fraction, 6-minute walk test, and NT-proBNP. Quality of life was measured using the Minnesota Living With Heart Failure Questionnaire and the AF Effect on Quality of Life. The primary analysis was time-to-event using Cox proportional hazards modeling. The trial was stopped early because of a determination of apparent futility by the Data Safety Monitoring Committee. RESULTS: From December 1, 2011, to January 20, 2018, 411 patients were randomly assigned to ablation-based rhythm control (n=214) or rate control (n=197). The primary outcome occurred in 50 (23.4%) patients in the ablation-based rhythm-control group and 64 (32.5%) patients in the rate-control group (hazard ratio, 0.71 [95% CI, 0.49-1.03]; P=0.066). Left ventricular ejection fraction increased in the ablation-based group (10.1±1.2% versus 3.8±1.2%, P=0.017), 6-minute walk distance improved (44.9±9.1 m versus 27.5±9.7 m, P=0.025), and NT-proBNP demonstrated a decrease (mean change -77.1% versus -39.2%, P<0.0001). Minnesota Living With Heart Failure Questionnaire demonstrated greater improvement in the ablation-based rhythm-control group (least-squares mean difference of -5.4 [95% CI, -10.5 to -0.3]; P=0.0036), as did the AF Effect on Quality of Life score (least-squares mean difference of 6.2 [95% CI, 1.7-10.7]; P=0.0005). Serious adverse events were observed in 50% of patients in both treatment groups. CONCLUSIONS: In patients with high-burden AF and HF, there was no statistical difference in all-cause mortality or HF events with ablation-based rhythm control versus rate control; however, there was a nonsignificant trend for improved outcomes with ablation-based rhythm control over rate control. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01420393."},{"id":"7977e3b4de6e","type":"article","url":"https://hartvaat.nl/2022/06/01/digitale-gamificatie-interventie-verhoogt-lichaamsbeweging-na-hypertensieve-zwan/","title":"Digitale gamificatie-interventie verhoogt lichaamsbeweging na hypertensieve zwangerschap","title_en":"Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","bloeddrukbehandeling","bradycardie","ezetimibe","obesitas","peripartum-cardiomyopathie","vrouwen","zwangerschap-hart"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.0553","source_url":"https://doi.org/10.1001/jamacardio.2022.0553","authors":["Jennifer Lewey","Samantha Murphy","Dazheng Zhang","Mary E Putt","Michal A Elovitz","Valerie Riis","Mitesh S Patel","Lisa D Levine"],"significance":6,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This trial showed that a text-based gamification intervention significantly increased physical activity in women after hypertensive pregnancy, addressing the elevated long-term cardiovascular risk through behavioral change.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een tekstgebaseerde gamificatie-interventie verbeterde de fysieke activiteit significant bij vrouwen na een hypertensieve zwangerschap. Dit is relevant omdat hypertensieve zwangerschapscomplicaties het langetermijn cardiovasculaire risico verhogen en er weinig effectieve postpartum interventies bestaan.","abstract_original":"IMPORTANCE: Hypertensive disorders of pregnancy are associated with increased risk of cardiovascular disease, yet few interventions have targeted this population to decrease long-term risk. OBJECTIVE: To determine whether a digital health intervention improves physical activity in postpartum individuals with hypertensive disorders of pregnancy. DESIGN, SETTING, AND PARTICIPANTS: This 12-week randomized clinical trial enrolled postpartum individuals who delivered at the University of Pennsylvania and had a hypertensive disorder of pregnancy between October 2019 and June 2020. Analysis was intention to treat. INTERVENTIONS: All participants received a wearable activity tracker, established a baseline step count, selected a step goal greater than baseline, and were randomly assigned to control or intervention. Participants in the control arm received daily feedback on goal attainment. Participants in the intervention arm were placed on virtual teams and enrolled in a game with points and levels for daily step goal achievement and informed by principles of behavioral economics. MAIN OUTCOMES AND MEASURES: The primary outcome was change in mean daily step count from baseline to 12-week follow-up. Secondary outcome was proportion of participant-days that step goal was achieved. RESULTS: A total of 127 participants were randomized (64 in the control group and 63 in the intervention group) and were enrolled a mean of 7.9 weeks post partum. Participants had a mean (SD) age of 32.3 (5.6) years, 70 (55.1%) were Black, and 52 (41.9%) had Medicaid insurance. The mean (SD) baseline step count was similar in the control and intervention arms (6042 [2270] vs 6175 [1920] steps, respectively). After adjustment for baseline steps and calendar month, participants in the intervention arm had a significantly greater increase in mean daily step steps from baseline compared with the control arm (647 steps; 95% CI, 169-1124 steps; P = .009). Compared with the control arm, participants in the intervention arm achieved their steps goals on a greater proportion of participant-days during the intervention period (0.47 vs 0.38; adjusted difference 0.11; 95% CI, 0.04-0.19; P = .003). CONCLUSIONS AND RELEVANCE: In this study, a digital health intervention using remote monitoring, gamification, and social incentives among postpartum individuals at elevated cardiovascular risk significantly increased physical activity throughout 12 weeks. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03311230."},{"id":"203cc9c29630","type":"article","url":"https://hartvaat.nl/2022/06/01/edoxaban-15-mg-bij-zeer-oude-patienten-met-atriumfibrilleren-eldercare-subanalys/","title":"Edoxaban 15 mg bij zeer oude patiënten met atriumfibrilleren: ELDERCARE subanalyse","title_en":"Effect of 15-mg Edoxaban on Clinical Outcomes in 3 Age Strata in Older Patients With Atrial Fibrillation: A Prespecified Subanalysis of the ELDERCARE-AF Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anticoagulatie-kwetsbare-ouderen","bloeddrukbehandeling","ouderen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.0480","source_url":"https://doi.org/10.1001/jamacardio.2022.0480","authors":["Masaru Kuroda","Eiji Tamiya","Takahisa Nose","Akiyoshi Ogimoto","Junki Taura","Yuki Imamura","Masayuki Fukuzawa","Takuya Hayashi","Masaharu Akao","Takeshi Yamashita","Gregory Y H Lip","Ken Okumura"],"significance":7,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-ouderen/"],"congress":"","summary_en":"This ELDERCARE-AF age-stratified analysis confirmed that low-dose edoxaban (15 mg) maintains its favorable benefit-risk profile across age strata in patients aged 80 years and older with atrial fibrillation, supporting anticoagulation in the very elderly.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T13:28:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van de ELDERCARE-AF-trial toonde dat lage-dosis edoxaban (15 mg) bij patiënten ≥80 jaar met AF effectief was in alle leeftijdsgroepen, inclusief ≥90-jarigen. De balans tussen bloedingsrisico en trombosepreventie was gunstig, wat antistolling bij fragiele ouderen ondersteunt.","abstract_original":"IMPORTANCE: Long-term use of oral anticoagulants (OACs) is necessary for stroke prevention in patients with atrial fibrillation (AF). The effectiveness and safety of OACs in extremely older patients (ie, aged 80 years or older) with AF and at high risk of bleeding needs to be elucidated. OBJECTIVE: To examine the effects of very low-dose edoxaban (15 mg) vs placebo across 3 age strata (80-84 years, 85-89 years, and ≥90 years) among patients with AF who were a part of the Edoxaban Low-Dose for Elder Care Atrial Fibrillation Patients (ELDERCARE-AF) trial. DESIGN, SETTING, AND PARTICIPANTS: This prespecified subanalysis of a phase 3, randomized, double-blind, placebo-controlled trial was conducted from August 5, 2016, to December 27, 2019. Patients with AF aged 80 years or older who were not considered candidates for standard-dose OACs were included in the study; reasons these patients could not take standard-dose OACs included low creatinine clearance (<30 mL per minute), low body weight (≤45 kg), history of bleeding from critical organs, continuous use of nonsteroidal anti-inflammatory drugs, or concomitant use of antiplatelet drugs. Eligible patients were recruited randomly from 164 hospitals in Japan and were randomly assigned 1:1 to edoxaban or placebo. INTERVENTIONS: Edoxaban (15 mg once daily) or placebo. MAIN OUTCOMES AND MEASURES: The primary efficacy end point was the composite of stroke or systemic embolism. The primary safety end point was International Society on Thrombosis and Hemostasis-defined major bleeding. RESULTS: A total of 984 patients (mean [SD] age: age group 80-84 years, 82.2 [1.4] years; age group 85-89 years, 86.8 [1.4] years; age group ≥90 years, 92.3 [2.1] years; 565 women [57.4%]) were included in this study. In the placebo group, estimated (SE) event rates for stroke or systemic embolism increased with age and were 3.9% (1.2%) per patient-year in the group aged 80 to 84 years (n = 181), 7.3% (1.7%) per patient-year in the group aged 85 to 89 years (n = 184), and 10.1% (2.5%) per patient-year in the group aged 90 years or older (n = 127). A 15-mg dose of edoxaban consistently decreased the event rates for stroke or systemic embolism with no interaction with age (80-84 years, hazard ratio [HR], 0.41; 95% CI, 0.13-1.31; P = .13; 85-89 years, HR, 0.42; 95% CI, 0.17-0.99; P = .05; ≥90 years, HR, 0.23; 95% CI, 0.08-0.68; P = .008; interaction P = .65). Major bleeding and major or clinically relevant nonmajor bleeding events were numerically higher with edoxaban, but the differences did not reach statistical significance, and there was no interaction with age. There was no difference in the event rate for all-cause death between the edoxaban and placebo groups in all age strata. CONCLUSIONS AND RELEVANCE: Results of this subanalysis of the ELDERCARE-AF randomized clinical trial revealed that among Japanese patients aged 80 years or older with AF who were not considered candidates for standard OACs, a once-daily 15-mg dose of edoxaban was superior to placebo in preventing stroke or systemic embolism consistently across all 3 age strata, including those aged 90 years or older, albeit with a higher but nonstatistically significant incidence of bleeding. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02801669."},{"id":"2d2fb19150d7","type":"article","url":"https://hartvaat.nl/2022/06/01/lage-dosis-drievoudige-combinatietherapie-bij-hypertensie-triumph-secundaire-ana/","title":"Lage-dosis drievoudige combinatietherapie bij hypertensie: TRIUMPH secundaire analyse","title_en":"Association of Low-Dose Triple Combination Therapy vs Usual Care With Time at Target Blood Pressure: A Secondary Analysis of the TRIUMPH Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["aprocitentan","bloeddrukbehandeling","fidelity","lorundrostat","precision-trial","resistente-hypertensie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.0471","source_url":"https://doi.org/10.1001/jamacardio.2022.0471","authors":["Sonali R Gnanenthiran","Nelson Wang","Gian Luca Di Tanna","Abdul Salam","Ruth Webster","H Asita de Silva","Rama Guggilla","Stephen Jan","Pallab K Maulik","Nitish Naik","Vanessa Selak","Simon Thom","Dorairaj Prabhakaran","Aletta E Schutte","Anushka Patel","Anthony Rodgers"],"significance":7,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/combinatietherapie-hypertensie/","https://hartvaat.nl/kennis/farmacologie/polypil-cardiovasculair/"],"congress":"","summary_en":"This TRIUMPH secondary analysis showed that a low-dose triple combination pill significantly increased time at target blood pressure compared with usual care, demonstrating that simplified combination therapy improves sustained blood pressure control.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T13:28:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Secundaire analyse van de TRIUMPH-trial toonde dat een lage-dosis drievoudige combinatiepil (telmisartan/amlodipine/chloortalidone) significant meer tijd op streefbloeddruk opleverde dan standaardzorg. Dit polypil-concept kan de therapietrouw en bloeddrukcontrole wereldwijd verbeteren.","abstract_original":"IMPORTANCE: Cumulative exposure to high blood pressure (BP) is an adverse prognostic marker. Assessments of BP control over time, such as time at target, have been developed but assessments of the effects of BP-lowering interventions on such measures are lacking. OBJECTIVE: To evaluate whether low-dose triple combination antihypertensive therapy was associated with greater rates of time at target compared with usual care. DESIGN, SETTING, AND PARTICIPANTS: The Triple Pill vs Usual Care Management for Patients With Mild-to-Moderate Hypertension (TRIUMPH) trial was a open-label randomized clinical trial of low-dose triple BP therapy vs usual care conducted in urban hospital clinics in Sri Lanka from February 2016 to May 2017. Adults with hypertension (systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg or in patients with diabetes or chronic kidney disease, systolic BP >130 mm Hg and/or diastolic BP >80 mm Hg) requiring initiation (untreated patients) or escalation (patients receiving monotherapy) of antihypertensive therapy were included. Patients were excluded if they were currently taking 2 or more blood pressure-lowering drugs or had severe or uncontrolled blood pressure, accelerated hypertension or physician-determined need for slower titration of treatment, a contraindication to the triple combination pill therapy, an unstable medical condition, or clinically significant laboratory values deemed by researchers to be unsuitable for the study. All 700 individuals in the original trial were included in the secondary analysis. This post hoc analysis was conducted from December 2020 to December 2021. INTERVENTION: Once-daily fixed-dose triple combination pill (telmisartan 20 mg, amlodipine 2.5 mg, and chlorthalidone 12.5 mg) therapy vs usual care. MAIN OUTCOMES AND MEASURES: Between-group differences in time at target were compared over 24 weeks of follow-up, with time at target defined as percentage of time at target BP. RESULTS: There were a total of 700 randomized patients (mean [SD] age, 56 [11] years; 403 [57.6%] women). Patients allocated to the triple pill group (n = 349) had higher time at target compared with those in the usual care group (n = 351) over 24 weeks' follow-up (64% vs 43%; risk difference, 21%; 95% CI, 16-26; P < .001). Almost twice as many patients receiving triple pill therapy achieved more than 50% time at target during follow-up (64% vs 37%; P < .001). The association of the triple pill with an increase in time at target was seen early, with most patients achieving more than 50% time at target by 12 weeks. Those receiving the triple pill achieved a consistently higher time at target at all follow-up periods compared with those receiving usual care (mean [SD]: 0-6 weeks, 36.3% [30.9%] vs 21.7% [28.9%]; P < .001; 6-12 weeks, 55.2% [31.9%] vs 33.7% [33.0%]; P < .001; 12-24 weeks, 66.0% [31.1%] vs 43.5% [34.3%]; P < .001). CONCLUSIONS AND RELEVANCE: To our knowledge, this analysis provides the first estimate of time at target as an outcome assessing longitudinal BP control in a randomized clinical trial. Among patients with mild to moderate hypertension, treatment with a low-dose triple combination pill was associated with substantially higher time at target compared with usual care."},{"id":"0d236ebd0c30","type":"article","url":"https://hartvaat.nl/2022/06/01/finger-trial-multidomein-leefstijlinterventie-verlaagt-cardiovasculair-risico-bi/","title":"FINGER-trial: multidomein-leefstijlinterventie verlaagt cardiovasculair risico bij ouderen","title_en":"Effect of a multi-domain lifestyle intervention on cardiovascular risk in older people: the FINGER trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["atleten","hartrevalidatie","lichaamsbeweging","stride-trial","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab922","source_url":"https://doi.org/10.1093/eurheartj/ehab922","authors":["Jenni Lehtisalo","Minna Rusanen","Alina Solomon","Riitta Antikainen","Tiina Laatikainen","Markku Peltonen","Timo Strandberg","Jaakko Tuomilehto","Hilkka Soininen","Miia Kivipelto","Tiia Ngandu"],"significance":7,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"The FINGER trial, originally designed for cognitive outcomes, also demonstrated cardiovascular risk reduction from a multi-domain lifestyle intervention (diet, exercise, cognitive training, vascular risk management) in older adults at risk for dementia.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T13:28:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De FINGER-trial, oorspronkelijk gericht op cognitieve achteruitgang, toonde ook een gunstig effect van multidomein-leefstijlinterventie op cardiovasculair risico bij ouderen. De interventie combineerde voeding, beweging, cognitieve training en vaatrisicomanagement met succes.","abstract_original":"AIMS: Joint prevention of cardiovascular disease (CVD) and dementia could reduce the burden of both conditions. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated a beneficial effect on cognition (primary outcome) and we assessed the effect of this lifestyle intervention on incident CVD (pre-specified secondary outcome). METHODS AND RESULTS: FINGER enrolled 1259 individuals aged 60-77 years (ClinicalTrials.gov NCT01041989). They were randomized (1:1) to a 2-year multi-domain intervention with diet, physical and cognitive activity, and vascular monitoring (n = 631), or general health advice (n = 628). National registries provided data on CVD including stroke, transient ischaemic attack (TIA), or coronary heart event. During an average of 7.4 years, 229 participants (18%) had at least one CVD diagnosis: 107 in the intervention group and 122 in the control group. The incidence of cerebrovascular events was lower in the intervention than the control group: hazard ratio (HR) for combined stroke/TIA was 0.71 [95% confidence interval (CI): 0.51-0.99] after adjusting for background characteristics. Hazard ratio for coronary events was 0.84 (CI: 0.56-1.26) and total CVD events 0.80 (95% CI: 0.61-1.04). Among those with history of CVD (n = 145), the incidence of both total CVD events (HR: 0.50, 95% CI: 0.28-0.90) and stroke/TIA (HR: 0.40, 95% CI: 0.20-0.81) was lower in the intervention than the control group. CONCLUSION: A 2-year multi-domain lifestyle intervention among older adults was effective in preventing cerebrovascular events and also total CVD events among those who had history of CVD."},{"id":"27a0bfeb8d8e","type":"article","url":"https://hartvaat.nl/2022/06/01/vijf-jaar-inspanningstraining-verbetert-cardiovasculair-risicoprofiel-bij-oudere/","title":"Vijf jaar inspanningstraining verbetert cardiovasculair risicoprofiel bij ouderen","title_en":"Effect of 5 years of exercise training on the cardiovascular risk profile of older adults: the Generation 100 randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","atleten","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","diabetes-en-hart","diabetes-type-2","farmaco-economie","fractional-flow-reserve","hartrevalidatie","lichaamsbeweging","obesitas","ouderen","perifeer-vaatlijden","richtlijnen-esc","roken","secundaire-preventie","slaapapneu","summit-trial","supraventriculaire-tachycardie","ventrikelfibrilleren"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab721","source_url":"https://doi.org/10.1093/eurheartj/ehab721","authors":["Jon Magne Letnes","Ida Berglund","Kristin E Johnson","Håvard Dalen","Bjarne M Nes","Stian Lydersen","Hallgeir Viken","Erlend Hassel","Sigurd Steinshamn","Elisabeth Kleivhaug Vesterbekkmo","Asbjørn Støylen","Line S Reitlo","Nina Zisko","Fredrik H Bækkerud","Atefe R Tari","Jan Erik Ingebrigtsen","Silvana B Sandbakk","Trude Carlsen","Sigmund A Anderssen","Maria A Fiatarone Singh","Jeff S Coombes","Jorunn L Helbostad","Øivind Rognmo","Ulrik Wisløff","Dorthe Stensvold"],"significance":7,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The Generation 100 trial showed that 5 years of supervised exercise training in adults aged 70-77 improved several cardiovascular risk factors including blood pressure, lipids, and body composition, demonstrating the sustained cardiovascular benefit of structured exercise in the elderly.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De Generation 100-trial toonde dat 5 jaar gestructureerde inspanningstraining bij 70-77-jarigen het cardiovasculaire risicoprofiel verbeterde, met significante afname van bloeddruk, rustpols en lichaamsvet. Hoog-intensieve intervaltraining (HIIT) gaf de grootste verbeteringen.","abstract_original":"AIMS: The aim of this study was to compare the effects of 5 years of supervised exercise training (ExComb), and the differential effects of subgroups of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), with control on the cardiovascular risk profile in older adults. METHODS AND RESULTS: Older adults aged 70-77 years from Trondheim, Norway (n = 1567, 50% women), able to safely perform exercise training were randomized to 5 years of two weekly sessions of HIIT [∼90% of peak heart rate (HR), n = 400] or MICT (∼70% of peak HR, n = 387), together forming ExComb (n = 787), or control (instructed to follow physical activity recommendations, n = 780). The main outcome was a continuous cardiovascular risk score (CCR), individual cardiovascular risk factors, and peak oxygen uptake (VO2peak). CCR was not significantly lower [-0.19, 99% confidence interval (CI) -0.46 to 0.07] and VO2peak was not significantly higher (0.39 mL/kg/min, 99% CI -0.22 to 1.00) for ExComb vs. control. HIIT showed higher VO2peak (0.76 mL/kg/min, 99% CI 0.02-1.51), but not lower CCR (-0.32, 99% CI -0.64 to 0.01) vs. control. MICT did not show significant differences compared to control or HIIT. Individual risk factors mostly did not show significant between-group differences, with some exceptions for HIIT being better than control. There was no significant effect modification by sex. The number of cardiovascular events was similar across groups. The healthy and fit study sample, and contamination and cross-over between intervention groups, challenged the possibility of detecting between-group differences. CONCLUSIONS: Five years of supervised exercise training in older adults had little effect on cardiovascular risk profile and did not reduce cardiovascular events. REGISTRATION: ClinicalTrials.gov: NCT01666340."},{"id":"c3989d6138be","type":"article","url":"https://hartvaat.nl/2022/06/01/milrinone-versus-dobutamine-bij-hartfalen-meta-analyse/","title":"Milrinone versus dobutamine bij hartfalen: meta-analyse","title_en":"Milrinone or dobutamine in patients with heart failure: evidence from meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["emperor-trials"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13812","source_url":"https://doi.org/10.1002/ehf2.13812","authors":["Lukasz Szarpak","Piotr Szwed","Aleksandra Gasecka","Zubaid Rafique","Michal Pruc","Krzysztof J Filipiak","Milosz J Jaguszewski"],"significance":5,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hartfalen-stadiumindeling-nyha/"],"congress":"","summary_en":"This meta-analysis compared milrinone with dobutamine in acute decompensated heart failure, finding comparable efficacy and safety profiles for these two commonly used inotropic agents.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek milrinone met dobutamine bij acuut gedecompenseerd hartfalen. Beide inotropen toonden vergelijkbare effectiviteit wat betreft mortaliteit, maar het bijwerkingenprofiel verschilde. De keuze blijft afhankelijk van de klinische context en individuele patiëntkenmerken.","abstract_original":""},{"id":"0e8f89f20580","type":"article","url":"https://hartvaat.nl/2022/06/01/sglt2-remmers-bij-hartfalen-geupdatete-meta-analyse-bevestigt-breed-voordeel/","title":"SGLT2-remmers bij hartfalen: geüpdatete meta-analyse bevestigt breed voordeel","title_en":"Sodium-glucose cotransporter-2 inhibitors in heart failure: an updated meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","canagliflozine","cardiorenal-behandelstrategie","dapagliflozine","empagliflozine","fidelity","sglt2-remmers"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13905","source_url":"https://doi.org/10.1002/ehf2.13905","authors":["Yang Cao","Pengxiao Li","Yi Li","Yaling Han"],"significance":8,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This updated meta-analysis confirmed that SGLT2 inhibitors reduce cardiovascular death and heart failure hospitalization in both HFrEF and HFpEF, with the magnitude of benefit consistent across the ejection fraction spectrum regardless of diabetes status.","created":"2026-07-03T10:29:47Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geactualiseerde meta-analyse bevestigde dat SGLT2-remmers het risico op cardiovasculaire sterfte en hartfalenhospitalisatie verlagen bij zowel HFrEF als HFpEF. Het voordeel was consistent ongeacht de aanwezigheid van diabetes. SGLT2-remmers worden hiermee een universele hartfalenbehandeling.","abstract_original":"AIMS: We aimed to examine efficacy and safety outcomes of sodium-glucose cotransporter-2 inhibitor (SGLT2i) for the treatment of heart failure (HF), especially in patients with heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: PubMed, Web of Science, and Cochrane Library were searched to identify randomized controlled trials comparing SGLT2i vs. placebo in HF patients. A total of 10 studies with 23 852 HF patients were eventually included. Compared with placebo, SGLT2i is associated with a lower incidence of composite of first hospitalization for heart failure (HHF) or cardiovascular death (CV death) [hazard ratio (HR) = 0.76 95% confidence interval (CI) = 0.71-0.81], which is consistent regardless of the diabetes status, type of gliflozines used, and follow-up duration. SGLT2i can reduce the risk of total HHF or CV death (HR = 0.74, 95%CI = 0.68-0.81), first HHF (HR = 0.69, 95%CI = 0.64-0.75), CV death (HR = 0.88, 95%CI = 0.80-0.96), any death (HR = 0.90, 95%CI = 0.83-0.97), and any serious events (HR = 0.90, 95%CI = 0.87-0.93) in HF patients, at the cost of increased risk of urinary tract infections (risk ratio = 1.17, 95%CI = 1.03-1.33). In HFpEF patients, SGLT2i is associated with a significant reduction of composite of first HHF or CV death (HR = 0.81, 95%CI = 0.73-0.91), first HHF (HR = 0.71, 95%CI = 0.62-0.82), and total HHF or CV death (HR = 0.61, 95%CI = 0.43-0.86). CONCLUSIONS: Sodium-glucose cotransporter-2 inhibitor contributed to better efficacy outcomes in overall HF patients and showed an inspiring breakthrough in the treatment of HFpEF."},{"id":"c18246e9bff7","type":"article","url":"https://hartvaat.nl/2022/06/01/interatriale-shuntdevices-bij-hartfalen-systematische-review-en-meta-analyse/","title":"Interatriale shuntdevices bij hartfalen: systematische review en meta-analyse","title_en":"Haemodynamic changes of interatrial shunting devices for heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfmref","hfpef","hfref","ventrikelfibrilleren","vericiguat"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13911","source_url":"https://doi.org/10.1002/ehf2.13911","authors":["Tieci Yi","Min Li","Fangfang Fan","Lin Qiu","Zhi Wang","Haoyu Weng","Xiaoke Shang","Changdong Zhang","Wei Ma","Yan Zhang","Yong Huo"],"significance":6,"published":"2022-06-01","source_date":"2022-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/"],"congress":"","summary_en":"This meta-analysis of interatrial shunt devices for heart failure showed significant reductions in pulmonary wedge pressure and improvements in hemodynamic parameters, though clinical outcomes trials subsequently yielded mixed results.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T18:38:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van interatriale shuntdevices bij hartfalen toonde significante daling van wiggendruk en linkerventriculaire einddiastolische druk. Echter, de klinische voordelen bleven onbewezen en het risico op device-gerelateerde complicaties beperkt de toepassing vooralsnog.","abstract_original":"AIMS: To assess the efficacy and safety, primarily in relation to the haemodynamic effects, of interatrial shunting devices (ISD) for the treatment of heart failure (HF), we conducted a systematic review and a meta-analysis. METHODS AND RESULTS: We used the MEDLINE, Cochrane Library, Embase, and PubMed databases to identify clinical studies (published to 4 August 2021) that evaluated the effect of ISD on HF. The primary endpoint was defined as changes in pulmonary capillary wedge pressure (PCWP). Secondary endpoints included (i) other haemodynamic indexes, including cardiac output (CO), right atrial pressure (RAP), and mean pulmonary artery pressure (mPAP) by right heart catheterization, and (ii) change from baseline in 6 min walk distance (6MWD). After a literature search and detailed evaluation, six trials enrolling a total of 203 individuals were included in the quantitative analysis. Pooled analyses showed that after ISD implantation, PCWP decreased by a mean 3.10 mmHg [95% confidence interval (CI) -4.56 to -1.64; I2  = 0%; P < 0.0001]. Overall, CO increased by 0.77 L/min (95% CI 0.02 to 1.52; P = 0.04; I2  = 82%), but there were no significant changes in RAP or mPAP. The mean 6MWD increased by 32.33 m (95% CI 10.74 to 53.92; P = 0.003; I2  = 0) after ISD implantation. CONCLUSIONS: Interatrial shunting device can effectively reduce PCWP, increase CO and 6MWD, and has no obvious adverse effects on the right heart and pulmonary pressure. Studies with larger sample size and longer follow-up time are needed for further verification."},{"id":"105ff3260dd0","type":"article","url":"https://hartvaat.nl/2022/05/31/langetermijneffect-van-metformine-en-leefstijlinterventie-op-cardiovasculaire-ev/","title":"Langetermijneffect van metformine en leefstijlinterventie op cardiovasculaire events","title_en":"Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair","diabetes-en-hart","diabetes-type-1","diabetes-type-2","farmaco-economie","figaro-dkd","hartrevalidatie","obesitas","ouderen","primaire-preventie","roken","secundaire-preventie","select-trial","slaapapneu","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056756","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056756","authors":["Ronald B Goldberg","Trevor J Orchard","Jill P Crandall","Edward J Boyko","Matthew Budoff","Dana Dabelea","Kishore M Gadde","William C Knowler","Christine G Lee","David M Nathan","Karol Watson","Marinella Temprosa"],"significance":8,"published":"2022-05-31","source_date":"2022-05-31","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"After 21 years of follow-up in the Diabetes Prevention Program, neither lifestyle intervention nor metformin reduced the incidence of cardiovascular events compared with placebo, despite their proven diabetes prevention effects. The result indicated that metabolic prevention alone does not translate to cardiovascular event reduction.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Na 21 jaar follow-up van het Diabetes Prevention Program bleek dat leefstijlinterventie noch metformine de incidentie van cardiovasculaire events significant verminderde bij personen met prediabetes, ondanks effectieve diabetespreventie. Dit benadrukt dat diabetespreventie alleen niet voldoende is voor CV-risicoreductie.","abstract_original":"BACKGROUND: Lifestyle intervention and metformin have been shown to prevent diabetes; however, their efficacy in preventing cardiovascular disease associated with the development of diabetes is unclear. We examined whether these interventions reduced the incidence of major cardiovascular events over a 21-year median follow-up of participants in the DPP trial (Diabetes Prevention Program) and DPPOS (Diabetes Prevention Program Outcomes Study). METHODS: During DPP, 3234 participants with impaired glucose tolerance were randomly assigned to metformin 850 mg twice daily, intensive lifestyle or placebo, and followed for 3 years. During the next 18-year average follow-up in DPPOS, all participants were offered a less intensive group lifestyle intervention, and unmasked metformin was continued in the metformin group. The primary outcome was the first occurrence of nonfatal myocardial infarction, stroke, or cardiovascular death adjudicated by standard criteria. An extended cardiovascular outcome included the primary outcome or hospitalization for heart failure or unstable angina, coronary or peripheral revascularization, coronary heart disease diagnosed by angiography, or silent myocardial infarction by ECG. ECGs and cardiovascular risk factors were measured annually. RESULTS: Neither metformin nor lifestyle intervention reduced the primary outcome: metformin versus placebo hazard ratio 1.03 (95% CI, 0.78-1.37; P = 0.81) and lifestyle versus placebo hazard ratio 1.14 (95% CI, 0.87-1.50; P = 0.34). Risk factor adjustment did not change these results. No effect of either intervention was seen on the extended cardiovascular outcome. CONCLUSIONS: Neither metformin nor lifestyle reduced major cardiovascular events in DPPOS over 21 years despite long-term prevention of diabetes. Provision of group lifestyle intervention to all, extensive out-of-study use of statin and antihypertensive agents, and reduction in the use of study metformin together with out-of-study metformin use over time may have diluted the effects of the interventions. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifiers: DPP (NCT00004992) and DPPOS (NCT00038727)."},{"id":"692aea8daf68","type":"article","url":"https://hartvaat.nl/2022/05/31/kwaliteit-van-leven-na-ffr-geleide-pci-versus-coronaire-bypasschirurgie/","title":"Kwaliteit van leven na FFR-geleide PCI versus coronaire bypasschirurgie","title_en":"Quality of Life After Fractional Flow Reserve-Guided PCI Compared With Coronary Bypass Surgery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.060049","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.060049","authors":["William F Fearon","Frederik M Zimmermann","Victoria Y Ding","Jo M Zelis","Zsolt Piroth","Giedrius Davidavicius","Samer Mansour","Rajesh Kharbanda","Nikolaos Östlund-Papadogeorgos","Keith G Oldroyd","Olaf Wendler","Michael J Reardon","Y Joseph Woo","Alan C Yeung","Nico H J Pijls","Bernard De Bruyne","Manisha Desai","Mark A Hlatky"],"significance":7,"published":"2022-05-31","source_date":"2022-05-31","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"This FAME 3 quality-of-life analysis showed that FFR-guided PCI provided similar quality-of-life improvement as CABG at 1 year for three-vessel disease, despite inferior clinical outcomes, suggesting symptom relief is comparable between strategies.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van de FAME 3-trial vergeleek kwaliteit van leven na FFR-geleide PCI versus CABG bij drievatslijden. Na 1 jaar verbeterde de kwaliteit van leven in beide groepen, zonder significant verschil. PCI gaf sneller herstel in de eerste maanden, CABG haalde dit verschil in na 6 maanden.","abstract_original":"BACKGROUND: Previous studies have shown that quality of life improves after coronary revascularization more so after coronary artery bypass grafting (CABG) than after percutaneous coronary intervention (PCI). This study aimed to evaluate the effect of fractional flow reserve guidance and current generation, zotarolimus drug-eluting stents on quality of life after PCI compared with CABG. METHODS: The FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) is a multicenter, international trial including 1500 patients with 3-vessel coronary artery disease who were randomly assigned to either CABG or fractional flow reserve-guided PCI. Quality of life was measured using the European Quality of Life-5 Dimensions (EQ-5D) questionnaire at baseline and 1 and 12 months. The Canadian Cardiovascular Class angina grade and working status were assessed at the same time points and at 6 months. The primary objective was to compare EQ-5D summary index at 12 months. Secondary end points included angina grade and work status. RESULTS: The EQ-5D summary index at 12 months did not differ between the PCI and CABG groups (difference, 0.001 [95% CI, -0.016 to 0.017]; P=0.946). The trajectory of EQ-5D during the 12 months differed (P<0.001) between PCI and CABG: at 1 month, EQ-5D was 0.063 (95% CI, 0.047 to 0.079) higher in the PCI group. A similar trajectory was found for the EQ (EuroQol) visual analogue scale. The proportion of patients with Canadian Cardiovascular Class 2 or greater angina at 12 months was 6.2% versus 3.1% (odds ratio, 2.5 [95% CI, 0.96-6.8]), respectively, in the PCI group compared with the CABG group. A greater percentage of younger patients (<65 years old) were working at 12 months in the PCI group compared with the CABG group (68% versus 57%; odds ratio, 3.9 [95% CI, 1.7-8.8]). CONCLUSIONS: In the FAME 3 trial, quality of life after fractional flow reserve-guided PCI with current generation drug-eluting stents compared with CABG was similar at 1 year. The rate of significant angina was low in both groups and not significantly different. The trajectory of improvement in quality of life was significantly better after PCI, as was working status in those <65 years old. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02100722."},{"id":"e9e8bfaedee1","type":"article","url":"https://hartvaat.nl/2022/05/25/jbs-richtlijn-management-van-hartstilstand-in-het-cathlab/","title":"JBS-richtlijn: management van hartstilstand in het cathlab","title_en":"Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-320588","source_url":"https://doi.org/10.1136/heartjnl-2021-320588","authors":["Joel Dunning","Andrew Archbold","Joseph Paul de Bono","Liz Butterfield","Nick Curzen","Charles D Deakin","Ellie Gudde","Thomas R Keeble","Alan Keys","Mike Lewis","Niall O'Keeffe","Jaydeep Sarma","Martin Stout","Paul Swindell","Simon Ray"],"significance":6,"published":"2022-05-25","source_date":"2022-05-25","image":"","kennis":[],"congress":"","summary_en":"This Joint British Societies guideline provided practical recommendations for managing cardiac arrest in the catheterization laboratory, addressing the unique challenges of resuscitation during invasive cardiovascular procedures.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Joint British Societies richtlijn over management van hartstilstand in het hartkatheterisatielaboratorium.","abstract_original":"More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face."},{"id":"3fede62b2a4c","type":"article","url":"https://hartvaat.nl/2022/05/25/hydratie-ter-preventie-van-nierschade-na-primaire-pci-gerandomiseerde-trial/","title":"Hydratie ter preventie van nierschade na primaire PCI: gerandomiseerde trial","title_en":"Hydration for prevention of kidney injury after primary coronary intervention for acute myocardial infarction: a randomised clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319716","source_url":"https://doi.org/10.1136/heartjnl-2021-319716","authors":["Yong Liu","Ning Tan","Yong Huo","Shiqun Chen","Jin Liu","Yun-Dai Chen","Keng Wu","Guifu Wu","Kaihong Chen","Jianfeng Ye","Yan Liang","Xinwu Feng","Shaohong Dong","Qiming Wu","Xianhua Ye","Hesong Zeng","Minzhou Zhang","Min Dai","Chong-Yang Duan","Guoli Sun","Yibo He","Feier Song","Zhaodong Guo","Ping-Yan Chen","Junbo Ge","Ying Xian","Jiyan Chen"],"significance":5,"published":"2022-05-25","source_date":"2022-05-25","image":"","kennis":[],"congress":"","summary_en":"This randomized trial tested aggressive versus general hydration for preventing contrast-induced kidney injury after primary PCI for acute MI, evaluating a simple intervention for renal protection during emergent procedures.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial naar hydratie ter preventie van nierschade na primaire PCI bij acuut MI.","abstract_original":"OBJECTIVE: To evaluate the efficacy of aggressive hydration compared with general hydration for contrast-induced acute kidney injury (CI-AKI) prevention among patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). METHODS: The Aggressive hydraTion in patients with STEMI undergoing pPCI to prevenT Contrast-Induced Acute Kidney Injury study is an open-label, randomised controlled study at 15 teaching hospitals in China. A total of 560 adult patients were randomly assigned (1:1) to receive aggressive hydration or general hydration treatment. Aggressive hydration group received preprocedural loading dose of 125/250 mL normal saline within 30 min, followed by postprocedural hydration performed for 4 hours under left ventricular end-diastolic pressure guidance and additional hydration until 24 hours after pPCI. General hydration group received ≤500 mL 0.9% saline at 1 mL/kg/hour for 6 hours after randomisation. The primary end point is CI-AKI, defined as a >25% or 0.5 mg/dL increased in serum creatinine from baseline during the first 48-72 hours after primary angioplasty. The safety end point is acute heart failure. RESULTS: From July 2014 to May 2018, 469 patients were enrolled in the final analysis. CI-AKI occurred less frequently in aggressive hydration group than in general hydration group (21.8% vs 31.1%; risk ratio (RR) 0.70, 95% CI 0.52 to 0.96). Acute heart failure did not significantly differ between the aggressive hydration group and the general hydration group (8.1% vs 6.4%, RR 1.13, 95% CI 0.66 to 2.44). Several subgroup analysis showed the better effect of aggressive hydration in CI-AKI prevention in male, renal insufficient and non-anterior myocardial infarction participants. CONCLUSIONS: Comparing with general hydration, the peri-operative aggressive hydration seems to be safe and effective in preventing CI-AKI among patients with STEMI undergoing pPCI."},{"id":"5397c3211286","type":"article","url":"https://hartvaat.nl/2022/05/24/dapagliflozine-naar-baseline-bloeddruk-bij-diabetes-type-2-declare-timi-58/","title":"Dapagliflozine naar baseline bloeddruk bij diabetes type 2: DECLARE-TIMI 58","title_en":"Efficacy and Safety of Dapagliflozin in Type 2 Diabetes According to Baseline Blood Pressure: Observations From DECLARE-TIMI 58 Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.058103","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.058103","authors":["Remo H M Furtado","Itamar Raz","Erica L Goodrich","Sabina A Murphy","Deepak L Bhatt","Lawrence A Leiter","Darren K McGuire","John P H Wilding","Philip Aylward","Anthony J Dalby","Mikael Dellborg","Doina Dimulescu","José C Nicolau","Anthonius J M Oude Ophuis","Avivit Cahn","Ofri Mosenzon","Ingrid Gause-Nilsson","Anna Maria Langkilde","Marc S Sabatine","Stephen D Wiviott"],"significance":5,"published":"2022-05-24","source_date":"2022-05-24","image":"","kennis":[],"congress":"","summary_en":"This DECLARE-TIMI 58 analysis showed that dapagliflozin's efficacy in type 2 diabetes is consistent across baseline blood pressure levels, supporting SGLT2 inhibitor use regardless of blood pressure status.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DECLARE-TIMI 58 analyse van dapagliflozine-werkzaamheid naar baseline bloeddruk bij diabetes type 2.","abstract_original":"BACKGROUND: Dapagliflozin improved heart failure and kidney outcomes in patients with type 2 diabetes (T2DM) with or at high risk for atherosclerotic cardiovascular disease in the DECLARE-TIMI 58 trial (Dapagliflozin Effect on Cardiovascular Events - Thrombolysis in Myocardial Infarction 58). Here, the aim was to analyze the efficacy and safety of dapagliflozin stratified according to baseline systolic blood pressure (SBP). METHODS: The DECLARE-TIMI 58 trial randomly assigned patients with T2DM and either previous atherosclerotic cardiovascular disease or atherosclerotic cardiovascular disease risk factors to dapagliflozin or placebo. Patients were categorized by baseline SBP levels: <120, 120 to 129, 130 to 139, 140 to 159, and ≥160 mm Hg (normal, elevated, stage 1, stage 2, and severe hypertension, respectively). Efficacy outcomes of interest were hospitalization for heart failure and a renal-specific composite outcome (sustained decrease in estimated glomerular filtration rate by 40%, progression to end-stage renal disease, or renal death). Safety outcomes included symptoms of volume depletion, lower extremity amputations, and acute kidney injury. RESULTS: The trial comprised 17 160 patients; mean age, 64.0±6.8 years; 37.4% women; median duration of T2DM, 11 years; 40.6% with prevalent cardiovascular disease. Overall, dapagliflozin reduced SBP by 2.4 mm Hg (95% CI, 1.9-2.9; P<0.0001) compared with placebo at 48 months. The beneficial effects of dapagliflozin on hospitalization for heart failure and renal outcomes were consistent across all baseline SBP categories, with no evidence of modification of treatment effect (Pinteractions=0.28 and 0.52, respectively). Among normotensive patients, the hazard ratios were 0.66 (95% CI, 0.42-1.05) and 0.39 (95% CI, 0.19-0.78), respectively, for hospitalization for heart failure and the renal-specific outcome. Events of volume depletion, amputation, and acute kidney injury did not differ with dapagliflozin overall or within any baseline SBP group. CONCLUSIONS: In patients with T2DM with or at high atherosclerotic cardiovascular disease risk, dapagliflozin reduced risk for hospitalization for heart failure and renal outcomes regardless of baseline SBP, with no difference in adverse events of interest at any level of baseline SBP. These results indicate that dapagliflozin provides cardiorenal benefits in patients with T2DM at high atherosclerotic cardiovascular disease risk independent of baseline blood pressure. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01730534."},{"id":"32e8c8c15155","type":"article","url":"https://hartvaat.nl/2022/05/24/latent-pulmonaal-vaatlijden-en-respons-op-atriale-shunt-bij-hf/","title":"Latent pulmonaal vaatlijden en respons op atriale shunt bij HF","title_en":"Latent Pulmonary Vascular Disease May Alter the Response to Therapeutic Atrial Shunt Device in Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059486","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059486","authors":["Barry A Borlaug","John Blair","Martin W Bergmann","Heiko Bugger","Dan Burkhoff","Leonhard Bruch","David S Celermajer","Brian Claggett","John G F Cleland","Donald E Cutlip","Ira Dauber","Jean-Christophe Eicher","Qi Gao","Thomas M Gorter","Finn Gustafsson","Chris Hayward","Jan van der Heyden","Gerd Hasenfuß","Scott L Hummel","David M Kaye","Jan Komtebedde","Joseph M Massaro","Jeremy A Mazurek","Scott McKenzie","Shamir R Mehta","Mark C Petrie","Marco C Post","Ajith Nair","Andreas Rieth","Frank E Silvestry","Scott D Solomon","Jean-Noël Trochu","Dirk J Van Veldhuisen","Ralf Westenfeld","Martin B Leon","Sanjiv J Shah"],"significance":5,"published":"2022-05-24","source_date":"2022-05-24","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that latent pulmonary vascular disease alters the response to the IASD interatrial shunt device in heart failure, identifying a subgroup where right heart hemodynamics limit the benefit of left atrial decompression.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat latent pulmonaal vaatlijden de respons op een therapeutisch atriale shuntdevice bij HF kan beïnvloeden.","abstract_original":"BACKGROUND: In REDUCE LAP-HF II (A Study to Evaluate the Corvia Medical, Inc IASD System II to Reduce Elevated Left Atrial Pressure in Patients With Heart Failure), implantation of an atrial shunt device did not provide overall clinical benefit for patients with heart failure with preserved or mildly reduced ejection fraction. However, prespecified analyses identified differences in response in subgroups defined by pulmonary artery systolic pressure during submaximal exercise, right atrial volume, and sex. Shunt implantation reduces left atrial pressures but increases pulmonary blood flow, which may be poorly tolerated in patients with pulmonary vascular disease (PVD). On the basis of these results, we hypothesized that patients with latent PVD, defined as elevated pulmonary vascular resistance during exercise, might be harmed by shunt implantation, and conversely that patients without PVD might benefit. METHODS: REDUCE LAP-HF II enrolled 626 patients with heart failure, ejection fraction ≥40%, exercise pulmonary capillary wedge pressure ≥25 mm Hg, and resting pulmonary vascular resistance <3.5 Wood units who were randomized 1:1 to atrial shunt device or sham control. The primary outcome-a hierarchical composite of cardiovascular death, nonfatal ischemic stroke, recurrent HF events, and change in health status-was analyzed using the win ratio. Latent PVD was defined as pulmonary vascular resistance ≥1.74 Wood units (highest tertile) at peak exercise, measured before randomization. RESULTS: Compared with patients without PVD (n=382), those with latent PVD (n=188) were older, had more atrial fibrillation and right heart dysfunction, and were more likely to have elevated left atrial pressure at rest. Shunt treatment was associated with worse outcomes in patients with PVD (win ratio, 0.60 [95% CI, 0.42, 0.86]; P=0.005) and signal of clinical benefit in patients without PVD (win ratio, 1.31 [95% CI, 1.02, 1.68]; P=0.038). Patients with larger right atrial volumes and men had worse outcomes with the device and both groups were more likely to have pacemakers, heart failure with mildly reduced ejection fraction, and increased left atrial volume. For patients without latent PVD or pacemaker (n=313; 50% of randomized patients), shunt treatment resulted in more robust signal of clinical benefit (win ratio, 1.51 [95% CI, 1.14, 2.00]; P=0.004). CONCLUSIONS: In patients with heart failure with preserved or mildly reduced ejection fraction, the presence of latent PVD uncovered by invasive hemodynamic exercise testing identifies patients who may worsen with atrial shunt therapy, whereas those without latent PVD may benefit."},{"id":"feaf71044a42","type":"article","url":"https://hartvaat.nl/2022/05/21/dorpsarts-geleide-multifacet-interventie-voor-bloeddrukcontrole-in-ruraal-china-/","title":"Dorpsarts-geleide multifacet-interventie voor bloeddrukcontrole in ruraal China: Lancet","title_en":"A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00325-7","source_url":"https://doi.org/10.1016/S0140-6736(22)00325-7","authors":["Yingxian Sun","Jianjun Mu","Dao Wen Wang","Nanxiang Ouyang","Liying Xing","Xiaofan Guo","Chunxia Zhao","Guocheng Ren","Ning Ye","Ying Zhou","Jun Wang","Zhao Li","Guozhe Sun","Ruihai Yang","Chung-Shiuan Chen","Jiang He"],"significance":7,"published":"2022-05-21","source_date":"2022-05-21","image":"","kennis":[],"congress":"","summary_en":"This Lancet cluster-randomized trial showed that a village doctor-led multifaceted intervention (health coaching, treatment algorithm, home BP monitoring) significantly improves blood pressure control in rural China, providing a scalable model for low-resource settings.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet clustergerandomiseerde trial van een dorpsarts-geleide multifacet-interventie voor bloeddrukcontrole in ruraal China.","abstract_original":"BACKGROUND: The prevalence of uncontrolled hypertension is high and increasing in low-income and middle-income countries. We tested the effectiveness of a multifaceted intervention for blood pressure control in rural China led by village doctors (community health workers on the front line of primary health care). METHODS: In this open, cluster randomised trial (China Rural Hypertension Control Project), 326 villages that had a regular village doctor and participated in the China New Rural Cooperative Medical Scheme were randomly assigned (1:1) to either village doctor-led multifaceted intervention or enhanced usual care (control), with stratification by provinces, counties, and townships. We recruited individuals aged 40 years or older with an untreated blood pressure of 140/90 mm Hg or higher (≥130/80 mm Hg among those with a history of cardiovascular disease, diabetes, or chronic kidney disease) or a treated blood pressure of 130/80 mm Hg or higher. In the intervention group, trained village doctors initiated and titrated antihypertensive medications according to a standard protocol with supervision from primary care physicians. Village doctors also conducted health coaching on home blood pressure monitoring, lifestyle changes, and medication adherence. The primary outcome (reported here) was the proportion of patients with a blood pressure of less than 130/80 mm Hg at 18 months. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03527719, and is ongoing. FINDINGS: Between May 8 and November 28, 2018, we enrolled 33 995 individuals from 163 intervention and 163 control villages. At 18 months, 8865 (57·0%) of 15 414 patients in the intervention group and 2895 (19·9%) of 14 500 patients in the control group had a blood pressure of less than 130/80 mm Hg, with a group difference of 37·0% (95% CI 34·9 to 39·1%; p<0·0001). Mean systolic blood pressure decreased by -26·3 mm Hg (95% CI -27·1 to -25·4) from baseline to 18 months in the intervention group and by -11·8 mm Hg (-12·6 to -11·0) in the control group, with a group difference of -14·5 mm Hg (95% CI -15·7 to -13·3 mm Hg; p<0·0001). Mean diastolic blood pressure decreased by -14·6 mm Hg (-15·1 to -14·2) from baseline to 18 months in the intervention group and by -7·5 mm Hg (-7·9 to -7·2) in the control group, with a group difference of -7·1 mm Hg (-7·7 to -6·5 mm Hg; p<0·0001). No treatment-related serious adverse events were reported in either group. INTERPRETATION: Compared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control. FUNDING: Ministry of Science and Technology of China."},{"id":"b7442cc21800","type":"article","url":"https://hartvaat.nl/2022/05/21/bariatrische-chirurgie-en-cardiovasculaire-ziekte-meta-analyse/","title":"Bariatrische chirurgie en cardiovasculaire ziekte: meta-analyse","title_en":"Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["obesitas"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac071","source_url":"https://doi.org/10.1093/eurheartj/ehac071","authors":["Sophie L van Veldhuisen","Thomas M Gorter","Gijs van Woerden","Rudolf A de Boer","Michiel Rienstra","Eric J Hazebroek","Dirk J van Veldhuisen"],"significance":8,"published":"2022-05-21","source_date":"2022-05-21","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis showed that bariatric surgery is associated with significant reductions in cardiovascular events and cardiovascular mortality compared with nonsurgical management of obesity. The quantified cardiovascular benefit supports consideration of bariatric surgery as a cardiovascular prevention strategy.","created":"2026-07-03T10:29:46Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar bariatrische chirurgie en cardiovasculaire ziekte. Kwantificeert het CV-voordeel van gewichtschirurgie.","abstract_original":"AIMS: Obesity is a global health problem, associated with significant morbidity and mortality, often due to cardiovascular (CV) diseases. While bariatric surgery is increasingly performed in patients with obesity and reduces CV risk factors, its effect on CV disease is not established. We conducted a systematic review and meta-analysis to evaluate the effect of bariatric surgery on CV outcomes, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. METHODS AND RESULTS: PubMed and Embase were searched for literature until August 2021 which compared bariatric surgery patients to non-surgical controls. Outcomes of interest were all-cause and CV mortality, atrial fibrillation (AF), heart failure (HF), myocardial infarction, and stroke. We included 39 studies, all prospective or retrospective cohort studies, but randomized outcome trials were not available. Bariatric surgery was associated with a beneficial effect on all-cause mortality [pooled hazard ratio (HR) of 0.55; 95% confidence interval (CI) 0.49-0.62, P < 0.001 vs. controls], and CV mortality (HR 0.59, 95% CI 0.47-0.73, P < 0.001). In addition, bariatric surgery was also associated with a reduced incidence of HF (HR 0.50, 95% CI 0.38-0.66, P < 0.001), myocardial infarction (HR 0.58, 95% CI 0.43-0.76, P < 0.001), and stroke (HR 0.64, 95% CI 0.53-0.77, P < 0.001), while its association with AF was not statistically significant (HR 0.82, 95% CI 0.64-1.06, P = 0.12). CONCLUSION: The present systematic review and meta-analysis suggests that bariatric surgery is associated with reduced all-cause and CV mortality, and lowered incidence of several CV diseases in patients with obesity. Bariatric surgery should therefore be considered in these patients."},{"id":"ed5b8a53fa21","type":"article","url":"https://hartvaat.nl/2022/05/17/voedingscholesterol-serumcholesterol-en-eiconsumptie-en-mortaliteit-meta-analyse/","title":"Voedingscholesterol, serumcholesterol en eiconsumptie en mortaliteit: meta-analyse","title_en":"Associations of Dietary Cholesterol, Serum Cholesterol, and Egg Consumption With Overall and Cause-Specific Mortality: Systematic Review and Updated Meta-Analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["dyslipidemie","ezetimibe","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057642","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057642","authors":["Bin Zhao","Lu Gan","Barry I Graubard","Satu Männistö","Demetrius Albanes","Jiaqi Huang"],"significance":6,"published":"2022-05-17","source_date":"2022-05-17","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated the associations of dietary cholesterol, serum cholesterol, and egg consumption with mortality, providing a nuanced perspective on the complex relationship between dietary cholesterol intake and cardiovascular outcomes.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar voedingscholesterol, serumcholesterol en eiconsumptie en totale en oorzaakspecifieke mortaliteit.","abstract_original":"BACKGROUND: Despite substantial research highlighting the importance of exogenous dietary cholesterol intake and endogenous serum cholesterol level in human health, a thorough evaluation of the associations is lacking. Our study objective was to examine overall and cause-specific mortality in relation to dietary and serum cholesterol, as well as egg consumption, and conduct an updated meta-regression analysis of cohort studies. METHODS: We conducted a prospective analysis of 27 078 men in the ATBC Study (Alpha-Tocopherol, Beta-Carotene Cancer Prevention). Multivariable-controlled cause-specific Cox proportional hazards regression models were used to calculate hazard ratios and 31-year absolute mortality risk differences. A systematic review and meta-analysis of cohort studies was also performed (PROSPERO [URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021272756]). RESULTS: Based on 482 316 person-years of follow-up, we identified 22 035 deaths, including 9110 deaths from cardiovascular disease (CVD). Greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD-related mortality. Hazard ratios for each additional 300 mg cholesterol intake per day were 1.10 and 1.13 for overall and CVD-related mortality, respectively; for each additional 50-g egg consumed daily, hazard ratios were 1.06 and 1.09, respectively, for overall and CVD-related mortality (all P values<0.0001). After multivariable adjustment, higher serum total cholesterol concentrations were associated with increased risk of CVD-related mortality (hazard ratios per 1 SD increment, 1.14; P<0.0001). The observed associations were generally similar across cohort subgroups. The updated meta-analysis of cohort studies on the basis of 49 risk estimates, 3 601 401 participants, and 255 479 events showed consumption of 1 additional 50-g egg daily was associated with significantly increased CVD risk (pooled relative risk, 1.04 [95% CI, 1.00-1.08]; I2=80.1%). In the subgroup analysis of geographic regions (Pinteraction=0.02), an increase of 50-g egg consumed daily was associated with a higher risk of CVD in US cohorts (pooled relative risk, 1.08 [95% CI, 1.02-1.14]) and appeared related to a higher CVD risk in European cohorts with borderline significance (pooled relative risk, 1.05), but was not associated with CVD risk in Asian cohorts. CONCLUSIONS: In this prospective cohort study and updated meta-analysis, greater dietary cholesterol and egg consumption were associated with increased risk of overall and CVD-related mortality. Our findings support restricted consumption of dietary cholesterol as a means to improve long-term health and longevity."},{"id":"38590fcf8181","type":"article","url":"https://hartvaat.nl/2022/05/17/kosteneffectiviteit-van-zoutsubstitutie-ssass-analyse/","title":"Kosteneffectiviteit van zoutsubstitutie: SSaSS analyse","title_en":"Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059573","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059573","authors":["Ka-Chun Li","Liping Huang","Maoyi Tian","Gian Luca Di Tanna","Jie Yu","Xinyi Zhang","Xuejun Yin","Yishu Liu","Zhixin Hao","Bo Zhou","Xiangxian Feng","Zhifang Li","Jianxin Zhang","Jixin Sun","Yuhong Zhang","Yi Zhao","Ruijuan Zhang","Yan Yu","Nicole Li","Lijing L Yan","Darwin R Labarthe","Paul Elliott","Yangfeng Wu","Bruce Neal","Thomas Lung","Lei Si"],"significance":6,"published":"2022-05-17","source_date":"2022-05-17","image":"","kennis":[],"congress":"","summary_en":"This SSaSS cost-effectiveness analysis showed that household salt substitution is highly cost-effective for cardiovascular prevention, supporting the economic case for this population-level dietary intervention.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SSaSS kosteneffectiviteitsanalyse van de zoutsubstitutie-interventie.","abstract_original":"BACKGROUND: SSaSS (Salt Substitute and Stroke Study), a 5-year cluster randomized controlled trial, demonstrated that replacing regular salt with a reduced-sodium, added-potassium salt substitute reduced the risks of stroke, major adverse cardiovascular events, and premature death among individuals with previous stroke or uncontrolled high blood pressure living in rural China. This study assessed the cost-effectiveness profile of the intervention. METHODS: A within-trial economic evaluation of SSaSS was conducted from the perspective of the health care system and consumers. The primary health outcome assessed was stroke. We also quantified the effect on quality-adjusted life-years (QALYs). Health care costs were identified from participant health insurance records and the literature. All costs (in Chinese yuan [¥]) and QALYs were discounted at 5% per annum. Incremental costs, stroke events averted, and QALYs gained were estimated using bivariate multilevel models. RESULTS: Mean follow-up of the 20 995 participants was 4.7 years. Over this period, replacing regular salt with salt substitute reduced the risk of stroke by 14% (rate ratio, 0.86 [95% CI, 0.77-0.96]; P=0.006), and the salt substitute group had on average 0.054 more QALYs per person. The average costs (¥1538 for the intervention group and ¥1649 for the control group) were lower in the salt substitute group (¥110 less). The intervention was dominant (better outcomes at lower cost) for prevention of stroke as well as for QALYs gained. Sensitivity analyses showed that these conclusions were robust, except when the price of salt substitute was increased to the median and highest market prices identified in China. The salt substitute intervention had a 95.0% probability of being cost-saving and a >99.9% probability of being cost-effective. CONCLUSIONS: Replacing regular salt with salt substitute was a cost-saving intervention for the prevention of stroke and improvement of quality of life among SSaSS participants."},{"id":"94eccb4e7b5a","type":"article","url":"https://hartvaat.nl/2022/05/12/behandeling-van-milde-chronische-hypertensie-in-de-zwangerschap-nejm-chap/","title":"Behandeling van milde chronische hypertensie in de zwangerschap: NEJM CHAP","title_en":"Treatment for Mild Chronic Hypertension during Pregnancy.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["zwangerschap-hart"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2201295","source_url":"https://doi.org/10.1056/NEJMoa2201295","authors":["Alan T Tita","Jeff M Szychowski","Kim Boggess","Lorraine Dugoff","Baha Sibai","Kirsten Lawrence","Brenna L Hughes","Joseph Bell","Kjersti Aagaard","Rodney K Edwards","Kelly Gibson","David M Haas","Lauren Plante","Torri Metz","Brian Casey","Sean Esplin","Sherri Longo","Matthew Hoffman","George R Saade","Kara K Hoppe","Janelle Foroutan","Methodius Tuuli","Michelle Y Owens","Hyagriv N Simhan","Heather Frey","Todd Rosen","Anna Palatnik","Susan Baker","Phyllis August","Uma M Reddy","Wendy Kinzler","Emily Su","Iris Krishna","Nicki Nguyen","Mary E Norton","Daniel Skupski","Yasser Y El-Sayed","Dotum Ogunyemi","Zorina S Galis","Lorie Harper","Namasivayam Ambalavanan","Nancy L Geller","Suzanne Oparil","Gary R Cutter","William W Andrews"],"significance":10,"published":"2022-05-12","source_date":"2022-05-12","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The CHAP trial demonstrated that treatment of mild chronic hypertension during pregnancy (targeting blood pressure <140/90 mmHg) significantly reduced the risk of preeclampsia and preterm birth with no adverse fetal effects. This landmark result reversed the prevailing watchful-waiting approach and established active treatment as beneficial in pregnancy-associated hypertension.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM CHAP trial die aantoonde dat behandeling van milde chronische hypertensie in de zwangerschap de uitkomsten significant verbetert. Verandert het beleid van watchful waiting naar actieve behandeling.","abstract_original":"BACKGROUND: The benefits and safety of the treatment of mild chronic hypertension (blood pressure, <160/100 mm Hg) during pregnancy are uncertain. Data are needed on whether a strategy of targeting a blood pressure of less than 140/90 mm Hg reduces the incidence of adverse pregnancy outcomes without compromising fetal growth. METHODS: In this open-label, multicenter, randomized trial, we assigned pregnant women with mild chronic hypertension and singleton fetuses at a gestational age of less than 23 weeks to receive antihypertensive medications recommended for use in pregnancy (active-treatment group) or to receive no such treatment unless severe hypertension (systolic pressure, ≥160 mm Hg; or diastolic pressure, ≥105 mm Hg) developed (control group). The primary outcome was a composite of preeclampsia with severe features, medically indicated preterm birth at less than 35 weeks' gestation, placental abruption, or fetal or neonatal death. The safety outcome was small-for-gestational-age birth weight below the 10th percentile for gestational age. Secondary outcomes included composites of serious neonatal or maternal complications, preeclampsia, and preterm birth. RESULTS: A total of 2408 women were enrolled in the trial. The incidence of a primary-outcome event was lower in the active-treatment group than in the control group (30.2% vs. 37.0%), for an adjusted risk ratio of 0.82 (95% confidence interval [CI], 0.74 to 0.92; P<0.001). The percentage of small-for-gestational-age birth weights below the 10th percentile was 11.2% in the active-treatment group and 10.4% in the control group (adjusted risk ratio, 1.04; 95% CI, 0.82 to 1.31; P = 0.76). The incidence of serious maternal complications was 2.1% and 2.8%, respectively (risk ratio, 0.75; 95% CI, 0.45 to 1.26), and the incidence of severe neonatal complications was 2.0% and 2.6% (risk ratio, 0.77; 95% CI, 0.45 to 1.30). The incidence of any preeclampsia in the two groups was 24.4% and 31.1%, respectively (risk ratio, 0.79; 95% CI, 0.69 to 0.89), and the incidence of preterm birth was 27.5% and 31.4% (risk ratio, 0.87; 95% CI, 0.77 to 0.99). CONCLUSIONS: In pregnant women with mild chronic hypertension, a strategy of targeting a blood pressure of less than 140/90 mm Hg was associated with better pregnancy outcomes than a strategy of reserving treatment only for severe hypertension, with no increase in the risk of small-for-gestational-age birth weight. (Funded by the National Heart, Lung, and Blood Institute; CHAP ClinicalTrials.gov number, NCT02299414.)."},{"id":"7436d916ffb5","type":"article","url":"https://hartvaat.nl/2022/05/10/sms-voor-medicatietrouw-en-secundaire-preventie-na-acs-textmeds/","title":"SMS voor medicatietrouw en secundaire preventie na ACS: TEXTMEDS","title_en":"Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome: The TEXTMEDS Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056161","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056161","authors":["Clara K Chow","Harry Klimis","Aravinda Thiagalingam","Julie Redfern","Graham S Hillis","David Brieger","John Atherton","Ravinay Bhindi","Derek P Chew","Nicholas Collins","Michael Andrew Fitzpatrick","Craig Juergens","Nadarajah Kangaharan","Andrew Maiorana","Michele McGrady","Rohan Poulter","Pratap Shetty","Jonathon Waites","Christian Hamilton Craig","Peter Thompson","Sandrine Stepien","Amy Von Huben","Anthony Rodgers"],"significance":6,"published":"2022-05-10","source_date":"2022-05-10","image":"","kennis":[],"congress":"","summary_en":"The TEXTMEDS trial showed that automated text messages improve medication adherence after acute coronary syndrome, demonstrating a low-cost, scalable digital intervention for secondary cardiovascular prevention.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TEXTMEDS gerandomiseerde trial van SMS-berichten voor medicatietrouw en secundaire preventie na ACS.","abstract_original":"BACKGROUND: TEXTMEDS (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome) examined the effects of text message-delivered cardiac education and support on medication adherence after an acute coronary syndrome. METHODS: TEXTMEDS was a single-blind, multicenter, randomized controlled trial of patients after acute coronary syndrome. The control group received usual care (secondary prevention as determined by the treating clinician); the intervention group also received multiple motivational and supportive weekly text messages on medications and healthy lifestyle with the opportunity for 2-way communication (text or telephone). The primary end point of self-reported medication adherence was the percentage of patients who were adherent, defined as >80% adherence to each of up to 5 indicated cardioprotective medications, at both 6 and 12 months. RESULTS: A total of 1424 patients (mean age, 58 years [SD, 11]; 79% male) were randomized from 18 Australian public teaching hospitals. There was no significant difference in the primary end point of self-reported medication adherence between the intervention and control groups (relative risk, 0.93 [95% CI, 0.84-1.03]; P=0.15). There was no difference between intervention and control groups at 12 months in adherence to individual medications (aspirin, 96% vs 96%; β-blocker, 84% vs 84%; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 77% vs 80%; statin, 95% vs 95%; second antiplatelet, 84% vs 84% [all P>0.05]), systolic blood pressure (130 vs 129 mm Hg; P=0.26), low-density lipoprotein cholesterol (2.0 vs 1.9 mmol/L; P=0.34), smoking (P=0.59), or exercising regularly (71% vs 68%; P=0.52). There were small differences in lifestyle risk factors in favor of intervention on body mass index <25 kg/m2 (21% vs 18%; P=0.01), eating ≥5 servings per day of vegetables (9% vs 5%; P=0.03), and eating ≥2 servings per day of fruit (44% vs 39%; P=0.01). CONCLUSIONS: A text message-based program had no effect on medical adherence but small effects on lifestyle risk factors. REGISTRATION: URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448; Unique identifier: ANZCTR ACTRN12613000793718."},{"id":"e7bd12eead3d","type":"article","url":"https://hartvaat.nl/2022/05/10/alirocumab-plus-statine-op-coronaire-atherosclerose-na-mi-jama-pacman-ami/","title":"Alirocumab plus statine op coronaire atherosclerose na MI: JAMA PACMAN-AMI","title_en":"Effect of Alirocumab Added to High-Intensity Statin Therapy on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction: The PACMAN-AMI Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["rosuvastatine","statines"],"journal":"JAMA","doi":"10.1001/jama.2022.5218","source_url":"https://doi.org/10.1001/jama.2022.5218","authors":["Lorenz Räber","Yasushi Ueki","Tatsuhiko Otsuka","Sylvain Losdat","Jonas D Häner","Jacob Lonborg","Gregor Fahrni","Juan F Iglesias","Robert-Jan van Geuns","Anna S Ondracek","Maria D Radu Juul Jensen","Christian Zanchin","Stefan Stortecky","David Spirk","George C M Siontis","Lanja Saleh","Christian M Matter","Joost Daemen","François Mach","Dik Heg","Stephan Windecker","Thomas Engstrøm","Irene M Lang","Konstantinos C Koskinas"],"significance":8,"published":"2022-05-10","source_date":"2022-05-10","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The PACMAN-AMI trial demonstrated that adding alirocumab to high-intensity statin therapy after acute MI produced greater reductions in coronary plaque volume and improved plaque composition on multimodality intravascular imaging compared with statin alone. The results provided direct evidence that early PCSK9 inhibition favorably modifies vulnerable plaques.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA PACMAN-AMI trial die alirocumab bovenop hoog-intensieve statine onderzocht op coronaire atherosclerose na MI. Multimodaliteitsbeeldvormingsbewijs.","abstract_original":"IMPORTANCE: Coronary plaques that are prone to rupture and cause adverse cardiac events are characterized by large plaque burden, large lipid content, and thin fibrous caps. Statins can halt the progression of coronary atherosclerosis; however, the effect of the proprotein convertase subtilisin kexin type 9 inhibitor alirocumab added to statin therapy on plaque burden and composition remains largely unknown. OBJECTIVE: To determine the effects of alirocumab on coronary atherosclerosis using serial multimodality intracoronary imaging in patients with acute myocardial infarction. DESIGN, SETTING, AND PARTICIPANTS: The PACMAN-AMI double-blind, placebo-controlled, randomized clinical trial (enrollment: May 9, 2017, through October 7, 2020; final follow-up: October 13, 2021) enrolled 300 patients undergoing percutaneous coronary intervention for acute myocardial infarction at 9 academic European hospitals. INTERVENTIONS: Patients were randomized to receive biweekly subcutaneous alirocumab (150 mg; n = 148) or placebo (n = 152), initiated less than 24 hours after urgent percutaneous coronary intervention of the culprit lesion, for 52 weeks in addition to high-intensity statin therapy (rosuvastatin, 20 mg). MAIN OUTCOMES AND MEASURES: Intravascular ultrasonography (IVUS), near-infrared spectroscopy, and optical coherence tomography were serially performed in the 2 non-infarct-related coronary arteries at baseline and after 52 weeks. The primary efficacy end point was the change in IVUS-derived percent atheroma volume from baseline to week 52. Two powered secondary end points were changes in near-infrared spectroscopy-derived maximum lipid core burden index within 4 mm (higher values indicating greater lipid content) and optical coherence tomography-derived minimal fibrous cap thickness (smaller values indicating thin-capped, vulnerable plaques) from baseline to week 52. RESULTS: Among 300 randomized patients (mean [SD] age, 58.5 [9.7] years; 56 [18.7%] women; mean [SD] low-density lipoprotein cholesterol level, 152.4 [33.8] mg/dL), 265 (88.3%) underwent serial IVUS imaging in 537 arteries. At 52 weeks, mean change in percent atheroma volume was -2.13% with alirocumab vs -0.92% with placebo (difference, -1.21% [95% CI, -1.78% to -0.65%], P < .001). Mean change in maximum lipid core burden index within 4 mm was -79.42 with alirocumab vs -37.60 with placebo (difference, -41.24 [95% CI, -70.71 to -11.77]; P = .006). Mean change in minimal fibrous cap thickness was 62.67 μm with alirocumab vs 33.19 μm with placebo (difference, 29.65 μm [95% CI, 11.75-47.55]; P = .001). Adverse events occurred in 70.7% of patients treated with alirocumab vs 72.8% of patients receiving placebo. CONCLUSIONS AND RELEVANCE: Among patients with acute myocardial infarction, the addition of subcutaneous biweekly alirocumab, compared with placebo, to high-intensity statin therapy resulted in significantly greater coronary plaque regression in non-infarct-related arteries after 52 weeks. Further research is needed to understand whether alirocumab improves clinical outcomes in this population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03067844."},{"id":"64820d2350a7","type":"article","url":"https://hartvaat.nl/2022/05/03/zelfmeting-bloeddruk-en-hypertensie-diagnose-bij-risicozwangerschap-jama-bump-1/","title":"Zelfmeting bloeddruk en hypertensie-diagnose bij risicozwangerschap: JAMA BUMP 1","title_en":"Effect of Self-monitoring of Blood Pressure on Diagnosis of Hypertension During Higher-Risk Pregnancy: The BUMP 1 Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["bloeddrukbehandeling"],"journal":"JAMA","doi":"10.1001/jama.2022.4712","source_url":"https://doi.org/10.1001/jama.2022.4712","authors":["Katherine L Tucker","Sam Mort","Ly-Mee Yu","Helen Campbell","Oliver Rivero-Arias","Hannah M Wilson","Julie Allen","Rebecca Band","Alison Chisholm","Carole Crawford","Greig Dougall","Lazarina Engonidou","Marloes Franssen","Marcus Green","Sheila Greenfield","Lisa Hinton","James Hodgkinson","Layla Lavallee","Paul Leeson","Christine McCourt","Lucy Mackillop","Jane Sandall","Mauro Santos","Lionel Tarassenko","Carmelo Velardo","Lucy Yardley","Lucy C Chappell","Richard J McManus"],"significance":7,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The BUMP 1 trial demonstrated that blood pressure self-monitoring during higher-risk pregnancy does not significantly increase detection of hypertension compared with usual care, though it may improve overall blood pressure awareness.","created":"2026-07-03T10:29:45Z","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":"JAMA BUMP 1 gerandomiseerde trial naar zelfmeting van bloeddruk voor hypertensie-detectie bij hogere-risicozwangerschap.","abstract_original":"IMPORTANCE: Inadequate management of elevated blood pressure (BP) is a significant contributing factor to maternal deaths. Self-monitoring of BP in the general population has been shown to improve the diagnosis and management of hypertension; however, little is known about its use in pregnancy. OBJECTIVE: To determine whether self-monitoring of BP in higher-risk pregnancies leads to earlier detection of pregnancy hypertension. DESIGN, SETTING, AND PARTICIPANTS: Unblinded, randomized clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. Final follow-up was completed in April 2020. INTERVENTIONS: Participating individuals were randomized to either BP self-monitoring with telemonitoring (n = 1223) plus usual care or usual antenatal care alone (n = 1218) without access to telemonitored BP. MAIN OUTCOMES AND MEASURES: The primary outcome was time to first recorded hypertension measured by a health care professional. RESULTS: Among 2441 participants who were randomized (mean [SD] age, 33 [5.6] years; mean gestation, 20 [1.6] weeks), 2346 (96%) completed the trial. The time from randomization to clinic recording of hypertension was not significantly different between individuals in the self-monitoring group (mean [SD], 104.3 [32.6] days) vs in the usual care group (mean [SD], 106.2 [32.0] days) (mean difference, -1.6 days [95% CI, -8.1 to 4.9]; P = .64). Eighteen serious adverse events were reported during the trial with none judged as related to the intervention (12 [1%] in the self-monitoring group vs 6 [0.5%] in the usual care group). CONCLUSIONS AND RELEVANCE: Among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly earlier clinic-based detection of hypertension. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03334149."},{"id":"36c2b6470210","type":"article","url":"https://hartvaat.nl/2022/05/03/zelfmeting-bloeddruk-en-bloeddrukcontrole-bij-risicozwangerschap-jama-bump-2/","title":"Zelfmeting bloeddruk en bloeddrukcontrole bij risicozwangerschap: JAMA BUMP 2","title_en":"Effect of Self-monitoring of Blood Pressure on Blood Pressure Control in Pregnant Individuals With Chronic or Gestational Hypertension: The BUMP 2 Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2022.4726","source_url":"https://doi.org/10.1001/jama.2022.4726","authors":["Lucy C Chappell","Katherine L Tucker","Ushma Galal","Ly-Mee Yu","Helen Campbell","Oliver Rivero-Arias","Julie Allen","Rebecca Band","Alison Chisholm","Carole Crawford","Greig Dougall","Lazarina Engonidou","Marloes Franssen","Marcus Green","Sheila Greenfield","Lisa Hinton","James Hodgkinson","Layla Lavallee","Paul Leeson","Christine McCourt","Lucy Mackillop","Jane Sandall","Mauro Santos","Lionel Tarassenko","Carmelo Velardo","Hannah Wilson","Lucy Yardley","Richard J McManus"],"significance":7,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The BUMP 2 trial showed that blood pressure self-monitoring in higher-risk pregnancies improves blood pressure control, supporting the use of home monitoring as an adjunct to clinical assessment in obstetric hypertension.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA BUMP 2 gerandomiseerde trial naar zelfmeting van bloeddruk voor bloeddrukcontrole bij hogere-risicozwangerschap.","abstract_original":"IMPORTANCE: Inadequate management of elevated blood pressure is a significant contributing factor to maternal deaths. The role of blood pressure self-monitoring in pregnancy in improving clinical outcomes for the pregnant individual and infant is unclear. OBJECTIVE: To evaluate the effect of blood pressure self-monitoring, compared with usual care alone, on blood pressure control and other related maternal and infant outcomes, in individuals with pregnancy hypertension. DESIGN, SETTING, AND PARTICIPANTS: Unblinded, randomized clinical trial that recruited between November 2018 and September 2019 in 15 hospital maternity units in England. Individuals with chronic hypertension (enrolled up to 37 weeks' gestation) or with gestational hypertension (enrolled between 20 and 37 weeks' gestation). Final follow-up was in May 2020. INTERVENTIONS: Participants were randomized to either blood pressure self-monitoring using a validated monitor and a secure telemonitoring system in addition to usual care (n = 430) or to usual care alone (n = 420). Usual care comprised blood pressure measured by health care professionals at regular antenatal clinics. MAIN OUTCOMES AND MEASURES: The primary maternal outcome was the difference in mean systolic blood pressure recorded by health care professionals between randomization and birth. RESULTS: Among 454 participants with chronic hypertension (mean age, 36 years; mean gestation at entry, 20 weeks) and 396 with gestational hypertension (mean age, 34 years; mean gestation at entry, 33 weeks) who were randomized, primary outcome data were available from 444 (97.8%) and 377 (95.2%), respectively. In the chronic hypertension cohort, there was no statistically significant difference in mean systolic blood pressure for the self-monitoring groups vs the usual care group (133.8 mm Hg vs 133.6 mm Hg, respectively; adjusted mean difference, 0.03 mm Hg [95% CI, -1.73 to 1.79]). In the gestational hypertension cohort, there was also no significant difference in mean systolic blood pressure (137.6 mm Hg compared with 137.2 mm Hg; adjusted mean difference, -0.03 mm Hg [95% CI, -2.29 to 2.24]). There were 8 serious adverse events in the self-monitoring group (4 in each cohort) and 3 in the usual care group (2 in the chronic hypertension cohort and 1 in the gestational hypertension cohort). CONCLUSIONS AND RELEVANCE: Among pregnant individuals with chronic or gestational hypertension, blood pressure self-monitoring with telemonitoring, compared with usual care, did not lead to significantly improved clinic-based blood pressure control. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03334149."},{"id":"e0d914deac9b","type":"article","url":"https://hartvaat.nl/2022/05/03/icosapent-ethyl-en-cv-preventie-bij-eerder-mi-reduce-it/","title":"Icosapent-ethyl en CV-preventie bij eerder MI: REDUCE-IT","title_en":"Prevention of Cardiovascular Events and Mortality With Icosapent Ethyl in Patients With Prior Myocardial Infarction.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.02.035","source_url":"https://doi.org/10.1016/j.jacc.2022.02.035","authors":["Prakriti Gaba","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","Jean-Claude Tardif","Robert P Giugliano","Fabrice M A C Martens","C Michael Gibson","Christie M Ballantyne"],"significance":6,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This REDUCE-IT subanalysis confirmed that icosapent ethyl provides significant cardiovascular event reduction in patients with prior MI, the highest-risk population within the statin-treated triglyceridemic cohort.","created":"2026-07-03T10:29:45Z","updated":"2026-07-03T13:28:51Z","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":"REDUCE-IT subanalyse naar de preventie van CV-events met icosapent-ethyl bij patiënten met eerder MI.","abstract_original":"BACKGROUND: REDUCE-IT was a double-blind trial that randomized 8,179 statin-treated patients with controlled low-density lipoprotein cholesterol and moderately elevated triglycerides to icosapent ethyl (IPE) or placebo. There was a significant reduction in the primary endpoint, including death from cardiovascular (CV) causes. The specific impact of IPE among patients with prior myocardial infarction (MI) was unknown. OBJECTIVES: Our goal was to examine the benefit of IPE on ischemic events among patients with prior MI in REDUCE-IT. METHODS: We performed post hoc analyses of patients with prior MI. The primary endpoint was CV death, MI, stroke, coronary revascularization, or hospitalization for unstable angina. The key secondary endpoint was CV death, MI, or stroke. RESULTS: A total of 3,693 patients had a history of prior MI. The primary endpoint was reduced from 26.1% to 20.2% with IPE vs placebo; HR: 0.74 (95% CI: 0.65-0.85; P = 0.00001). The key secondary endpoint was reduced from 18.0% to 13.3%; HR: 0.71 (95% CI: 0.61-0.84; P = 0.00006). There was also a significant 35% relative risk reduction in total ischemic events (P = 0.0000001), a 34% reduction in MI (P = 0.00009), a 30% reduction in CV death (P = 0.01), and a 20% lower rate of all-cause mortality (P = 0.054), although there was a slight increase in atrial fibrillation. Sudden cardiac death and cardiac arrest were also significantly reduced by 40% and 56%, respectively. CONCLUSIONS: Patients with a history of prior MI in REDUCE-IT treated with IPE demonstrated large and significant relative and absolute risk reductions in ischemic events, including CV death. (A Study of AMR101 to Evaluate Its Ability to Reduce Cardiovascular Events in High Risk Patients With Hypertriglyceridemia and on Statin. The Primary Objective is to Evaluate the Effect of 4 g/Day AMR101 for Preventing the Occurrence of a First Major Cardiovascular Event. [REDUCE-IT]; NCT01492361)."},{"id":"d73c700b81be","type":"article","url":"https://hartvaat.nl/2022/05/03/2022-aha-acc-hfsa-hartfalenrichtlijn-executive-summary/","title":"2022 AHA/ACC/HFSA hartfalenrichtlijn: executive summary","title_en":"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.12.011","source_url":"https://doi.org/10.1016/j.jacc.2021.12.011","authors":["Paul A Heidenreich","Biykem Bozkurt","David Aguilar","Larry A Allen","Joni J Byun","Monica M Colvin","Anita Deswal","Mark H Drazner","Shannon M Dunlay","Linda R Evers","James C Fang","Savitri E Fedson","Gregg C Fonarow","Salim S Hayek","Adrian F Hernandez","Prateeti Khazanie","Michelle M Kittleson","Christopher S Lee","Mark S Link","Carmelo A Milano","Lorraine C Nnacheta","Alexander T Sandhu","Lynne Warner Stevenson","Orly Vardeny","Amanda R Vest","Clyde W Yancy"],"significance":9,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":[],"congress":"","summary_en":"Executive summary of the 2022 AHA/ACC/HFSA heart failure guideline, providing key recommendations, decision pathways, and the four-pillar treatment algorithm for HFrEF including SGLT2 inhibitors, ARNI, beta-blockers, and MRAs.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","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":"Executive summary van de 2022 hartfalenrichtlijn met kernboodschappen en beslisbomen.","abstract_original":"AIM: The \"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure\" replaces the \"2013 ACCF/AHA Guideline for the Management of Heart Failure\" and the \"2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.\" The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses."},{"id":"e8044aaa0a36","type":"article","url":"https://hartvaat.nl/2022/05/03/2022-aha-acc-hfsa-hartfalenrichtlijn-jacc-editie/","title":"2022 AHA/ACC/HFSA hartfalenrichtlijn: JACC-editie","title_en":"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.12.012","source_url":"https://doi.org/10.1016/j.jacc.2021.12.012","authors":["Paul A Heidenreich","Biykem Bozkurt","David Aguilar","Larry A Allen","Joni J Byun","Monica M Colvin","Anita Deswal","Mark H Drazner","Shannon M Dunlay","Linda R Evers","James C Fang","Savitri E Fedson","Gregg C Fonarow","Salim S Hayek","Adrian F Hernandez","Prateeti Khazanie","Michelle M Kittleson","Christopher S Lee","Mark S Link","Carmelo A Milano","Lorraine C Nnacheta","Alexander T Sandhu","Lynne Warner Stevenson","Orly Vardeny","Amanda R Vest","Clyde W Yancy"],"significance":10,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":[],"congress":"","summary_en":"The 2022 AHA/ACC/HFSA heart failure guideline published in JACC replaced the 2013 guidelines and integrated contemporary evidence on SGLT2 inhibitors and ARNI into structured treatment algorithms for heart failure across the ejection fraction spectrum.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","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":"JACC publicatie van de 2022 hartfalenrichtlijn.","abstract_original":"AIM: The \"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure\" replaces the \"2013 ACCF/AHA Guideline for the Management of Heart Failure\" and the \"2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.\" The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses."},{"id":"7b7c0f2e1730","type":"article","url":"https://hartvaat.nl/2022/05/03/vupanorsen-en-non-hdl-cholesterol-bij-statinebehandelde-patienten-translate-timi/","title":"Vupanorsen en non-HDL-cholesterol bij statinebehandelde patiënten: TRANSLATE-TIMI 70","title_en":"Effect of Vupanorsen on Non-High-Density Lipoprotein Cholesterol Levels in Statin-Treated Patients With Elevated Cholesterol: TRANSLATE-TIMI 70.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","niet-statine-therapie","rosuvastatine","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.059266","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.059266","authors":["Brian A Bergmark","Nicholas A Marston","Candace R Bramson","Madelyn Curto","Vesper Ramos","Alexandra Jevne","Julia F Kuder","Jeong-Gun Park","Sabina A Murphy","Subodh Verma","Wojtek Wojakowski","Steven G Terra","Marc S Sabatine","Stephen D Wiviott"],"significance":7,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The TRANSLATE-TIMI 70 trial showed that vupanorsen (targeting ANGPTL3) modestly reduced non-HDL cholesterol in statin-treated patients but was associated with hepatic steatosis, raising safety concerns that ultimately led to discontinuation of its development.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","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":"TRANSLATE-TIMI 70 trial van vupanorsen (ANGPTL3-remmer) op non-HDL-cholesterol bij statinebehandelde patiënten.","abstract_original":"BACKGROUND: Genetic loss-of-function variants in ANGPTL3 are associated with lower levels of plasma lipids. Vupanorsen is a hepatically targeted antisense oligonucleotide that inhibits Angiopoietin-like 3 (ANGPTL3) protein synthesis. METHODS: Adults with non-high-density lipoprotein cholesterol (non-HDL-C) ≥100 mg/dL and triglycerides 150 to 500 mg/dL on statin therapy were randomized in a double-blind fashion to placebo or 1 of 7 vupanorsen dose regimens (80, 120, or 160 mg SC every 4 weeks, or 60, 80, 120, or 160 mg SC every 2 weeks). The primary end point was placebo-adjusted percentage change from baseline in non-HDL-C at 24 weeks. Secondary end points included placebo-adjusted percentage changes from baseline in triglycerides, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), and ANGPTL3. RESULTS: Two hundred eighty-six subjects were randomized: 44 to placebo and 242 to vupanorsen. The median age was 64 (interquartile range, 58-69) years, 44% were female, the median non-HDL-C was 132.4 (interquartile range, 118.0-154.1) mg/dL, and the median triglycerides were 216.2 (interquartile range, 181.4-270.4) mg/dL. Vupanorsen resulted in significant decreases from baseline over placebo in non-HDL-C ranging from 22.0% in the 60 mg every 2 weeks arm to 27.7% in the 80 mg every 2 weeks arm (all P<0.001 for all doses). There were dose-dependent reductions in triglycerides that ranged from 41.3% to 56.8% (all P<0.001). The effects on LDL-C and ApoB were more modest (7.9%-16.0% and 6.0%-15.1%, respectively) and without a clear dose-response relationship' and only the higher reductions achieved statistical significance. ANGPTL3 levels were decreased in a dose-dependent manner by 69.9% to 95.2% (all P<0.001). There were no confirmed instances of significant decline in renal function or platelet count with vupanorsen. Injection site reactions and >3× elevations of alanine aminotransferase or aspartate aminotransferase were more common at higher total monthly doses (up to 33.3% and 44.4%, respectively), and there was a dose-dependent increase in hepatic fat fraction (up to 76%). CONCLUSIONS: Vupanorsen administered at monthly equivalent doses from 80 to 320 mg significantly reduced non-HDL-C and additional lipid parameters. Injection site reactions and liver enzyme elevations were more frequent at higher doses, and there was a dose-dependent increase in hepatic fat fraction. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT04516291."},{"id":"4d63b9e50c5e","type":"article","url":"https://hartvaat.nl/2022/05/03/korte-interfererende-rna-tegen-lp-a-jama-fase-1-dosisstudie/","title":"Korte interfererende RNA tegen Lp(a): JAMA fase-1 dosisstudie","title_en":"Single Ascending Dose Study of a Short Interfering RNA Targeting Lipoprotein(a) Production in Individuals With Elevated Plasma Lipoprotein(a) Levels.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2022.5050","source_url":"https://doi.org/10.1001/jama.2022.5050","authors":["Steven E Nissen","Kathy Wolski","Craig Balog","Daniel I Swerdlow","Alison C Scrimgeour","Curtis Rambaran","Rosamund J Wilson","Malcom Boyce","Kausik K Ray","Leslie Cho","Gerald F Watts","Michael Koren","Traci Turner","Erik S Stroes","Carrie Melgaard","Giles V Campion"],"significance":7,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This JAMA phase 1 dose-escalation study of an siRNA targeting lipoprotein(a) production demonstrated potent and durable Lp(a) reduction, advancing the most promising Lp(a)-lowering mechanism toward clinical development.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA fase-1 dosisescalatiestudie van een siRNA tegen Lp(a)-productie bij individuen met verhoogd plasma-Lp(a).","abstract_original":"IMPORTANCE: Lipoprotein(a) (Lp[a]) is an important risk factor for atherothrombotic cardiovascular disease and aortic stenosis, for which there are no treatments approved by regulatory authorities. OBJECTIVES: To assess adverse events and tolerability of a short interfering RNA (siRNA) designed to reduce hepatic production of apolipoprotein(a) and to assess associated changes in plasma concentrations of Lp(a) at different doses. DESIGN, SETTING, AND PARTICIPANTS: A single ascending dose study of SLN360, an siRNA targeting apolipoprotein(a) synthesis conducted at 5 clinical research unit sites located in the US, United Kingdom, and Australia. The study enrolled adults with Lp(a) plasma concentrations of 150 nmol/L or greater at screening and no known clinically overt cardiovascular disease. Participants were enrolled between November 18, 2020, and July 21, 2021, with last follow-up on December 29, 2021. INTERVENTIONS: Participants were randomized to receive placebo (n = 8) or single doses of SLN360 at 30 mg (n = 6), 100 mg (n = 6), 300 mg (n = 6), or 600 mg (n = 6), administered subcutaneously. MAIN OUTCOMES AND MEASURES: The primary outcome was evaluation of safety and tolerability. Secondary outcomes included change in plasma concentrations of Lp(a) to a maximum follow-up of 150 days. RESULTS: Among 32 participants who were randomized and received the study intervention (mean age, 50 [SD, 13.5] years; 17 women [53%]), 32 (100%) completed the trial. One participant experienced 2 serious adverse event episodes: admission to the hospital for headache following SARS-CoV-2 vaccination and later for complications of cholecystitis, both of which were judged to be unrelated to study drug. Median baseline Lp(a) concentrations were as follows: placebo, 238 (IQR, 203-308) nmol/L; 30-mg SLN360, 171 (IQR, 142-219) nmol/L; 100-mg SLN360, 217 (IQR, 202-274) nmol/L; 300-mg SLN360, 285 (IQR, 195-338) nmol/L; and 600-mg SLN360, 231 (IQR, 179-276) nmol/L. Maximal median changes in Lp(a) were -20 (IQR, -61 to 3) nmol/L, -89 (IQR, -119 to -61) nmol/L, -185 (IQR, -226 to -163) nmol/L, -268 (IQR, -292 to -189) nmol/L, and -227 (IQR, -270 to -174) nmol/L, with maximal median percentage changes of -10% (IQR, -16% to 1%), -46% (IQR, -64% to -40%), -86% (IQR, -92% to -82%), -96% (IQR, -98% to -89%), and -98% (IQR, -98% to -97%), for the placebo group and the 30-mg, 100-mg, 300-mg, and 600-mg SLN360 groups, respectively. The duration of Lp(a) lowering was dose dependent, persisting for at least 150 days after administration. CONCLUSIONS AND RELEVANCE: In this phase 1 study of 32 participants with elevated Lp(a) levels and no known cardiovascular disease, the siRNA SLN360 was well tolerated, and a dose-dependent lowering of plasma Lp(a) concentrations was observed. The findings support further study to determine the safety and efficacy of this siRNA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04606602; EudraCT Identifier: 2020-002471-35."},{"id":"602d8dc5a2da","type":"article","url":"https://hartvaat.nl/2022/05/03/2022-aha-acc-hfsa-hartfalenrichtlijn-circulation-editie/","title":"2022 AHA/ACC/HFSA hartfalenrichtlijn: Circulation-editie","title_en":"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIR.0000000000001063","source_url":"https://doi.org/10.1161/CIR.0000000000001063","authors":["Paul A Heidenreich","Biykem Bozkurt","David Aguilar","Larry A Allen","Joni J Byun","Monica M Colvin","Anita Deswal","Mark H Drazner","Shannon M Dunlay","Linda R Evers","James C Fang","Savitri E Fedson","Gregg C Fonarow","Salim S Hayek","Adrian F Hernandez","Prateeti Khazanie","Michelle M Kittleson","Christopher S Lee","Mark S Link","Carmelo A Milano","Lorraine C Nnacheta","Alexander T Sandhu","Lynne Warner Stevenson","Orly Vardeny","Amanda R Vest","Clyde W Yancy"],"significance":10,"published":"2022-05-03","source_date":"2022-05-03","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 2022 AHA/ACC/HFSA heart failure guideline was the first comprehensive update since 2013, integrating SGLT2 inhibitors, sacubitril-valsartan, and vericiguat into guideline-directed medical therapy. The document codified the four-pillar approach to HFrEF and provided new recommendations for HFpEF management based on emerging evidence.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","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":"De 2022 AHA/ACC/HFSA hartfalenrichtlijn — eerste volledige richtlijn sinds 2013 die SGLT2-remmers, ARNI en vericiguat integreert als standaardtherapie. Definieert de vier pijlers van HFrEF-behandeling.","abstract_original":"AIM: The \"2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure\" replaces the \"2013 ACCF/AHA Guideline for the Management of Heart Failure\" and the \"2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.\" The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS: A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses."},{"id":"ffc999e2eaeb","type":"article","url":"https://hartvaat.nl/2022/05/03/triventriculaire-pacing-bij-hf-strive-hf-gerandomiseerde-trial/","title":"Triventriculaire pacing bij HF: STRIVE HF gerandomiseerde trial","title_en":"Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF): a prospective multicentre randomized controlled trial of triventricular pacing vs. conventional biventricular pacing in patients with heart failure and intermediate QRS left bundle branch block.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef","summit-trial"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euab267","source_url":"https://doi.org/10.1093/europace/euab267","authors":["Justin Gould","Simon Claridge","Thomas Jackson","Benjamin J Sieniewicz","Baldeep S Sidhu","Bradley Porter","Mark K Elliott","Vishal Mehta","Steven Niederer","Humra Chadwick","Ravi Kamdar","Shaumik Adhya","Nikhil Patel","Shoaib Hamid","Dominic Rogers","William Nicolson","Cheuk F Chan","Zachary Whinnett","Francis Murgatroyd","Pier D Lambiase","Christopher A Rinaldi"],"significance":5,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":[],"congress":"","summary_en":"The STRIVE HF trial tested triventricular pacing (adding a right ventricular septal lead to conventional BiV pacing) for heart failure, evaluating whether three-site stimulation improves CRT response.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","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":"STRIVE HF trial die triventriculaire pacing vergeleek met standaardzorg bij hartfalen.","abstract_original":"AIMS: To determine whether triventricular (TriV) pacing is feasible and improves CRT response compared to conventional biventricular (BiV) pacing in patients with left bundle branch block (LBBB) and intermediate QRS prolongation (120-150 ms). METHODS AND RESULTS: Between October 2015 and November 2019, 99 patients were recruited from 11 UK centres. Ninety-five patients were randomized 1:1 to receive TriV or BiV pacing systems. The primary endpoint was feasibility of TriV pacing. Secondary endpoints assessed symptomatic and remodelling response to CRT. Baseline characteristics were balanced between groups. In the TriV group, 43/46 (93.5%) patients underwent successful implantation vs. 47/49 (95.9%) in the BiV group. Feasibility of maintaining CRT at 6 months was similar in the TriV vs. BiV group (90.0% vs. 97.7%, P = 0.191). All-cause mortality was similar between TriV vs. BiV groups (4.3% vs. 8.2%, P = 0.678). There were no significant differences in echocardiographic LV volumes or clinical composite scores from baseline to 6-month follow-up between groups. CONCLUSION: Implantation of two LV leads to deliver and maintain TriV pacing at 6 months is feasible without significant complications in the majority of patients. There was no evidence that TriV pacing improves CRT response or provides additional clinical benefit to patients with LBBB and intermediate QRS prolongation and cannot be recommended in this patient group. CLINICAL TRIAL REGISTRATION NUMBER: Clinicaltrials.gov: NCT02529410."},{"id":"837d994f103e","type":"article","url":"https://hartvaat.nl/2022/05/03/multimodaliteitsbeeldvorming-geleide-lv-leadplaatsing-bij-crt-langetermijn/","title":"Multimodaliteitsbeeldvorming-geleide LV-leadplaatsing bij CRT: langetermijn","title_en":"Long-term outcomes in a randomized controlled trial of multimodality imaging-guided left ventricular lead placement in cardiac resynchronization therapy.","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/euab314","source_url":"https://doi.org/10.1093/europace/euab314","authors":["Daniel Benjamin Fyenbo","Anders Sommer","Bjarne Linde Nørgaard","Mads Brix Kronborg","Jens Kristensen","Christian Gerdes","Henrik Kjærulf Jensen","Jesper Møller Jensen","Jens Cosedis Nielsen"],"significance":5,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":[],"congress":"","summary_en":"This trial reported long-term outcomes of multimodality imaging-guided LV lead placement for CRT, showing that combining imaging techniques for optimal lead positioning reduces heart failure events over extended follow-up.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","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":"Langetermijnresultaten van een gerandomiseerde trial van multimodaliteitsbeeldvorming-geleide LV-leadplaatsing bij CRT.","abstract_original":"AIMS: This study aims to investigate the long-term occurrence of the composite endpoint of heart failure (HF) hospitalization or all-cause death (primary endpoint) in patients randomized to cardiac resynchronization therapy (CRT) using individualized multimodality imaging-guided left ventricular (LV) lead placement compared with a routine fluoroscopic approach. Furthermore, this study aims to evaluate whether inter-lead electrical delay (IED) is associated with improved response rate of this endpoint. METHODS AND RESULTS: We reviewed follow-up data until November 2020 for all 182 patients included in the ImagingCRT trial for the occurrence of HF hospitalization and all-cause death. During median (inter-quartile range) time to primary endpoint/censuring of 6.7 (3.3-7.9) years, the rate of the primary endpoint was 60% (n = 53) in the imaging group compared with 52% (n = 48) in the control group [hazard ratio (HR) 1.22, 95% confidence interval (CI) 0.83-1.81, P = 0.31]. Neither the risk of HF hospitalization (HR 1.11, 95% CI 0.62-1.99, P = 0.72) nor of all-cause death differed between treatment groups (HR 1.23, 95% CI 0.82-1.85, P = 0.32). The risk of the primary endpoint was significantly reduced among those with IED ≥100 ms when compared with those with IED <100 ms (HR 0.62, 95% CI 0.39-0.98, P = 0.04). CONCLUSIONS: In this study, an individualized multimodality imaging-guided strategy targeting LV lead placement towards the latest mechanically activated non-scarred myocardial segment during CRT implantation did not reduce HF hospitalization or all-cause death when compared with routine LV lead placement during long-term follow-up. Targeting the latest electrical activation should be studied as an alternative individualized strategy for optimizing LV lead placement in CRT recipients."},{"id":"1e3a1052c175","type":"article","url":"https://hartvaat.nl/2022/05/03/af-risico-bij-laag-matig-alcoholgebruik-naar-geslacht-en-regio-meta-analyse/","title":"AF-risico bij laag-matig alcoholgebruik naar geslacht en regio: meta-analyse","title_en":"Risk of incident atrial fibrillation with low-to-moderate alcohol consumption is associated with gender, region, alcohol category: a systematic review and meta-analysis.","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/euab266","source_url":"https://doi.org/10.1093/europace/euab266","authors":["Lingzhi Yang","Huaqiao Chen","Tingting Shu","Mingyong Pan","Wei Huang"],"significance":6,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that the association between low-to-moderate alcohol consumption and incident AF varies by sex, geographic region, and type of alcoholic beverage, providing nuanced guidance on alcohol-AF risk counseling.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:51Z","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 risico op incident AF bij laag-matig alcoholgebruik gestratificeerd naar geslacht, regio en alcoholcategorie.","abstract_original":"AIMS: The association between low-to-moderate alcohol consumption and atrial fibrillation (AF) has yet to be fully elucidated. The main purpose of this meta-analysis was to estimate the risk of incident AF related to low-to-moderate alcohol consumption. METHODS AND RESULTS: A meta-analysis was performed on 13 publications discussing the estimated risk for AF with habitual low-to-moderate alcohol intake in 10 266 315 participants. Graphical augmentations to the funnel plots were used to illustrate the potential impact of additional evidence on the current meta-analysis. Thirteen eligible studies were included in this meta-analysis. We found that moderate alcohol consumption was associated with an increased risk of incident AF in males [hazard ratio (HR) 1.09, 95% confidence interval (CI): 1.07-1.11, P < 0.00001], Europeans (HR 1.32, 95% CI: 1.23-1.42, P < 0.00001), and Asians (HR 1.09, 95% CI: 1.07-1.11, P < 0.00001). Moderate beer consumption was associated with an increased risk of developing AF (HR 1.11, 95% CI: 1.02-1.21, P = 0.01). Low alcohol consumption conferred an increased risk of AF in males (HR 1.14, 95% CI: 1.01-1.28, P = 0.04) and Europeans (HR 1.12, 95% CI: 1.07-1.17, P < 0.00001). CONCLUSIONS: This analysis represents the increased risk of incident AF in males, Europeans, and Asians at moderate alcohol consumption levels and in males and Europeans at low alcohol consumption levels. Those who drink any preferred alcohol beverage at moderate levels should be cautious for incident AF. More studies are warranted to find those factors that influence alcohol's effect on predisposing AF."},{"id":"c7f7675f1cdd","type":"article","url":"https://hartvaat.nl/2022/05/03/radiale-strain-geleide-leadplaatsing-voor-crt-bij-ischemisch-hf/","title":"Radiale strain geleide leadplaatsing voor CRT bij ischemisch HF","title_en":"Radial strain imaging-guided lead placement for improving response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy: the Raise CRT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euab253","source_url":"https://doi.org/10.1093/europace/euab253","authors":["Michael Glikson","Roy Beinart","Gregory Golovchiner","Alon Bar Sheshet","Moshe Swissa","Munther Bolous","Raphael Rosso","Aharon Medina","Moti Haim","Paul Friedman","Vladimir Khalamaizer","Shlomit Benzvi","Saki Ito","Ilan Goldenberg","Robert Klempfner","Ori Vaturi","Jae K Oh"],"significance":5,"published":"2022-05-03","source_date":"2022-05-03","image":"","kennis":[],"congress":"","summary_en":"This study evaluated radial strain imaging-guided LV lead placement for improving CRT response in ischemic heart failure, testing whether targeting the latest activated non-scarred segment improves resynchronization.","created":"2026-07-03T10:29:44Z","updated":"2026-07-03T13:28:50Z","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 radiale strain beeldvorming-geleide LV-leadplaatsing voor verbetering van CRT-respons bij ischemisch hartfalen.","abstract_original":"AIMS: To evaluate the benefit of speckle tracking radial strain imaging (STRSI)-guided left ventricular (LV) lead (LVL) positioning in cardiac resynchronization therapy (CRT) in patients (pts) with ischaemic cardiomyopathy with CRT indication. METHODS AND RESULTS: We conducted a prospective randomized controlled trial. Patients were enrolled in nine centres with 2:1 randomization into two groups (guided vs. control). Patients underwent STRSI to identify the optimal LV position from six LV segments at midventricular level. Implantation via STRSI was attempted for recommended segment in the guided group only. Follow-up included echocardiography (6 months) and clinical evaluation (6 and 12 months). The primary endpoint was comparison % reduction in LV end-systolic volume at 6 months with baseline. Secondary endpoints included hospitalizations for heart failure and death, and improvement in additional echocardiographic measurements and quality of life score. A total of 172 patients (115 guided vs. 57 control) were enrolled. In the guided group, 60% of the implanted LV leads were adjudicated to be successfully located at the recommended segment, whereas in the control group 44% reached the best STRSI determined segment. There was no difference between the groups in any of the primary or secondary endpoints at 6 and 12 months. CONCLUSION: Our findings suggest that echo-guided implantation of an LV lead using STRSI does not improve the clinical or echocardiographic response compared with conventional implantation."},{"id":"dc6abf65ad15","type":"article","url":"https://hartvaat.nl/2022/05/01/nierdisfunctie-en-uitkomsten-bij-hf-met-mr-coapt/","title":"Nierdisfunctie en uitkomsten bij HF met MR: COAPT","title_en":"Impact of baseline renal dysfunction on cardiac outcomes and end-stage renal disease in heart failure patients with mitral regurgitation: the COAPT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac026","source_url":"https://doi.org/10.1093/eurheartj/ehac026","authors":["Nirat Beohar","Gorav Ailawadi","Lak N Kotinkaduwa","Björn Redfors","Matheus Simonato","Zixuan Zhang","Loren Garrison Morgan","Esteban Escolar","Saibal Kar","David Scott Lim","Jacob M Mishell","Brian K Whisenant","William T Abraham","JoAnn Lindenfeld","Michael J Mack","Gregg W Stone"],"significance":6,"published":"2022-05-01","source_date":"2022-05-01","image":"","kennis":[],"congress":"","summary_en":"This COAPT analysis showed that baseline renal dysfunction worsens outcomes in heart failure with severe MR, but that MitraClip provides consistent relative benefit regardless of kidney function status.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","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":"COAPT analyse naar de impact van baseline nierdisfunctie op cardiale uitkomsten en eindstadium nierziekte bij HF met MR.","abstract_original":"AIMS: Baseline renal dysfunction (RD) adversely impacts outcomes among patients with heart failure (HF) and severe secondary mitral regurgitation (MR). Heart failure and MR, in turn, accelerate progression to end-stage renal disease (ESRD), worsening prognosis. We sought to determine the impact of RD in HF patients with severe MR and the impact of transcatheter mitral valve repair (TMVr) on new-onset ESRD and the need for renal replacement therapy (RRT). METHODS AND RESULTS: The COAPT trial randomized 614 patients with HF and severe MR to MitraClip plus guideline-directed medical therapy (GDMT) vs. GDMT alone. Patients were stratified into three RD subgroups based on baseline estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): none (≥60), moderate (30-60), and severe (<30). End-stage renal disease was defined as eGFR <15 mL/min/1.73 m2 or RRT. The 2-year rates of all-cause death or HF hospitalization (HFH), new-onset ESRD, and RRT according to RD and treatment were assessed. Baseline RD was present in 77.0% of patients, including 23.8% severe RD, 6.0% ESRD, and 5.2% RRT. Worse RD was associated with greater 2-year risk of death or HFH (none 45.3%; moderate 53.9%; severe 69.2%; P < 0.0001). MitraClip vs. GDMT alone improved outcomes regardless of RD (Pinteraction = 0.62) and reduced new-onset ESRD [2.9 vs. 8.1%, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.15-0.76, P = 0.008] and the need for new RRT (2.5 vs. 7.4%, HR 0.33, 95% CI 0.14-0.78, P = 0.011). CONCLUSION: Baseline RD was common in the HF patients with severe MR enrolled in COAPT and strongly predicted 2-year death and HFH. MitraClip treatment reduced new-onset ESRD and the need for RRT, contributing to the improved prognosis after TMVr."},{"id":"927a54de4497","type":"article","url":"https://hartvaat.nl/2022/05/01/antihypertensivaklasse-en-uitkomsten-in-sprint/","title":"Antihypertensivaklasse en uitkomsten in SPRINT","title_en":"Impact of Antihypertensive Drug Class on Outcomes in SPRINT.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18369","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18369","authors":["Douglas D DeCarolis","Amy Gravely","Christine M Olney","Areef Ishani"],"significance":6,"published":"2022-05-01","source_date":"2022-05-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis examined whether any specific antihypertensive drug class was associated with better outcomes under intensive blood pressure control, informing the drug selection component of aggressive treatment strategies.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","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":"SPRINT analyse naar de impact van antihypertensivaklasse op uitkomsten. Relevant voor de startkeuze.","abstract_original":"BACKGROUND: The primary objective of this analysis is to assess if greater exposure to any major antihypertensive drug class was associated with reduced primary composite outcome events in SPRINT (Systolic Blood Pressure Intervention Trial). METHODS: This is a secondary analysis of the SPRINT trial evaluating whether longitudinal, time varying exposure to any major antihypertensive drug class had any impact on primary outcome events, after adjusting for effects of randomization arm, time varying achieved systolic blood pressure, other drug class exposure, and baseline characteristics. RESULTS: Nine thousand two hundred fifty-two participants were included. After adjustments, exposure of one year or greater to thiazide-type diuretics or renin-angiotensin system blockers was associated with significantly fewer primary events than exposure of less than one year (hazard ratio, 0.78 [95% CI, 0.64-0.94]). There was no significant difference with longer versus shorter exposure to calcium channel blockers. Greater exposure to beta-blockers was associated with an increase in primary events compared with exposure of <1 year (hazard ratio, 1.35 [95% CI, 1.13-1.62]). Furthermore, thiazide-type diuretics were associated with a reduction in heart failure events and renin-angiotensin system blockers with reduced myocardial infarction. Both were associated with less cardiovascular deaths. CONCLUSIONS: The SPRINT trial demonstrated a lower target blood pressure led to reductions in adverse cardiovascular events. This analysis suggests greater exposure to thiazide-type diuretics and renin-angiotensin system blockers also contributed to reduced adverse cardiovascular events. Greater exposure to beta-blockers was associated with increased cardiovascular events."},{"id":"fa610a44db7d","type":"article","url":"https://hartvaat.nl/2022/05/01/risicostratificatie-door-kruisclassificatie-van-centrale-en-brachiale-systolisch/","title":"Risicostratificatie door kruisclassificatie van centrale en brachiale systolische bloeddruk","title_en":"Risk Stratification by Cross-Classification of Central and Brachial Systolic Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18773","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18773","authors":["Yi-Bang Cheng","Lutgarde Thijs","Lucas S Aparicio","Qi-Fang Huang","Fang-Fei Wei","Yu-Ling Yu","Jessica Barochiner","Chang-Sheng Sheng","Wen-Yi Yang","Teemu J Niiranen","José Boggia","Zhen-Yu Zhang","Katarzyna Stolarz-Skrzypek","Natasza Gilis-Malinowska","Valérie Tikhonoff","Wiktoria Wojciechowska","Edoardo Casiglia","Krzysztof Narkiewicz","Jan Filipovský","Kalina Kawecka-Jaszcz","Ji-Guang Wang","Yan Li","Jan A Staessen"],"significance":5,"published":"2022-05-01","source_date":"2022-05-01","image":"","kennis":[],"congress":"","summary_en":"This study used cross-classification of central and brachial systolic blood pressure for cardiovascular risk stratification, testing whether discordant central-peripheral readings identify patients at differential risk.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","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 risicostratificatie door gecombineerde beoordeling van centrale en brachiale systolische bloeddruk.","abstract_original":"BACKGROUND: Whether cardiovascular risk is more tightly associated with central (cSBP) than brachial (bSBP) systolic pressure remains debated, because of their close correlation and uncertain thresholds to differentiate cSBP into normotension versus hypertension. METHODS: In a person-level meta-analysis of the International Database of Central Arterial Properties for Risk Stratification (n=5576; 54.1% women; mean age 54.2 years), outcome-driven thresholds for cSBP were determined and whether the cross-classification of cSBP and bSBP improved risk stratification was explored. cSBP was tonometrically estimated from the radial pulse wave using SphygmoCor software. RESULTS: Over 4.1 years (median), 255 composite cardiovascular end points occurred. In multivariable bootstrapped analyses, cSBP thresholds (in mm Hg) of 110.5 (95% CI, 109.1-111.8), 120.2 (119.4-121.0), 130.0 (129.6-130.3), and 149.5 (148.4-150.5) generated 5-year cardiovascular risks equivalent to the American College of Cardiology/American Heart Association bSBP thresholds of 120, 130, 140, and 160. Applying 120/130 mm Hg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (43.1%) and hypertension (48.2%) versus isolated brachial hypertension (5.0%) and isolated central hypertension (3.7%). With concordant normotension as reference, the multivariable hazard ratios for the cardiovascular end point were 1.30 (95% CI, 0.58-2.94) for isolated brachial hypertension, 2.28 (1.21-4.30) for isolated central hypertension, and 2.02 (1.41-2.91) for concordant hypertension. The increased cardiovascular risk associated with isolated central and concordant hypertension was paralleled by cerebrovascular end points with hazard ratios of 3.71 (1.37-10.06) and 2.60 (1.35-5.00), respectively. CONCLUSIONS: Irrespective of the brachial blood pressure status, central hypertension increased cardiovascular and cerebrovascular risk indicating the importance of controlling central hypertension."},{"id":"63ad8f847719","type":"article","url":"https://hartvaat.nl/2022/05/01/antihypertensieve-behandeling-en-cerebrale-bloedflow-meta-analyse/","title":"Antihypertensieve behandeling en cerebrale bloedflow: meta-analyse","title_en":"Effect of Antihypertensive Treatment on Cerebral Blood Flow in Older Adults: a Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18255","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18255","authors":["Anniek E van Rijssel","Bram C Stins","Lucy C Beishon","Marit L Sanders","Terence J Quinn","Jurgen A H R Claassen","Rianne A A de Heus"],"significance":6,"published":"2022-05-01","source_date":"2022-05-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated the effect of antihypertensive treatment on cerebral blood flow in older adults, addressing the concern that blood pressure lowering may compromise brain perfusion in the elderly.","created":"2026-07-03T10:29:43Z","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":"Systematische review en meta-analyse naar het effect van antihypertensieve behandeling op cerebrale bloedflow.","abstract_original":"BACKGROUND: In older age, the benefits of antihypertensive treatment (AHT) become less evident, with greater associated risk. Of particular concern is compromising cerebral blood flow (CBF), especially in those with cognitive impairment. METHODS: We created a synthesis of the published evidence by searching multiple electronic databases from 1970 to May 2021. Included studies had participants with mean age ≥50 years, hypertension or cognitive impairment, and assessed CBF before and after initiating AHT. Two authors independently determined eligibility and extracted data. Study quality was assessed using The Risk of Bias in Nonrandomized Studies of Interventions tool. We summarized study characteristics (qualitative synthesis) and performed random-effects meta-analyses (quantitative synthesis). RESULTS: Thirty-two studies (total n=1306) were included, of which 23 were eligible for meta-analysis. In line with the qualitative synthesis, the meta-analysis indicated no effect of AHT initiation on CBF (standardized mean difference, 0.08 [95% CI, -0.07 to 0.22]; P=0.31, I2=42%). This was consistent across subgroups of acute versus chronic AHT, drug class, study design, and CBF measurement. Subgroups by age demonstrated an increase in CBF after AHT in those aged >70 years (standardized mean difference, 4.15 [95% CI, 0.16-8.15]; P=0.04, I2=42%), but not in those aged 50 to 65 and 65 to 70 years (standardized mean difference, 0.18 [95% CI,-2.02 to 2.38]; P=0.87, I2=49%; standardized mean difference, 1.22 [95% CI, -0.45 to 2.88]; P=0.15, I2=68%). Overall, risk of bias was moderate-to-high and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation) was very low, reflecting the observational nature of the data. CONCLUSIONS: Accepting the observed limitations, current evidence does not suggest a harmful effect of AHT on CBF. Concerns over CBF should not preclude treatment of hypertension."},{"id":"9781e92c6b6a","type":"article","url":"https://hartvaat.nl/2022/05/01/remote-ischemische-conditionering-bij-stemi-registergebaseerde-gerandomiseerde-t/","title":"Remote ischemische conditionering bij STEMI: registergebaseerde gerandomiseerde trial","title_en":"Remote ischaemic conditioning in ST elevation myocardial infarction: a registry-based randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319455","source_url":"https://doi.org/10.1136/heartjnl-2021-319455","authors":["Kevin R Bainey","Yinggan Zheng","Richard Coulden","Emer Sonnex","Richard Thompson","Junyi Mei","Alexandra Bastiany","Robert Welsh"],"significance":5,"published":"2022-05-01","source_date":"2022-05-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This registry-based randomized trial of remote ischemic conditioning in STEMI tested cardioprotection at the population level, evaluating whether the benefits seen in controlled trials translate to routine clinical practice.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","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":"Registergebaseerde gerandomiseerde trial van remote ischemische conditionering bij STEMI.","abstract_original":"OBJECTIVES: Remote ischaemic conditioning (RIC) has been tested as a possible strategy for mitigating reperfusion injury in ST elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI). However, surrogate outcomes have shown inconsistent effects with lack of clinical correlation. METHODS: We performed a registry-based randomised study of patients with STEMI allocated to RIC (4 cycles of blood pressure cuff inflation to 200 mm Hg for 5 min of ischaemia followed by 5 min of reperfusion) or standard of care (SOC) during PPCI. We examined the associations of RIC on core laboratory measurements of myocardial perfusion, infarct size (IS), left ventricular (LV) performance and clinical outcomes. RESULTS: A total of 252 patients were enrolled. The median age was 61 (IQR: 55-70) years and 72.8% were male. Sum ST segment deviation resolution ≥50% was similar between RIC and SOC (65.2% vs 55.7%, p=0.269). In those with 3-day cardiovascular MRI (n=88), no difference in median (25th, 75th percentiles) IS (14.9% (4.5%, 23.1%) vs 16.1% (3.3%, 22.0%), p=0.980), LV dimensions (LV end-diastolic volume index: 78.7 (71.1, 91.2) mL/m2 vs 79.9 (71.2, 88.8) mL/m2, p=0.630; LV end-systolic volume index: 48.8 (35.7, 51.4) mL/m2 vs 37.9 (31.8, 47.5) mL/m2, p=0.551) or ejection fraction (50.0% (41.0%-55.0%) vs 50.0% (43.0%-56.0%), p=0.554) was demonstrated. Similar results were observed with 90-day cardiovascular MRI. At 1 year, the clinical composite of death, congestive heart failure, cardiogenic shock and recurrent myocardial infarction was similar in RIC and SOC (21.7% vs 13.3%, p=0.110). CONCLUSIONS: In a contemporary registry-based randomised study of patients with STEMI undergoing PPCI, adjunctive therapy with RIC did not improve myocardial perfusion, reduce IS or alter LV performance. Consequently, there was no difference in clinical outcomes within 1 year. TRIAL REGISTRATION NUMBER: NCT03930589."},{"id":"89d5fedf281c","type":"article","url":"https://hartvaat.nl/2022/04/30/abiraterone-bij-gemetastaseerd-castratiegevoelig-prostaatkanker-peace-1/","title":"Abiraterone bij gemetastaseerd castratiegevoelig prostaatkanker: PEACE-1","title_en":"Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00367-1","source_url":"https://doi.org/10.1016/S0140-6736(22)00367-1","authors":["Karim Fizazi","Stéphanie Foulon","Joan Carles","Guilhem Roubaud","Ray McDermott","Aude Fléchon","Bertrand Tombal","Stéphane Supiot","Dominik Berthold","Philippe Ronchin","Gabriel Kacso","Gwenaëlle Gravis","Fabio Calabro","Jean-François Berdah","Ali Hasbini","Marlon Silva","Antoine Thiery-Vuillemin","Igor Latorzeff","Loïc Mourey","Brigitte Laguerre","Sophie Abadie-Lacourtoisie","Etienne Martin","Claude El Kouri","Anne Escande","Alvar Rosello","Nicolas Magne","Friederike Schlurmann","Frank Priou","Marie-Eve Chand-Fouche","Salvador Villà Freixa","Muhammad Jamaluddin","Isabelle Rieger","Alberto Bossi"],"significance":5,"published":"2022-04-30","source_date":"2022-04-30","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/thiazidediuretica-hypertensie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"The PEACE-1 Lancet trial of abiraterone for metastatic prostate cancer is relevant to cardio-oncology due to the hypertension and hypokalemia side effects of androgen-pathway manipulation.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet PEACE-1 trial. Cardio-oncologisch relevant vanwege hypertensie en hypokaliëmie als bijwerkingen.","abstract_original":"BACKGROUND: Current standard of care for metastatic castration-sensitive prostate cancer supplements androgen deprivation therapy with either docetaxel, second-generation hormonal therapy, or radiotherapy. We aimed to evaluate the efficacy and safety of abiraterone plus prednisone, with or without radiotherapy, in addition to standard of care. METHODS: We conducted an open-label, randomised, phase 3 study with a 2 × 2 factorial design (PEACE-1) at 77 hospitals across Belgium, France, Ireland, Italy, Romania, Spain, and Switzerland. Eligible patients were male, aged 18 years or older, with histologically confirmed or cytologically confirmed de novo metastatic prostate adenocarcinoma, and an Eastern Cooperative Oncology Group performance status of 0-1 (or 2 due to bone pain). Participants were randomly assigned (1:1:1:1) to standard of care (androgen deprivation therapy alone or with intravenous docetaxel 75 mg/m2 once every 3 weeks), standard of care plus radiotherapy, standard of care plus abiraterone (oral 1000 mg abiraterone once daily plus oral 5 mg prednisone twice daily), or standard of care plus radiotherapy plus abiraterone. Neither the investigators nor the patients were masked to treatment allocation. The coprimary endpoints were radiographic progression-free survival and overall survival. Abiraterone efficacy was first assessed in the overall population and then in the population who received androgen deprivation therapy with docetaxel as standard of care (population of interest). This study is ongoing and is registered with ClinicalTrials.gov, NCT01957436. FINDINGS: Between Nov 27, 2013, and Dec 20, 2018, 1173 patients were enrolled (one patient subsequently withdrew consent for analysis of his data) and assigned to receive standard of care (n=296), standard of care plus radiotherapy (n=293), standard of care plus abiraterone (n=292), or standard of care plus radiotherapy plus abiraterone (n=291). Median follow-up was 3·5 years (IQR 2·8-4·6) for radiographic progression-free survival and 4·4 years (3·5-5·4) for overall survival. Adjusted Cox regression modelling revealed no interaction between abiraterone and radiotherapy, enabling the pooled analysis of abiraterone efficacy. In the overall population, patients assigned to receive abiraterone (n=583) had longer radiographic progression-free survival (hazard ratio [HR] 0·54, 99·9% CI 0·41-0·71; p<0·0001) and overall survival (0·82, 95·1% CI 0·69-0·98; p=0·030) than patients who did not receive abiraterone (n=589). In the androgen deprivation therapy with docetaxel population (n=355 in both with abiraterone and without abiraterone groups), the HRs were consistent (radiographic progression-free survival 0·50, 99·9% CI 0·34-0·71; p<0·0001; overall survival 0·75, 95·1% CI 0·59-0·95; p=0·017). In the androgen deprivation therapy with docetaxel population, grade 3 or worse adverse events occurred in 217 (63%) of 347 patients who received abiraterone and 181 (52%) of 350 who did not; hypertension had the largest difference in occurrence (76 [22%] patients and 45 [13%], respectively). Addition of abiraterone to androgen deprivation therapy plus docetaxel did not increase the rates of neutropenia, febrile neutropenia, fatigue, or neuropathy compared with androgen deprivation therapy plus docetaxel alone. INTERPRETATION: Combining androgen deprivation therapy, docetaxel, and abiraterone in de novo metastatic castration-sensitive prostate cancer improved overall survival and radiographic progression-free survival with a modest increase in toxicity, mostly hypertension. This triplet therapy could become a standard of care for these patients. FUNDING: Janssen-Cilag, Ipsen, Sanofi, and the French Government."},{"id":"e90221ac0230","type":"article","url":"https://hartvaat.nl/2022/04/26/aspirine-voor-cv-preventie-uspstf-aanbeveling-2022/","title":"Aspirine voor CV-preventie: USPSTF aanbeveling 2022","title_en":"Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts","internist"],"tags":["aspirine"],"journal":"JAMA","doi":"10.1001/jama.2022.4983","source_url":"https://doi.org/10.1001/jama.2022.4983","authors":["Karina W Davidson","Michael J Barry","Carol M Mangione","Michael Cabana","David Chelmow","Tumaini Rucker Coker","Esa M Davis","Katrina E Donahue","Carlos Roberto Jaén","Alex H Krist","Martha Kubik","Li Li","Gbenga Ogedegbe","Lori Pbert","John M Ruiz","James Stevermer","Chien-Wen Tseng","John B Wong"],"significance":10,"published":"2022-04-26","source_date":"2022-04-26","image":"","kennis":[],"congress":"","summary_en":"The 2022 USPSTF recommendation statement downgraded the role of aspirin in primary cardiovascular prevention, advising against initiation in adults 60 years or older and recommending individualized decision-making in those aged 40–59 with elevated CVD risk. This reflected accumulating evidence from ASPREE, ARRIVE, and ASCEND showing unfavorable bleeding-to-benefit ratios.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","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":"USPSTF 2022 aanbeveling die aspirine voor primaire CV-preventie afzwakt. Niet meer aanbevolen boven 60 jaar — paradigmashift na ASPREE, ARRIVE en ASCEND.","abstract_original":"IMPORTANCE: Cardiovascular disease (CVD) is the leading cause of mortality in the US, accounting for more than 1 in 4 deaths. Each year, an estimated 605 000 people in the US have a first myocardial infarction and an estimated 610 000 experience a first stroke. OBJECTIVE: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD. The systematic review also investigated the effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, as well as the harms (particularly bleeding) associated with aspirin use. The USPSTF also commissioned a microsimulation modeling study to assess the net balance of benefits and harms from aspirin use for primary prevention of CVD and CRC, stratified by age, sex, and CVD risk level. POPULATION: Adults 40 years or older without signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke) who are not at increased risk for bleeding (eg, no history of gastrointestinal ulcers, recent bleeding, other medical conditions, or use of medications that increase bleeding risk). EVIDENCE ASSESSMENT: The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit. The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit. RECOMMENDATION: The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. (C recommendation) The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older. (D recommendation)."},{"id":"2071c46c02c3","type":"article","url":"https://hartvaat.nl/2022/04/19/externe-validatie-van-de-freedom-score-voor-pci-versus-cabg/","title":"Externe validatie van de FREEDOM-score voor PCI versus CABG","title_en":"External Validation of the FREEDOM Score for Individualized Decision Making Between CABG and PCI.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.01.049","source_url":"https://doi.org/10.1016/j.jacc.2022.01.049","authors":["Kuniaki Takahashi","Patrick W Serruys","Valentin Fuster","Michael E Farkouh","John A Spertus","David J Cohen","Seung-Jung Park","Duk-Woo Park","Jung-Min Ahn","Yoshinobu Onuma","David M Kent","Ewout W Steyerberg","David van Klaveren"],"significance":6,"published":"2022-04-19","source_date":"2022-04-19","image":"","kennis":[],"congress":"","summary_en":"This external validation of the FREEDOM score confirmed its ability to predict individual benefit from CABG versus PCI, supporting the tool for personalized revascularization decision-making in diabetic multivessel disease.","created":"2026-07-03T10:29:43Z","updated":"2026-07-03T13:28:50Z","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":"Externe validatie van de FREEDOM-score voor geïndividualiseerde besluitvorming tussen CABG en PCI.","abstract_original":"BACKGROUND: Although randomized trials have established that coronary artery bypass grafting (CABG) is, on average, the most effective revascularization strategy compared with percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease (MVD), individual patients differ in many characteristics that can affect the benefits and harms of treatment. The FREEDOM (Future Revascularization Evaluation in Patients with Diabetes Mellitus) score was developed to predict different outcomes with CABG vs PCI on the basis of 8 patient characteristics and the smoking-treatment interaction. OBJECTIVES: This study aimed to assess the ability of the 5-year major adverse cardiovascular event (MACE) model to predict treatment benefit of CABG vs PCI in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) and BEST (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials. METHODS: This study identified 702 patients with diabetes and MVD to mirror the FREEDOM participants. Discrimination was assessed by C-index, and calibration was assessed by calibration plots in the PCI and CABG arms, respectively. The ability of the FREEDOM score to predict treatment benefit of CABG vs PCI was assessed. RESULTS: Overall, CABG was associated with a lower rate of 5-year MACE compared with PCI (12.4% vs 20.3%; log-rank P = 0.021) irrespective of a history of smoking (Pinteraction = 0.975). Both discrimination and calibration were helpful in the PCI arm (C-index: 0.69; slope: 0.96, intercept: -0.24), but moderate in the CABG arm (C-index: 0.61; slope: 0.61; intercept: -0.53). The FREEDOM score showed some heterogeneity of treatment benefit. CONCLUSIONS: The FREEDOM score could identify some heterogeneity of treatment benefit of CABG vs PCI for 5-year MACE. Until further prospective validations are performed, these results should be taken into consideration when using the FREEDOM score in patients with diabetes and MVD. (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972) (Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease [BEST]; NCT00997828) (Future Revascularization Evaluation in Patients with Diabetes Mellitus [FREEDOM]; NCT00086450)."},{"id":"b0c4337ec4ec","type":"article","url":"https://hartvaat.nl/2022/04/19/substraatablatie-versus-antiaritmica-bij-symptomatische-vt/","title":"Substraatablatie versus antiaritmica bij symptomatische VT","title_en":"Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["supraventriculaire-tachycardie","ventriculaire-tachycardie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.01.050","source_url":"https://doi.org/10.1016/j.jacc.2022.01.050","authors":["Ángel Arenal","Pablo Ávila","Javier Jiménez-Candil","Luis Tercedor","David Calvo","Fernando Arribas","Javier Fernández-Portales","José Luis Merino","Antonio Hernández-Madrid","Francisco J Fernández-Avilés","Antonio Berruezo"],"significance":7,"published":"2022-04-19","source_date":"2022-04-19","image":"","kennis":[],"congress":"","summary_en":"This study compared substrate-based catheter ablation with antiarrhythmic drug therapy for symptomatic ventricular tachycardia in patients with ischemic cardiomyopathy and an ICD, evaluating the optimal rhythm management approach.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","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":"Vergelijking van substraatablatie versus antiaritmische medicatie bij patiënten met symptomatische ventriculaire tachycardie.","abstract_original":"BACKGROUND: In patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD), catheter ablation and antiarrhythmic drugs (AADs) reduce ICD shocks, but the most effective approach remains uncertain. OBJECTIVES: This trial compares the efficacy and safety of catheter ablation vs AAD as first-line therapy in ICD patients with symptomatic ventricular tachycardias (VTs). METHODS: The SURVIVE-VT (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia) is a prospective, multicenter, randomized trial including patients with ischemic cardiomyopathy and appropriated ICD shock. Patients were 1:1 randomized to complete endocardial substrate-based catheter ablation or antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers). The primary outcome was a composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications. RESULTS: In this trial, 144 patients (median age, 70 years; 96% male) were randomized to catheter ablation (71 patients) or AAD (73 patients). After 24 months, the primary outcome occurred in 28.2% of patients in the ablation group and 46.6% of those in the AAD group (hazard ratio [HR]: 0.52; 95% CI: 0.30-0.90; P = 0.021). This difference was driven by a significant reduction in severe treatment-related complications (9.9% vs 28.8%, HR: 0.30; 95% CI: 0.13-0.71; P = 0.006). Eight patients were hospitalized for heart failure in the ablation group and 13 in the AAD group (HR: 0.56; 95% CI: 0.23-1.35; P = 0.198). There was no difference in cardiac mortality (HR: 0.93; 95% CI: 0.19-4.61; P = 0.929). CONCLUSIONS: In ICD patients with ischemic cardiomyopathy and symptomatic VT, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to AAD. (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia [SURVIVE-VT]: NCT03734562)."},{"id":"909b54440bb9","type":"article","url":"https://hartvaat.nl/2022/04/19/therapeutische-doelen-voor-hf-via-proteomics-en-mendeliaanse-randomisatie/","title":"Therapeutische doelen voor HF via proteomics en Mendeliaanse randomisatie","title_en":"Therapeutic Targets for Heart Failure Identified Using Proteomics and Mendelian Randomization.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056663","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056663","authors":["Albert Henry","María Gordillo-Marañón","Chris Finan","Amand F Schmidt","João Pedro Ferreira","Ravi Karra","Johan Sundström","Lars Lind","Johan Ärnlöv","Faiez Zannad","Anders Mälarstig","Aroon D Hingorani","R Thomas Lumbers"],"significance":6,"published":"2022-04-19","source_date":"2022-04-19","image":"","kennis":[],"congress":"","summary_en":"This study used proteomics and Mendelian randomization to identify novel therapeutic targets for heart failure, discovering disease-associated proteins that could be drugged for HF prevention or treatment.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die therapeutische doelen voor hartfalen identificeerde via proteomics en Mendeliaanse randomisatie.","abstract_original":"BACKGROUND: Heart failure (HF) is a highly prevalent disorder for which disease mechanisms are incompletely understood. The discovery of disease-associated proteins with causal genetic evidence provides an opportunity to identify new therapeutic targets. METHODS: We investigated the observational and causal associations of 90 cardiovascular proteins, which were measured using affinity-based proteomic assays. First, we estimated the associations of 90 cardiovascular proteins with incident heart failure by means of a fixed-effect meta-analysis of 4 population-based studies, composed of a total of 3019 participants with 732 HF events. The causal effects of HF-associated proteins were then investigated by Mendelian randomization, using cis-protein quantitative loci genetic instruments identified from genomewide association studies in more than 30 000 individuals. To improve the precision of causal estimates, we implemented an Mendelian randomization model that accounted for linkage disequilibrium between instruments and tested the robustness of causal estimates through a multiverse sensitivity analysis that included up to 120 combinations of instrument selection parameters and Mendelian randomization models per protein. The druggability of candidate proteins was surveyed, and mechanism of action and potential on-target side effects were explored with cross-trait Mendelian randomization analysis. RESULTS: Forty-four of ninety proteins were positively associated with risk of incident HF (P<6.0×10-4). Among these, 8 proteins had evidence of a causal association with HF that was robust to multiverse sensitivity analysis: higher CSF-1 (macrophage colony-stimulating factor 1), Gal-3 (galectin-3) and KIM-1 (kidney injury molecule 1) were positively associated with risk of HF, whereas higher ADM (adrenomedullin), CHI3L1 (chitinase-3-like protein 1), CTSL1 (cathepsin L1), FGF-23 (fibroblast growth factor 23), and MMP-12 (matrix metalloproteinase-12) were protective. Therapeutics targeting ADM and Gal-3 are currently under evaluation in clinical trials, and all the remaining proteins were considered druggable, except KIM-1. CONCLUSIONS: We identified 44 circulating proteins that were associated with incident HF, of which 8 showed evidence of a causal relationship and 7 were druggable, including adrenomedullin, which represents a particularly promising drug target. Our approach demonstrates a tractable roadmap for the triangulation of population genomic and proteomic data for the prioritization of therapeutic targets for complex human diseases."},{"id":"6b552931f0cc","type":"article","url":"https://hartvaat.nl/2022/04/19/alirocumab-na-acs-bij-patienten-met-hf-voorgeschiedenis-odyssey-outcomes/","title":"Alirocumab na ACS bij patiënten met HF-voorgeschiedenis: ODYSSEY OUTCOMES","title_en":"Alirocumab after acute coronary syndrome in patients with a history of heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab804","source_url":"https://doi.org/10.1093/eurheartj/ehab804","authors":["Harvey D White","Gregory G Schwartz","Michael Szarek","Deepak L Bhatt","Vera A Bittner","Chern-En Chiang","Rafael Diaz","Shaun G Goodman","Johan Wouter Jukema","Megan Loy","Neha Pagidipati","Robert Pordy","Arsen D Ristić","Andreas M Zeiher","Daniel M Wojdyla","Philippe Gabriel Steg"],"significance":6,"published":"2022-04-19","source_date":"2022-04-19","image":"","kennis":[],"congress":"","summary_en":"This ODYSSEY OUTCOMES subanalysis showed that alirocumab benefits ACS patients with a history of heart failure, a population previously thought to not respond to lipid-lowering therapy based on statin trial data.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","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":"ODYSSEY OUTCOMES subanalyse bij patiënten met een voorgeschiedenis van hartfalen na ACS.","abstract_original":"AIMS: Patients with heart failure (HF) have not been shown to benefit from statins. In a post hoc analysis, we evaluated outcomes in ODYSSEY OUTCOMES in patients with vs. without a history of HF randomized to the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab or placebo. METHODS AND RESULTS: Among 18 924 patients with recent acute coronary syndrome (ACS) receiving intensive or maximum-tolerated statin treatment, the primary outcome of major adverse cardiovascular events (MACE) was compared in patients with or without a history of HF. The pre-specified secondary outcome of hospitalization for HF was also analysed. Overall, 2815 (14.9%) patients had a history of HF. Alirocumab reduced low-density lipoprotein cholesterol and lipoprotein(a) similarly in patients with or without HF. Overall, alirocumab reduced MACE compared with placebo [hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.78-0.93; P = 0.0001]. This effect was observed among patients without a history of HF (HR: 0.78; 95% CI: 0.70-0.86; P < 0.0001), but not in those with a history of HF (HR: 1.17; 95% CI: 0.97-1.40; P = 0.10) (Pinteraction = 0.0001). Alirocumab did not reduce hospitalization for HF, overall or in patients with or without prior HF. CONCLUSION: Alirocumab reduced MACE in patients without a history of HF but not in patients with a history of HF. Alirocumab did not reduce hospitalizations for HF in either group. Patients with a history of HF are a high-risk group that does not appear to benefit from PCSK9 inhibition after ACS."},{"id":"cc89681a5adf","type":"article","url":"https://hartvaat.nl/2022/04/19/coronaire-flowreserve-en-cardiovasculaire-uitkomsten-meta-analyse/","title":"Coronaire flowreserve en cardiovasculaire uitkomsten: meta-analyse","title_en":"Coronary flow reserve and cardiovascular outcomes: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab775","source_url":"https://doi.org/10.1093/eurheartj/ehab775","authors":["Mihir A Kelshiker","Henry Seligman","James P Howard","Haseeb Rahman","Michael Foley","Alexandra N Nowbar","Christopher A Rajkumar","Matthew J Shun-Shin","Yousif Ahmad","Sayan Sen","Rasha Al-Lamee","Ricardo Petraco"],"significance":7,"published":"2022-04-19","source_date":"2022-04-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-ct-angiografie/","https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"This meta-analysis quantified the association between reduced coronary flow reserve and cardiovascular outcomes, establishing impaired coronary microvascular function as an independent predictor of adverse events across multiple measurement modalities.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar coronaire flowreserve en cardiovasculaire uitkomsten.","abstract_original":"AIMS: This meta-analysis aims to quantify the association of reduced coronary flow with all-cause mortality and major adverse cardiovascular events (MACE) across a broad range of patient groups and pathologies. METHODS AND RESULTS: We systematically identified all studies between 1 January 2000 and 1 August 2020, where coronary flow was measured and clinical outcomes were reported. The endpoints were all-cause mortality and MACE. Estimates of effect were calculated from published hazard ratios (HRs) using a random-effects model. Seventy-nine studies with a total of 59 740 subjects were included. Abnormal coronary flow reserve (CFR) was associated with a higher incidence of all-cause mortality [HR: 3.78, 95% confidence interval (CI): 2.39-5.97] and a higher incidence of MACE (HR 3.42, 95% CI: 2.92-3.99). Each 0.1 unit reduction in CFR was associated with a proportional increase in mortality (per 0.1 CFR unit HR: 1.16, 95% CI: 1.04-1.29) and MACE (per 0.1 CFR unit HR: 1.08, 95% CI: 1.04-1.11). In patients with isolated coronary microvascular dysfunction, an abnormal CFR was associated with a higher incidence of mortality (HR: 5.44, 95% CI: 3.78-7.83) and MACE (HR: 3.56, 95% CI: 2.14-5.90). Abnormal CFR was also associated with a higher incidence of MACE in patients with acute coronary syndromes (HR: 3.76, 95% CI: 2.35-6.00), heart failure (HR: 6.38, 95% CI: 1.95-20.90), heart transplant (HR: 3.32, 95% CI: 2.34-4.71), and diabetes mellitus (HR: 7.47, 95% CI: 3.37-16.55). CONCLUSION: Reduced coronary flow is strongly associated with increased risk of all-cause mortality and MACE across a wide range of pathological processes. This finding supports recent recommendations that coronary flow should be measured more routinely in clinical practice, to target aggressive vascular risk modification for individuals at higher risk."},{"id":"2f6e6c1221f2","type":"article","url":"https://hartvaat.nl/2022/04/09/renale-denervatie-met-antihypertensiva-lancet-spyral-htn-on-med-langetermijn/","title":"Renale denervatie met antihypertensiva: Lancet SPYRAL HTN-ON MED langetermijn","title_en":"Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie","sacubitril-valsartan"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00455-X","source_url":"https://doi.org/10.1016/S0140-6736(22)00455-X","authors":["Felix Mahfoud","David E Kandzari","Kazuomi Kario","Raymond R Townsend","Michael A Weber","Roland E Schmieder","Konstantinos Tsioufis","Stuart Pocock","Kyriakos Dimitriadis","James W Choi","Cara East","Richard D'Souza","Andrew S P Sharp","Sebastian Ewen","Antony Walton","Ingrid Hopper","Sandeep Brar","Pamela McKenna","Martin Fahy","Michael Böhm"],"significance":7,"published":"2022-04-09","source_date":"2022-04-09","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"Long-term SPYRAL HTN-ON MED results confirmed sustained blood pressure reduction with renal denervation in the presence of antihypertensive medications, providing durable efficacy and safety data for device-based therapy in medicated patients.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","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":"Lancet SPYRAL HTN-ON MED langetermijnresultaten van renale denervatie met achtergrondmedicatie. Duurzaam bloeddrukverlagend effect.","abstract_original":"BACKGROUND: Renal denervation has been shown to lower blood pressure in the presence of antihypertensive medications; however, long-term safety and efficacy data from randomised trials of renal denervation are lacking. In this pre-specified analysis of the SPYRAL HTN-ON MED study, we compared changes in blood pressure, antihypertensive drug use, and safety up to 36 months in renal denervation versus a sham control group. METHODS: This randomised, single-blind, sham-controlled trial enrolled patients from 25 clinical centres in the USA, Germany, Japan, the UK, Australia, Austria, and Greece, with uncontrolled hypertension and office systolic blood pressure between 150 mm Hg and 180 mm Hg and diastolic blood pressure of 90 mm Hg or higher. Eligible patients had to have 24-h ambulatory systolic blood pressure between 140 mm Hg and less than 170 mm Hg, while taking one to three antihypertensive drugs with stable doses for at least 6 weeks. Patients underwent renal angiography and were randomly assigned (1:1) to radiofrequency renal denervation or a sham control procedure. Patients and physicians were unmasked after 12-month follow-up and sham control patients could cross over after 12-month follow-up completion. The primary endpoint was the treatment difference in mean 24-h systolic blood pressure at 6 months between the renal denervation group and the sham control group. Statistical analyses were done on the intention-to-treat population. Long-term efficacy was assessed using ambulatory and office blood pressure measurements up to 36 months. Drug surveillance was used to assess medication use. Safety events were assessed up to 36 months. This trial is registered with ClinicalTrials.gov, NCT02439775; prospectively, an additional 260 patients are currently being randomly assigned as part of the SPYRAL HTN-ON MED Expansion trial. FINDINGS: Between July 22, 2015, and June 14, 2017, among 467 enrolled patients, 80 patients fulfilled the qualifying criteria and were randomly assigned to undergo renal denervation (n=38) or a sham control procedure (n=42). Mean ambulatory systolic and diastolic blood pressure were significantly reduced from baseline in the renal denervation group, and were significantly lower than the sham control group at 24 and 36 months, despite a similar treatment intensity of antihypertensive drugs. The medication burden at 36 months was 2·13 medications (SD 1·15) in the renal denervation group and 2·55 medications (2·19) in the sham control group (p=0·26). 24 (77%) of 31 patients in the renal denervation group and 25 (93%) of 27 patients in the sham control group adhered to medication at 36 months. At 36 months, the ambulatory systolic blood pressure reduction was -18·7 mm Hg (SD 12·4) for the renal denervation group (n=30) and -8·6 mm Hg (14·6) for the sham control group (n=32; adjusted treatment difference -10·0 mm Hg, 95% CI -16·6 to -3·3; p=0·0039). Treatment differences between the renal denervation group and sham control group at 36 months were -5·9 mm Hg (95% CI -10·1 to -1·8; p=0·0055) for mean ambulatory diastolic blood pressure, -11·0 mm Hg (-19·8 to -2·1; p=0·016) for morning systolic blood pressure, and -11·8 mm Hg (-19·0 to -4·7; p=0·0017) for night-time systolic blood pressure. There were no short-term or long-term safety issues associated with renal denervation. INTERPRETATION: Radiofrequency renal denervation compared with sham control produced a clinically meaningful and lasting blood pressure reduction up to 36 months of follow-up, independent of concomitant antihypertensive medications and without major safety events. Renal denervation could provide an adjunctive treatment modality in the management of patients with hypertension. FUNDING: Medtronic."},{"id":"f3813c6f5bb7","type":"article","url":"https://hartvaat.nl/2022/04/09/asundexian-factor-xia-remmer-versus-apixaban-bij-af-lancet-pacific-af/","title":"Asundexian (factor XIa-remmer) versus apixaban bij AF: Lancet PACIFIC-AF","title_en":"Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["abelacimab","aperitif-trial","rivaroxaban"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00456-1","source_url":"https://doi.org/10.1016/S0140-6736(22)00456-1","authors":["Jonathan P Piccini","Valeria Caso","Stuart J Connolly","Keith A A Fox","Jonas Oldgren","W Schuyler Jones","Diana A Gorog","Václav Durdil","Thomas Viethen","Christoph Neumann","Hardi Mundl","Manesh R Patel"],"significance":8,"published":"2022-04-09","source_date":"2022-04-09","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/antidota-anticoagulantia/"],"congress":"","summary_en":"The PACIFIC-AF phase 2 trial showed that asundexian, an oral factor XIa inhibitor, had significantly less bleeding than apixaban in AF patients while maintaining preliminary signals of anticoagulant efficacy. This early positive result set the stage for the subsequent (failed) OCEANIC-AF phase 3 trial.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","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":"Lancet PACIFIC-AF fase-2 trial van asundexian, een orale factor XIa-remmer, versus apixaban bij AF. Nieuwe generatie anticoagulantia.","abstract_original":"BACKGROUND: Direct-acting oral anticoagulant use for stroke prevention in atrial fibrillation is limited by bleeding concerns. Asundexian, a novel, oral small molecule activated coagulation factor XIa (FXIa) inhibitor, might reduce thrombosis with minimal effect on haemostasis. We aimed to determine the optimal dose of asundexian and to compare the incidence of bleeding with that of apixaban in patients with atrial fibrillation. METHODS: In this randomised, double-blind, phase 2 dose-finding study, we compared asundexian 20 mg or 50 mg once daily with apixaban 5 mg twice daily in patients aged 45 years or older with atrial fibrillation, a CHA2DS2-VASc score of at least 2 if male or at least 3 if female, and increased bleeding risk. The study was conducted at 93 sites in 14 countries, including 12 European countries, Canada, and Japan. Participants were randomly assigned (1:1:1) to a treatment group using an interactive web response system, with randomisation stratified by whether patients were receiving a direct-acting oral anticoagulant before the study start. Masking was achieved using a double-dummy design, with participants receiving both the assigned treatment and a placebo that resembled the non-assigned treatment. The primary endpoint was the composite of major or clinically relevant non-major bleeding according to International Society on Thrombosis and Haemostasis criteria, assessed in all patients who took at least one dose of study medication. This trial is registered with ClinicalTrials.gov, NCT04218266, and EudraCT, 2019-002365-35. FINDINGS: Between Jan 30, 2020, and June 21, 2021, 862 patients were enrolled. 755 patients were randomly assigned to treatment. Two patients (assigned to asundexian 20 mg) never took any study medication, resulting in 753 patients being included in the analysis (249 received asundexian 20 mg, 254 received asundexian 50 g, and 250 received apixaban). The mean age of participants was 73·7 years (SD 8·3), 309 (41%) were women, 216 (29%) had chronic kidney disease, and mean CHA2DS2-VASc score was 3·9 (1·3). Asundexian 20 mg resulted in 81% inhibition of FXIa activity at trough concentrations and 90% inhibition at peak concentrations; asundexian 50 mg resulted in 92% inhibition at trough concentrations and 94% inhibition at peak concentrations. Ratios of incidence proportions for the primary endpoint were 0·50 (90% CI 0·14-1·68) for asundexian 20 mg (three events), 0·16 (0·01-0·99) for asundexian 50 mg (one event), and 0·33 (0·09-0·97) for pooled asundexian (four events) versus apixaban (six events). The rate of any adverse event occurring was similar in the three treatment groups: 118 (47%) with asundexian 20 mg, 120 (47%) with asundexian 50 mg, and 122 (49%) with apixaban. INTERPRETATION: The FXIa inhibitor asundexian at doses of 20 mg and 50 mg once daily resulted in lower rates of bleeding compared with standard dosing of apixaban, with near-complete in-vivo FXIa inhibition, in patients with atrial fibrillation. FUNDING: Bayer."},{"id":"0b3be955bda4","type":"article","url":"https://hartvaat.nl/2022/04/09/natriumreductie-100-mmol-bij-hartfalen-lancet-sodium-hf/","title":"Natriumreductie <100 mmol bij hartfalen: Lancet SODIUM-HF","title_en":"Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["carvedilol","finearts-hf","hfpef","hfref"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00369-5","source_url":"https://doi.org/10.1016/S0140-6736(22)00369-5","authors":["Justin A Ezekowitz","Eloisa Colin-Ramirez","Heather Ross","Jorge Escobedo","Peter Macdonald","Richard Troughton","Clara Saldarriaga","Wendimagegn Alemayehu","Finlay A McAlister","JoAnne Arcand","John Atherton","Robert Doughty","Milan Gupta","Jonathan Howlett","Shahin Jaffer","Andrea Lavoie","Mayanna Lund","Thomas Marwick","Robert McKelvie","Gordon Moe","A Shekhar Pandey","Liane Porepa","Miroslaw Rajda","Haunnah Rheault","Jitendra Singh","Mustafa Toma","Sean Virani","Shelley Zieroth"],"significance":8,"published":"2022-04-09","source_date":"2022-04-09","image":"","kennis":[],"congress":"","summary_en":"The SODIUM-HF trial showed that strict dietary sodium restriction (<100 mmol/day) in heart failure patients did not significantly reduce the composite of cardiovascular hospitalization, emergency department visit, or death compared with usual care. The neutral result questioned the clinical benefit of intensive sodium restriction.","created":"2026-07-03T10:29:42Z","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 SODIUM-HF gerandomiseerde trial die strenge natriumbeperking (<100 mmol/dag) onderzocht bij hartfalen. Neutraal — geen klinisch voordeel van extreme zoutbeperking bij HF.","abstract_original":"BACKGROUND: Dietary restriction of sodium has been suggested to prevent fluid overload and adverse outcomes for patients with heart failure. We designed the Study of Dietary Intervention under 100 mmol in Heart Failure (SODIUM-HF) to test whether or not a reduction in dietary sodium reduces the incidence of future clinical events. METHODS: SODIUM-HF is an international, open-label, randomised, controlled trial that enrolled patients at 26 sites in six countries (Australia, Canada, Chile, Colombia, Mexico, and New Zealand). Eligible patients were aged 18 years or older, with chronic heart failure (New York Heart Association [NYHA] functional class 2-3), and receiving optimally tolerated guideline-directed medical treatment. Patients were randomly assigned (1:1), using a standard number generator and varying block sizes of two, four, or six, stratified by site, to either usual care according to local guidelines or a low sodium diet of less than 100 mmol (ie, <1500 mg/day). The primary outcome was the composite of cardiovascular-related admission to hospital, cardiovascular-related emergency department visit, or all-cause death within 12 months in the intention-to-treat (ITT) population (ie, all randomly assigned patients). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT02012179, and is closed to accrual. FINDINGS: Between March 24, 2014, and Dec 9, 2020, 806 patients were randomly assigned to a low sodium diet (n=397) or usual care (n=409). Median age was 67 years (IQR 58-74) and 268 (33%) were women and 538 (66%) were men. Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653-3005) to 1658 mg/day (1301-2189) in the low sodium group and from 2119 mg/day (1673-2804) to 2073 mg/day (1541-2900) in the usual care group. By 12 months, events comprising the primary outcome had occurred in 60 (15%) of 397 patients in the low sodium diet group and 70 (17%) of 409 in the usual care group (hazard ratio [HR] 0·89 [95% CI 0·63-1·26]; p=0·53). All-cause death occurred in 22 (6%) patients in the low sodium diet group and 17 (4%) in the usual care group (HR 1·38 [0·73-2·60]; p=0·32), cardiovascular-related hospitalisation occurred in 40 (10%) patients in the low sodium diet group and 51 (12%) patients in the usual care group (HR 0·82 [0·54-1·24]; p=0·36), and cardiovascular-related emergency department visits occurred in 17 (4%) patients in the low sodium diet group and 15 (4%) patients in the usual care group (HR 1·21 [0·60-2·41]; p=0·60). No safety events related to the study treatment were reported in either group. INTERPRETATION: In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events. FUNDING: Canadian Institutes of Health Research and the University Hospital Foundation, Edmonton, Alberta, Canada, and Health Research Council of New Zealand."},{"id":"da7c90b7b17e","type":"article","url":"https://hartvaat.nl/2022/04/06/apoc-iii-reductie-bij-matige-hypertriglyceridemie-met-hoog-cv-risico/","title":"ApoC-III-reductie bij matige hypertriglyceridemie met hoog CV-risico","title_en":"Apolipoprotein C-III reduction in subjects with moderate hypertriglyceridaemia and at high cardiovascular risk.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","hdl-cholesterol","hypertriglyceridemie","lipoproteïne-a","yellow-iii"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab820","source_url":"https://doi.org/10.1093/eurheartj/ehab820","authors":["Jean-Claude Tardif","Ewa Karwatowska-Prokopczuk","Eric St Amour","Christie M Ballantyne","Michael D Shapiro","Patrick M Moriarty","Seth J Baum","Eunju Hurh","Victoria J Bartlett","Joyce Kingsbury","Amparo L Figueroa","Veronica J Alexander","Joseph Tami","Joseph L Witztum","Richard S Geary","Louis St L O'Dea","Sotirios Tsimikas","Daniel Gaudet"],"significance":7,"published":"2022-04-06","source_date":"2022-04-06","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/hypertriglyceridemie/"],"congress":"","summary_en":"This clinical trial evaluated olezarsen, a GalNAc-conjugated antisense oligonucleotide targeting apoC-III, in patients with moderate hypertriglyceridemia and high cardiovascular risk, demonstrating significant triglyceride reduction with a favorable safety profile.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","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 apoliproteïne C-III reductie bij patiënten met matige hypertriglyceridemie en hoog cardiovasculair risico.","abstract_original":"AIMS: Hypertriglyceridaemia is associated with increased risk of cardiovascular events. This clinical trial evaluated olezarsen, an N-acetyl-galactosamine-conjugated antisense oligonucleotide targeted to hepatic APOC3 mRNA to inhibit apolipoprotein C-III (apoC-III) production, in lowering triglyceride levels in patients at high risk for or with established cardiovascular disease. METHODS AND RESULTS: A randomized, double-blind, placebo-controlled, dose-ranging study was conducted in 114 patients with fasting serum triglycerides 200-500 mg/dL (2.26-5.65 mmol/L). Patients received olezarsen (10 or 50 mg every 4 weeks, 15 mg every 2 weeks, or 10 mg every week) or saline placebo subcutaneously for 6-12 months. The primary endpoint was the percent change in fasting triglyceride levels from baseline to Month 6 of exposure. Baseline median (interquartile range) fasting triglyceride levels were 262 (222-329) mg/dL [2.96 (2.51-3.71) mmol/L]. Treatment with olezarsen resulted in mean percent triglyceride reductions of 23% with 10 mg every 4 weeks, 56% with 15 mg every 2 weeks, 60% with 10 mg every week, and 60% with 50 mg every 4 weeks, compared with increase by 6% for the pooled placebo group (P-values ranged from 0.0042 to <0.0001 compared with placebo). Significant decreases in apoC-III, very low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B were also observed. There were no platelet count, liver, or renal function changes in any of the olezarsen groups. The most common adverse event was mild erythema at the injection site. CONCLUSION: Olezarsen significantly reduced apoC-III, triglycerides, and atherogenic lipoproteins in patients with moderate hypertriglyceridaemia and at high risk for or with established cardiovascular disease. TRIAL REGISTRATION NUMBER: NCT03385239."},{"id":"4b4783cf0387","type":"article","url":"https://hartvaat.nl/2022/04/06/nierfunctiebeoordeling-en-eindpuntbepaling-in-klinische-trials-ehj/","title":"Nierfunctiebeoordeling en eindpuntbepaling in klinische trials: EHJ","title_en":"Kidney function assessment and endpoint ascertainment in clinical trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab832","source_url":"https://doi.org/10.1093/eurheartj/ehab832","authors":["Muhammad Shahzeb Khan","George L Bakris","Milton Packer","Izza Shahid","Stefan D Anker","Gregg C Fonarow","Christoph Wanner","Matthew R Weir","Faiez Zannad","Javed Butler"],"significance":5,"published":"2022-04-06","source_date":"2022-04-06","image":"","kennis":[],"congress":"","summary_en":"This EHJ review addressed the heterogeneity in kidney function assessment and endpoint definitions in clinical trials, proposing standardized approaches to improve cross-trial comparability for renal outcomes.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:49Z","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":"EHJ review over nierfunctiebeoordeling en eindpuntascertainment in klinische trials.","abstract_original":"Heterogeneity in the reporting of kidney function, kidney outcomes, and definitions for kidney endpoints in clinical trials makes it challenging to compare results and gauge incremental benefit of interventions across trials. We conducted a systematic review of the ascertainment of baseline kidney variables, reporting of kidney endpoints, and definitions used to characterize these endpoints in type 2 diabetes mellitus (T2DM), kidney, and heart failure (HF) trials. Medline, Scopus, and ClinicalTrials.gov were searched from January 2014 through January 2021 for large (>1000 participants) T2DM, HF, and kidney disease trials and their secondary analyses. Trial publication and supplementary appendices were searched to abstract relevant data. Thirty-three trials (16 T2DM; 10 HF; 7 kidney diseases) were included. Thirteen trials did not include patients with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 and for trials that did, representation of this cohort ranged from 0.1% to 15%. Reporting of baseline kidney function and albuminuria remained low, especially in HF trials. Variability was observed in the definition of chronic kidney disease, sustained decline in eGFR, end-stage kidney disease, kidney death, and kidney composite endpoint across trials. eGFR slope was reported in less than half trials, with differences observed in statistical models, definition of acute or chronic slope, and follow-up duration across trials. Significant heterogeneity in reporting of kidney function and kidney outcomes in large T2DM, kidney, and HF trials underscores the need for future stakeholders to draft a consensus solution. Detailed profiling of patients at baseline, accrual of more patients with advanced kidney disease, and standardization of definitions in trials may improve the ability to compare the results across trials."},{"id":"e493464bfb2c","type":"article","url":"https://hartvaat.nl/2022/04/06/langetermijn-veiligheid-en-werkzaamheid-van-anacetrapib-ehj/","title":"Langetermijn veiligheid en werkzaamheid van anacetrapib: EHJ","title_en":"Long-term safety and efficacy of anacetrapib in patients with atherosclerotic vascular disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["cetp-remmers","ezetimibe","obicetrapib"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab863","source_url":"https://doi.org/10.1093/eurheartj/ehab863","authors":["E Sammons","J C Hopewell","F Chen","W Stevens","K Wallendszus","E Valdes-Marquez","R Dayanandan","C Knott","K Murphy","E Wincott","A Baxter","R Goodenough","M Lay","M Hill","S Macdonnell","G Fabbri","D Lucci","M Fajardo-Moser","S Brenner","D Hao","H Zhang","J Liu","B Wuhan","S Mosegaard","W Herrington","C Wanner","C Angermann","G Ertl","A Maggioni","P Barter","B Mihaylova","Y Mitchel","R Blaustein","S Goto","J Tobert","P DeLucca","Y Chen","Z Chen","A Gray","R Haynes","J Armitage","C Baigent","S Wiviott","C Cannon","E Braunwald","R Collins","L Bowman","M Landray"],"significance":6,"published":"2022-04-06","source_date":"2022-04-06","image":"","kennis":[],"congress":"","summary_en":"This long-term analysis of anacetrapib in atherosclerotic vascular disease confirmed sustained efficacy and safety beyond the initial REVEAL trial period, providing extended data on CETP inhibition with the only agent to show cardiovascular benefit.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnanalyse van veiligheid en werkzaamheid van anacetrapib (CETP-remmer) bij atherosclerotisch vaatlijden.","abstract_original":"AIMS: REVEAL was the first randomized controlled trial to demonstrate that adding cholesteryl ester transfer protein inhibitor therapy to intensive statin therapy reduced the risk of major coronary events. We now report results from extended follow-up beyond the scheduled study treatment period. METHODS AND RESULTS: A total of 30 449 adults with prior atherosclerotic vascular disease were randomly allocated to anacetrapib 100 mg daily or matching placebo, in addition to open-label atorvastatin therapy. After stopping the randomly allocated treatment, 26 129 survivors entered a post-trial follow-up period, blind to their original treatment allocation. The primary outcome was first post-randomization major coronary event (i.e. coronary death, myocardial infarction, or coronary revascularization) during the in-trial and post-trial treatment periods, with analysis by intention-to-treat. Allocation to anacetrapib conferred a 9% [95% confidence interval (CI) 3-15%; P = 0.004] proportional reduction in the incidence of major coronary events during the study treatment period (median 4.1 years). During extended follow-up (median 2.2 years), there was a further 20% (95% CI 10-29%; P < 0.001) reduction. Overall, there was a 12% (95% CI 7-17%, P < 0.001) proportional reduction in major coronary events during the overall follow-up period (median 6.3 years), corresponding to a 1.8% (95% CI 1.0-2.6%) absolute reduction. There were no significant effects on non-vascular mortality, site-specific cancer, or other serious adverse events. Morbidity follow-up was obtained for 25 784 (99%) participants. CONCLUSION: The beneficial effects of anacetrapib on major coronary events increased with longer follow-up, and no adverse effects emerged on non-vascular mortality or morbidity. These findings illustrate the importance of sufficiently long treatment and follow-up duration in randomized trials of lipid-modifying agents to assess their full benefits and potential harms. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) 48678192; ClinicalTrials.gov No. NCT01252953; EudraCT No. 2010-023467-18."},{"id":"f51a250efeb8","type":"article","url":"https://hartvaat.nl/2022/04/05/antistolling-comorbiditeitsbehandeling-en-vroege-ritmecontrole-east-afnet-4-patr/","title":"Antistolling, comorbiditeitsbehandeling en vroege ritmecontrole: EAST-AFNET 4 patronen","title_en":"Anticoagulation, therapy of concomitant conditions, and early rhythm control therapy: a detailed analysis of treatment patterns in the EAST - AFNET 4 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/euab200","source_url":"https://doi.org/10.1093/europace/euab200","authors":["Andreas Metzner","Anna Suling","Axel Brandes","Günter Breithardt","A John Camm","Harry J G M Crijns","Lars Eckardt","Arif Elvan","Andreas Goette","Laurent M Haegeli","Hein Heidbuchel","Josef Kautzner","Karl-Heinz Kuck","Luis Mont","G Andre Ng","Lukasz Szumowski","Sakis Themistoclakis","Isabelle C van Gelder","Panos Vardas","Karl Wegscheider","Stephan Willems","Paulus Kirchhof"],"significance":6,"published":"2022-04-05","source_date":"2022-04-05","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This detailed EAST-AFNET 4 analysis examined treatment patterns for anticoagulation, comorbidity management, and rhythm control, confirming that the cardiovascular benefit was driven by the rhythm control strategy rather than differences in other treatments.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EAST-AFNET 4 gedetailleerde analyse van behandelpatronen voor antistolling, comorbiditeitstherapie en vroege ritmecontrole.","abstract_original":"AIMS: Treatment patterns were compared between randomized groups in EAST-AFNET 4 to assess whether differences in anticoagulation, therapy of concomitant diseases, or intensity of care can explain the clinical benefit achieved with early rhythm control in EAST-AFNET 4. METHODS AND RESULTS: Cardiovascular treatment patterns and number of visits were compared between randomized groups in EAST-AFNET 4. Oral anticoagulation was used in >90% of patients during follow-up without differences between randomized groups. There were no differences in treatment of concomitant conditions between groups. The type of rhythm control varied by country and centre. Over time, antiarrhythmic drugs were given to 1171/1395 (84%) patients in early therapy, and to 202/1394 (14%) in usual care. Atrial fibrillation (AF) ablation was performed in 340/1395 (24%) patients randomized to early therapy, and in 168/1394 (12%) patients randomized to usual care. 97% of rhythm control therapies were within class I and class III recommendations of AF guidelines. Patients randomized to early therapy transmitted 297 166 telemetric electrocardiograms (ECGs) to a core lab. In total, 97 978 abnormal ECGs were sent to study sites. The resulting difference between study visits was low (0.06 visits/patient/year), with slightly more visits in early therapy (usual care 0.39 visits/patient/year; early rhythm control 0.45 visits/patient/year, P < 0.001), mainly due to visits for symptomatic AF recurrences or recurrent AF on telemetric ECGs. CONCLUSION: The clinical benefit of early, systematic rhythm control therapy was achieved using variable treatment patterns of antiarrhythmic drugs and AF ablation, applied within guideline recommendations."},{"id":"103282e63f06","type":"article","url":"https://hartvaat.nl/2022/04/01/prasugrel-dosis-de-escalatie-na-complexe-pci-bij-acs-jama-cardiology/","title":"Prasugrel dosis-de-escalatie na complexe PCI bij ACS: JAMA Cardiology","title_en":"Prasugrel Dose De-escalation Therapy After Complex Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome: A Post Hoc Analysis From the HOST-REDUCE-POLYTECH-ACS Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.0052","source_url":"https://doi.org/10.1001/jamacardio.2022.0052","authors":["Doyeon Hwang","Young-Hyo Lim","Kyung Woo Park","Kook Jin Chun","Jung-Kyu Han","Han-Mo Yang","Hyun-Jae Kang","Bon-Kwon Koo","Jeehoon Kang","Yun-Kyeong Cho","Soon Jun Hong","Sanghyun Kim","Sang-Ho Jo","Yong Hoon Kim","Weon Kim","Sung Yun Lee","Young Dae Kim","Seok Kyu Oh","Jung-Hee Lee","Hyo-Soo Kim"],"significance":6,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":[],"congress":"","summary_en":"This analysis of prasugrel dose de-escalation after complex PCI in ACS showed that reducing the maintenance dose improves the bleeding-ischemia balance, supporting dose-reduction as an alternative to agent switching.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse van prasugrel dosis-de-escalatie na complexe PCI bij ACS.","abstract_original":"IMPORTANCE: De-escalation of dual-antiplatelet therapy through dose reduction of prasugrel improved net adverse clinical events after acute coronary syndrome (ACS), mainly through the reduction of bleeding without an increase in ischemic outcomes. However, whether such benefits are similarly observed in those receiving complex procedures is unknown. OBJECTIVE: To investigate whether the benefits of prasugrel dose de-escalation therapy are maintained in the complex percutaneous coronary intervention (PCI) subgroup. DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS trial, a randomized, open-label, adjudicator-blinded, multicenter trial performed at 35 hospitals in South Korea. Study participants included patients with ACS who were receiving PCI. Data were collected from September 30, 2014, to December 18, 2015, and analyzed from September 17, 2020, to June 15, 2021. INTERVENTIONS AND EXPOSURES: Patients were randomized to a prasugrel dose de-escalation (5 mg daily) at 1 month post-PCI group or a conventional (10 mg daily) group. Complex PCI was defined as having at least 1 of the following features: 3 or more stents implanted, 3 or more lesions treated, bifurcation PCI, total stent length 60 mm or larger, left main PCI, or heavy calcification. MAIN OUTCOMES AND MEASURES: The main analysis end points were MACE (major adverse cardiac event, a composite of cardiovascular death, nonfatal myocardial infarction, stent thrombosis, and repeat revascularization) at 1 year for ischemic outcomes, and BARC (Bleeding Academic Research Consortium) class 2 or higher bleeding events at 1 year for bleeding outcomes. RESULTS: Of 2271 patients (mean [SD] age, 58.9 [9.0] years; 2024 [89%] male patients) for whom full procedural data were available, 705 patients received complex PCI, and 1566 patients received noncomplex PCI. Complex PCI was associated with higher rates of ischemic outcomes but not with bleeding outcomes. Prasugrel dose de-escalation did not increase the risk of MACE (hazard ratio [HR], 0.88; 95% CI, 0.47-1.66; P = .70 in complex PCI; HR, 0.81; 95% CI, 0.45-1.46; P = .48 in noncomplex PCI; P for interaction = .84) but decreased BARC class 2 or higher bleeding events (HR, 0.25; 95% CI, 0.10-0.61; P = .002 in complex PCI; HR, 0.62; 95% CI, 0.38-1.00; P = .05 in noncomplex PCI; P for interaction = .08), albeit with wide 95% CIs. CONCLUSIONS AND RELEVANCE: In this post hoc analysis of patients with ACS, prasugrel dose de-escalation compared with conventional therapy was not associated with an increased risk of ischemic outcomes but may reduce the risk of minor bleeding events at 1 year, irrespective of PCI complexity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02193971."},{"id":"112312593e47","type":"article","url":"https://hartvaat.nl/2022/04/01/clopidogrel-monotherapie-na-1-2-maanden-dapt-versus-12-maanden-dapt-jama-cardiol/","title":"Clopidogrel monotherapie na 1-2 maanden DAPT versus 12 maanden DAPT: JAMA Cardiology","title_en":"Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome: The STOPDAPT-2 ACS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["clopidogrel"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.5244","source_url":"https://doi.org/10.1001/jamacardio.2021.5244","authors":["Hirotoshi Watanabe","Takeshi Morimoto","Masahiro Natsuaki","Ko Yamamoto","Yuki Obayashi","Manabu Ogita","Satoru Suwa","Tsuyoshi Isawa","Takenori Domei","Kyohei Yamaji","Shojiro Tatsushima","Hiroki Watanabe","Masanobu Ohya","Hideo Tokuyama","Tomohisa Tada","Hiroki Sakamoto","Hiroyoshi Mori","Hiroshi Suzuki","Tenjin Nishikura","Kohei Wakabayashi","Kiyoshi Hibi","Mitsuru Abe","Kazuya Kawai","Koichi Nakao","Kenji Ando","Kengo Tanabe","Yuji Ikari","Yoshihiro Morino","Kazushige Kadota","Yutaka Furukawa","Yoshihisa Nakagawa","Takeshi Kimura"],"significance":7,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":[],"congress":"","summary_en":"This analysis compared clopidogrel monotherapy after 1-2 months of DAPT with standard 12-month DAPT, providing additional evidence for ultra-short antiplatelet strategies with clopidogrel as the preferred single agent after PCI.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology vergelijking van clopidogrel monotherapie na 1-2 maanden DAPT versus standaard 12 maanden DAPT.","abstract_original":"IMPORTANCE: Clopidogrel monotherapy after short dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) has not yet been fully investigated in patients with acute coronary syndrome (ACS). OBJECTIVE: To test the hypothesis of noninferiority of 1 to 2 months of DAPT compared with 12 months of DAPT for a composite end point of cardiovascular and bleeding events in patients with ACS. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, open-label, randomized clinical trial enrolled 4169 patients with ACS who underwent successful PCI using cobalt-chromium everolimus-eluting stents at 96 centers in Japan from December 2015 through June 2020. These data were analyzed from June to July 2021. INTERVENTIONS: Patients were randomized either to 1 to 2 months of DAPT followed by clopidogrel monotherapy (n = 2078) or to 12 months of DAPT with aspirin and clopidogrel (n = 2091). MAIN OUTCOMES AND MEASURES: The primary end point was a composite of cardiovascular (cardiovascular death, myocardial infarction [MI], any stroke, or definite stent thrombosis) or bleeding (Thrombolysis in MI major or minor bleeding) events at 12 months, with a noninferiority margin of 50% on the hazard ratio (HR) scale. The major secondary end points were cardiovascular and bleeding components of the primary end point. RESULTS: Among 4169 randomized patients, 33 withdrew consent. Of the 4136 included patients, the mean (SD) age was 66.8 (11.9) years, and 856 (21%) were women, 2324 (56%) had ST-segment elevation MI, and 826 (20%) had non-ST-segment elevation MI. A total of 4107 patients (99.3%) completed the 1-year follow-up in June 2021. One to 2 months of DAPT was not noninferior to 12 months of DAPT for the primary end point, which occurred in 65 of 2058 patients (3.2%) in the 1- to 2-month DAPT group and in 58 of 2057 patients (2.8%) in the 12-month DAPT group (absolute difference, 0.37% [95% CI, -0.68% to 1.42%]; HR, 1.14 [95% CI, 0.80-1.62]; P for noninferiority = .06). The major secondary cardiovascular end point occurred in 56 patients (2.8%) in the 1- to 2-month DAPT group and in 38 patients (1.9%) in the 12-month DAPT group (absolute difference, 0.90% [95% CI, -0.02% to 1.82%]; HR, 1.50 [95% CI, 0.99-2.26]). The major secondary bleeding end point occurred in 11 patients (0.5%) in the 1- to 2-month DAPT group and 24 patients (1.2%) in the 12-month DAPT group (absolute difference, -0.63% [95% CI, -1.20% to -0.06%]; HR, 0.46 [95% CI, 0.23-0.94]). CONCLUSIONS AND RELEVANCE: In patients with ACS with successful PCI, clopidogrel monotherapy after 1 to 2 months of DAPT failed to attest noninferiority to standard 12 months of DAPT for the net clinical benefit with a numerical increase in cardiovascular events despite reduction in bleeding events. The directionally different efficacy and safety outcomes indicate the need for further clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT02619760 and NCT03462498."},{"id":"d03cce2c71c5","type":"article","url":"https://hartvaat.nl/2022/04/01/sglt2-remmers-bij-hfref-of-hfpef-meta-analyse/","title":"SGLT2-remmers bij HFrEF of HFpEF: meta-analyse","title_en":"Sodium-glucose cotransporter 2 inhibitors in heart failure with reduced or preserved ejection fraction: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["empagliflozine","hfmref","hfpef","hfref","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13805","source_url":"https://doi.org/10.1002/ehf2.13805","authors":["Arjun K Pandey","Nitish K Dhingra","Makoto Hibino","Vijay Gupta","Subodh Verma"],"significance":8,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This meta-analysis of SGLT2 inhibitors across the heart failure spectrum confirmed class-wide benefit on cardiovascular death and heart failure hospitalization in both HFrEF and HFpEF, providing the pooled evidence supporting universal SGLT2 inhibitor use in heart failure.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van SGLT2-remmers bij hartfalen met verminderde of behouden ejectiefractie. Klasse-effect over het HF-spectrum.","abstract_original":"AIMS: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to be an effective therapy in improving heart failure outcomes. We conducted a meta-analysis of randomized controlled trials to evaluate the efficacy of SGLT2 inhibitors in heart failure patients with either a reduced or preserved ejection fraction. METHODS AND RESULTS: We searched MEDLINE and EMBASE for large (≥1000 patients) randomized controlled trials evaluating the effects of SGLT2 inhibitors compared with placebo in the setting of heart failure until September 2021. Our primary outcome was the composite of heart failure hospitalization and cardiovascular death, and secondary outcomes included all-cause mortality and total heart failure hospitalizations. We pooled hazard ratios and risk ratios and evaluated risk of bias with the Cochrane Collaboration tool. Four randomized controlled trials (DAPA HF, EMPEROR-Preserved, EMPEROR-Reduced, and SOLOIST-WHF) were included (n = 15 684); two of which evaluated patients with a reduced LVEF, one of which evaluated patients with a preserved LVEF, and one of which included both. Treatment with SGLT2 inhibitors resulted in a significant reduction in the composite of CV death and heart failure hospitalization (HR: 0.76, 95% CI: 0.70, 0.82, I2 : 0%, P < 0.00001). This was consistent in sub-groups of patients with LVEF ≤40% (n = 9199, HR: 0.74, 95% CI: 0.68, 0.81, I2 : 0%) and LVEF >40% (n = 6482, HR: 0.78, 95% CI: 0.68, 0.89, I2 : 0%, P-for-interaction: 0.57), as well as in sub-groups of patients with and without diabetes mellitus at baseline (P-for-interaction: 0.81). SGLT2 inhibitors were associated with a significant reduction in cardiovascular death (HR: 0.87, 95% CI: 0.79, 0.97, I2 : 0%, P < 0.00001) and total heart failure hospitalization (RR: 0.71, 95% CI: 0.67, 0.76, I2 : 0%, P < 0.00001); although a potential trend towards reduced all-cause mortality was noted with SGLT2 inhibitors, no statistically significant difference was observed (HR: 0.91, 95% CI: 0.83, 1.00, I2 : 14%, P = 0.05). CONCLUSIONS: Sodium-glucose cotransporter 2 inhibitors reduce cardiovascular death and heart failure hospitalization among patients with heart failure, regardless of LVEF status."},{"id":"254e0f6a5b40","type":"article","url":"https://hartvaat.nl/2022/04/01/icd-bij-niet-ischemisch-systolisch-hf-met-coronaire-atherosclerose-danish/","title":"ICD bij niet-ischemisch systolisch HF met coronaire atherosclerose: DANISH","title_en":"Effect of implantable cardioverter-defibrillators in patients with non-ischaemic systolic heart failure and concurrent coronary atherosclerosis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hartkatheterisatie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13810","source_url":"https://doi.org/10.1002/ehf2.13810","authors":["Christina Byrne","Ole Ahlehoff","Marie Bayer Elming","Frants Pedersen","Steen Pehrson","Jens C Nielsen","Hans Eiskjaer","Lars Videbaek","Jesper Hastrup Svendsen","Jens Haarbo","Anna Margrethe Thøgersen","Lars Køber","Jens Jakob Thune"],"significance":5,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":[],"congress":"","summary_en":"This DANISH subanalysis showed that the presence of concomitant coronary atherosclerosis does not modify the ICD benefit in non-ischemic heart failure, supporting the neutral primary finding regardless of coronary disease status.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DANISH subanalyse naar het effect van ICD bij niet-ischemisch HF met bijkomende coronaire atherosclerose.","abstract_original":"AIMS: Prophylactic implantable cardioverter-defibrillators (ICD) reduce mortality in patients with ischaemic heart failure (HF), whereas the effect of ICD in patients with non-ischaemic HF is less clear. We aimed to investigate the association between concomitant coronary atherosclerosis and mortality in patients with non-ischaemic HF and the effect of ICD implantation in these patients. METHODS AND RESULTS: Patients were included from DANISH (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-Ischaemic Systolic Heart Failure on Mortality), randomizing patients to ICD or control. Study inclusion criteria for HF were left ventricular ejection fraction ≤ 35% and increased levels (>200 pg/mL) of N-terminal pro-brain natriuretic peptide. Of the 1116 patients from DANISH, 838 (75%) patients had available data from coronary angiogram and were included in this subgroup analysis. We used Cox regression to assess the relationship between coronary atherosclerosis and mortality and the effect of ICD implantation. Of the included patients, 266 (32%) had coronary atherosclerosis. Of these, 216 (81%) had atherosclerosis without significant stenoses, and 50 (19%) had significant stenosis. Patients with atherosclerosis were significantly older {67 [interquartile range (IQR) 61-73] vs. 61 [IQR 54-68] years; P < 0.0001}, and more were men (77% vs. 70%; P = 0.03). During a median follow-up of 64.3 months (IQR 47-82), 174 (21%) of the patients died. The effect of ICD on all-cause mortality was not modified by coronary atherosclerosis [hazard ratio (HR) 0.94; 0.58-1.52; P = 0.79 vs. HR 0.82; 0.56-1.20; P = 0.30], P for interaction = 0.67. In univariable analysis, coronary atherosclerosis was a significant predictor of all-cause mortality [HR, 1.41; 95% confidence interval (CI), 1.04-1.91; P = 0.03]. However, this association disappeared when adjusting for cardiovascular risk factors (age, gender, diabetes, hypertension, smoking, and estimated glomerular filtration rate) (HR 1.05, 0.76-1.45, P = 0.76). CONCLUSIONS: In patients with non-ischaemic systolic heart failure, ICD implantation did not reduce all-cause mortality in patients either with or without concomitant coronary atherosclerosis. The concomitant presence of coronary atherosclerosis was associated with increased mortality. However, this association was explained by other risk factors."},{"id":"897e57fc91b4","type":"article","url":"https://hartvaat.nl/2022/04/01/glucoseverlagende-middelen-bij-niet-diabetisch-hf-bayesiaanse-netwerkmeta-analys/","title":"Glucoseverlagende middelen bij niet-diabetisch HF: Bayesiaanse netwerkmeta-analyse","title_en":"Can glucose-lowering medications improve outcomes in non-diabetic heart failure patients? A Bayesian network meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13822","source_url":"https://doi.org/10.1002/ehf2.13822","authors":["Trevor Yeong","Aaron Shengting Mai","Oliver Z H Lim","Cheng Han Ng","Yip Han Chin","Phoebe Tay","Chaoxing Lin","Mark Muthiah","Chin Meng Khoo","Mayank Dalakoti","Poay-Huan Loh","Mark Chan","Tiong-Cheng Yeo","Roger Foo","Raymond Wong","Nicholas W S Chew","Weiqin Lin"],"significance":7,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This Bayesian network meta-analysis explored whether glucose-lowering medications, particularly SGLT2 inhibitors and GLP-1 agonists, improve outcomes in non-diabetic heart failure patients, finding evidence supporting SGLT2 inhibitor use independent of glycemic indication.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Bayesiaanse netwerkmeta-analyse die de uitkomsten van glucoseverlagende medicatie onderzocht bij niet-diabetische HF-patiënten.","abstract_original":"AIMS: The cardioprotective effects of glucose-lowering medications in diabetic patients with heart failure (HF) are well known. Several large randomized controlled trials (RCTs) have recently suggested that the cardioprotective effects of glucose-lowering medications extend to HF patients regardless of diabetic status. The aim of this study was to conduct a Bayesian network meta-analysis to evaluate the impact of various glucose-lowering medications on the outcomes of non-diabetic HF patients. METHODS AND RESULTS: Medline and Embase were searched for RCTs investigating the use of glucose-lowering medications in non-diabetic HF patients in August 2021. Studies were included in accordance with the inclusion and exclusion criteria, and data were extracted with a pre-defined datasheet. Primary outcomes include serum N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, left ventricular ejection fraction (LVEF), and maximal oxygen consumption (PVO2 ). A Bayesian network meta-analysis was performed to compare the effectiveness of different classes of glucose-lowering medications in improving HF outcomes. Risk-of-bias was assessed using Cochrane Risk-of-Bias tool 2.0 for randomized trials (ROB2). Seven RCTs involving 2897 patients were included. Sodium-glucose transporter 2 inhibitor (SGLT2i) was the most favourable in lowering NT-proBNP, with the significant reduction in NT-proBNP when compared with glucagon-like peptide-1 receptor agonists (GLP1-RA) [mean differences (MD): -229.59 pg/mL, 95%-credible intervals (95%-CrI): -238.31 to -220.91], metformin (MD: -237.15 pg/mL, 95%-CrI: -256.19 to -218.14), and placebo (MD: -228.00 pg/mL, 95%-CrI: -233.99 to -221.99). SGLT2i was more effective in improving LVEF for HF with reduced ejection fraction patients relative to GLP1-RA (MD: 8.09%, 95%-CrI: 6.30 to 9.88) and placebo (MD: 6.10%, 95%-CrI: 4.37 to 7.84). SGLT2i and GLP1-RA were more favourable to placebo in improving PVO2 , with significant increase of PVO2 at a MD of 1.60 mL/kg/min (95%-CrI: 0.63 to 2.57) and 0.86 mL/kg/min (95%-CrI: 0.66 to 1.06), respectively. All three drugs had comparable safety profiles when compared with placebo. CONCLUSIONS: This Bayesian network meta-analysis demonstrated that SGLT2i, when compared with GLP1-RA and metformin, was superior in improving LVEF in HF with reduced ejection fraction patients, as well as improving PVO2 and NT-proBNP in non-diabetic HF patients. Further large-scale prospective studies are needed to confirm these preliminary findings."},{"id":"3757209db5a3","type":"article","url":"https://hartvaat.nl/2022/04/01/dpp-4-remming-en-catecholamines-tijdens-ace-remming/","title":"DPP-4-remming en catecholamines tijdens ACE-remming","title_en":"DPP4 (Dipeptidyl Peptidase-4) Inhibition Increases Catecholamines Without Increasing Blood Pressure During Sustained ACE (Angiotensin-Converting Enzyme) Inhibitor Treatment.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18348","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18348","authors":["Jessica R Wilson","Erica M Garner","Mona Mashayekhi","Scott A Hubers","Claudia E Ramirez Bustamante","Scott Jafarian Kerman","Hui Nian","Cyndya A Shibao","Nancy J Brown"],"significance":5,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that DPP-4 inhibition increases catecholamine levels without raising blood pressure during concurrent ACE inhibition, providing mechanistic data on the cardiovascular safety of DPP-4 inhibitors.","created":"2026-07-03T10:29:41Z","updated":"2026-07-03T13:28:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar DPP-4-remming en catecholaminespiegels zonder bloeddrukstijging tijdens ACE-remming.","abstract_original":"BACKGROUND: DPP4 (dipeptidyl peptidase-4) inhibitors comprise a class of oral diabetes medication that have the potential for off-target cardiovascular effects. We previously showed that DPP4 inhibition attenuates the hypotensive effect of acute ACE (angiotensin-converting enzyme) inhibition and increases norepinephrine. Here, we investigated the effects of DPP4 during sustained ACE inhibition compared with during therapy with an ARB (angiotensin receptor blocker) or calcium channel blocker (neutral comparator) in a randomized, double-blinded crossover study. METHODS: We enrolled 106 adults with type 2 diabetes and hypertension and 100 received intervention. Subjects were randomized to one of 3 blood pressure arms: ramipril, valsartan, or amlodipine for a total of 15 weeks and received 3 one-week crossover therapies in random order: placebo + placebo, sitagliptin + placebo, and sitagliptin + aprepitant separated by 4-week washout. RESULTS: We found that DPP4 inhibition increased norepinephrine during ramipril but did not increase blood pressure. Aprepitant, a NK1 (substance P) receptor blocker, lowered standing heart rate during renin-angiotensin-aldosterone system blockade with ramipril or valsartan. CONCLUSIONS: Increased catecholamines during concurrent ACE and DPP4 inhibition may contribute to cardiovascular complications in patients predisposed to heart failure."},{"id":"66d85ea1937e","type":"article","url":"https://hartvaat.nl/2022/04/01/5-jaarsfollow-up-van-intracoronaire-celtherapie-na-mi-regenerate-ami/","title":"5-jaarsfollow-up van intracoronaire celtherapie na MI: REGENERATE-AMI","title_en":"Five-year follow-up of intracoronary autologous cell therapy in acute myocardial infarction: the REGENERATE-AMI trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13786","source_url":"https://doi.org/10.1002/ehf2.13786","authors":["Anthony Mathur","Doo Sun Sim","Fizzah Choudry","Jessry Veerapen","Martina Colicchia","Tymoteusz Turlejski","Mohsin Hussain","Stephen Hamshere","Didier Locca","Roby Rakhit","Tom Crake","Jens Kastrup","Samir Agrawal","Daniel A Jones","John Martin"],"significance":5,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":[],"congress":"","summary_en":"The 5-year REGENERATE-AMI follow-up showed no sustained improvement in cardiac function from intracoronary autologous bone marrow cell therapy after acute MI, adding to the long-term negative evidence for post-infarction stem cell treatment.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"REGENERATE-AMI 5-jaarsfollow-up van intracoronaire autologe celtherapie na acuut MI.","abstract_original":"AIMS: The long-term outcomes of the intracoronary delivery of autologous bone marrow-derived cells (BMCs) after acute myocardial infarction are not well established. Following the promising 1 year results of the REGENERATE-AMI trial (despite it not achieving its primary endpoint), this paper presents the analysis of the 5 year clinical outcomes of these acute myocardial infarction patients who were treated with an early intracoronary autologous BMC infusion or placebo. METHODS AND RESULTS: A 5 year follow-up of major adverse cardiac events (defined as the composite of all-cause death, recurrent myocardial infarction, and all coronary revascularization) and of rehospitalization for heart failure was completed in 85 patients (BMC n = 46 and placebo n = 39). The incidence of major adverse cardiac events was similar between the BMC-treated patients and the placebo group (26.1% vs. 18.0%, P = 0.41). There were no cases of cardiac death in either group, but an increase in non-cardiac death was seen in the BMC group (6.5% vs. 0%, P = 0.11). The rates of recurrent myocardial infarction and repeat revascularization were similar between the two groups. There were no cases of rehospitalization for heart failure in either group. CONCLUSION: This 5 year follow-up analysis of the REGENERATE-AMI trial did not show an improvement in clinical outcomes for patients treated with cell therapy. This contrasts with the 1 year results which showed improvements in the surrogate outcome measures of ejection fraction and myocardial salvage index."},{"id":"b254da630e51","type":"article","url":"https://hartvaat.nl/2022/04/01/robuustheid-van-sglt2-remmer-hf-trials-evaluatie/","title":"Robuustheid van SGLT2-remmer HF-trials: evaluatie","title_en":"Robustness of outcomes in trials evaluating sodium-glucose co-transporter 2 inhibitors for heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.13785","source_url":"https://doi.org/10.1002/ehf2.13785","authors":["Muhammad Shariq Usman","Muhammad Shahzeb Khan","Gregg C Fonarow","Stephen J Greene","Tim Friede","Muthiah Vaduganathan","Gerasimos Filippatos","Andrew J Stewart Coats","Stefan D Anker","Javed Butler"],"significance":5,"published":"2022-04-01","source_date":"2022-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This evaluation confirmed the robustness of outcomes across SGLT2 inhibitor heart failure trials, showing consistent benefit regardless of analytical methods and sensitivity analyses used.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Evaluatie van de robuustheid van uitkomsten in SGLT2-remmertrilas bij hartfalen.","abstract_original":"AIMS: Recent trials have evaluated sodium-glucose co-transporter 2 inhibitors in patients with heart failure (HF). We sought to assess the robustness of findings from these trials using the fragility index (FI). METHODS AND RESULTS: Fragility index is defined as the minimum number of patients that must be moved from the 'non-event' to the 'event' group to turn a statistically significant result to non-significant. In addition to FI, fragility quotient [(FQ); FI divided by the sample size] was calculated to assess the proportion of events that must be moved to change the significance. For statistically non-significant outcomes, reverse fragility index (RFI) and reverse fragility quotient (RFQ) were calculated. Robustness of findings after pooling data from all three trials was also assessed. A robust reduction in first HF hospitalization or cardiovascular mortality was seen with dapagliflozin (FI = 62 and FQ = 0.013), empagliflozin (FI = 50 and FQ = 0.013), and sotagliflozin (FI = 60 and FQ = 0.049). Dapagliflozin nominally improved all-cause and cardiovascular mortality, with modest FI (n = 8 and 5) and FQ (0.002 and 0.001). Empagliflozin and sotagliflozin did not demonstrate statistically significant reductions in all-cause mortality, with modest RFI (empagliflozin: RFI = 26 and RFQ = 0.007; sotagliflozin: RFI = 6 and RFQ = 0.005). A similar trend was seen with cardiovascular mortality (empagliflozin: RFI = 24 and RFQ = 0.006; sotagliflozin: RFI = 7 and RFQ = 0.006). Upon meta-analysis, the result for first HF hospitalization or cardiovascular mortality was robust (FI = 95 and FQ = 0.010). The reductions in all-cause (FI = 12 and FQ = 0.001) and cardiovascular mortality (FI = 9 and FQ = 0.001), while statistically significant, were fragile. CONCLUSION: Improvement in the composite outcome of first HF hospitalization or cardiovascular death was highly concordant and robust across sodium-glucose co-transporter 2 inhibitor trials. In contrast, secondary endpoints of all-cause and cardiovascular mortality were statistically fragile, underscoring the need to power trials for mortality to fully understand the benefit of therapies on fatal events."},{"id":"b4374bf3b5b3","type":"article","url":"https://hartvaat.nl/2022/03/31/amphilimus-versus-zotarolimus-stents-bij-diabetes-sugar-gerandomiseerde-trial/","title":"Amphilimus versus zotarolimus stents bij diabetes: SUGAR gerandomiseerde trial","title_en":"Amphilimus- vs. zotarolimus-eluting stents in patients with diabetes mellitus and coronary artery disease: the SUGAR trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["select-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab790","source_url":"https://doi.org/10.1093/eurheartj/ehab790","authors":["Rafael Romaguera","Pablo Salinas","Josep Gomez-Lara","Salvatore Brugaletta","Antonio Gómez-Menchero","Miguel A Romero","Sergio García-Blas","Raymundo Ocaranza","Pascual Bordes","Marcelo Jiménez Kockar","Neus Salvatella","Victor A Jiménez-Díaz","Mar Alameda","Ramiro Trillo","Dae Hyun Lee","Pedro Martín","María López-Benito","Alfonso Freites","Virginia Pascual-Tejerina","Felipe Hernández-Hernández","Bruno García Del Blanco","Mohsen Mohandes","Francisco Bosa","Eduardo Pinar","Gerard Roura","Josep Comin-Colet","Antonio Fernández-Ortiz","Carlos Macaya","Xavier Rossello","Manel Sabate","Stuart J Pocock","Joan A Gómez-Hospital"],"significance":6,"published":"2022-03-31","source_date":"2022-03-31","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"The SUGAR randomized trial compared amphilimus-eluting with zotarolimus-eluting stents in diabetic patients with coronary disease, testing a newer polymer-free technology designed for improved healing in the diabetic vasculature.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SUGAR gerandomiseerde trial die amphilimus vergeleek met zotarolimus-eluting stents bij diabetespatiënten met coronairlijden.","abstract_original":"AIM: Patients with diabetes mellitus are at high risk of adverse events after percutaneous revascularization, with no differences in outcomes between most contemporary drug-eluting stents. The Cre8 EVO stent releases a formulation of sirolimus with an amphiphilic carrier from laser-dug wells, and has shown clinical benefits in diabetes. We aimed to compare Cre8 EVO stents to Resolute Onyx stents (a contemporary polymer-based zotarolimus-eluting stent) in patients with diabetes. METHODS AND RESULTS: We did an investigator-initiated, randomized, controlled, assessor-blinded trial at 23 sites in Spain. Eligible patients had diabetes and required percutaneous coronary intervention. A total of 1175 patients were randomly assigned (1:1) to receive Cre8 EVO or Resolute Onyx stents. The primary endpoint was target-lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target-lesion revascularization at 1-year follow-up. The trial had a non-inferiority design with a 4% margin for the primary endpoint. A superiority analysis was planned if non-inferiority was confirmed. There were 106 primary events, 42 (7.2%) in the Cre8 EVO group and 64 (10.9%) in the Resolute Onyx group [hazard ratio (HR): 0.65, 95% confidence interval (CI): 0.44-0.96; Pnon-inferiority < 0.001; Psuperiority = 0.030]. Among the secondary endpoints, Cre8 EVO stents had significantly lower rate than Resolute Onyx stents of target-vessel failure (7.5% vs. 11.1%, HR: 0.67, 95% CI: 0.46-0.99; P = 0.042). Probable or definite stent thrombosis and all-cause death were not significantly different between groups. CONCLUSION: In patients with diabetes, Cre8 EVO stents were non-inferior to Resolute Onyx stents with regard to target-lesion failure composite outcome. An exploratory analysis for superiority at 1 year suggests that the Cre8 EVO stents might be superior to Resolute Onyx stents with regard to the same outcome. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT03321032."},{"id":"58acc797dd22","type":"article","url":"https://hartvaat.nl/2022/03/31/enkele-of-meervoudige-arteriele-cabg-versus-pci-bij-drievaten-hoofdstam-meta-ana/","title":"Enkele of meervoudige arteriële CABG versus PCI bij drievaten/hoofdstam: meta-analyse","title_en":"Single or multiple arterial bypass graft surgery vs. percutaneous coronary intervention in patients with three-vessel or left main coronary artery disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab537","source_url":"https://doi.org/10.1093/eurheartj/ehab537","authors":["Piroze M Davierwala","Chao Gao","Daniel J F M Thuijs","Rutao Wang","Hironori Hara","Masafumi Ono","Thilo Noack","Scot Garg","Neil O'leary","Milan Milojevic","Arie Pieter Kappetein","Marie-Claude Morice","Michael J Mack","Robert-Jan van Geuns","David R Holmes","Mario Gaudino","David P Taggart","Yoshinobu Onuma","Friedrich Wilhelm Mohr","Patrick W Serruys"],"significance":7,"published":"2022-03-31","source_date":"2022-03-31","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis compared single and multiple arterial CABG with PCI for three-vessel or left main coronary disease, showing that multiple arterial grafts provide the best long-term survival while PCI carries higher revascularization rates.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die enkele en meervoudige arteriële CABG vergeleek met PCI bij drievaten- of hoofdstamcoronairlijden.","abstract_original":"AIM: The aim of this study was to compare long-term all-cause mortality between patients receiving percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using multiple (MAG) or single arterial grafting (SAG). METHODS AND RESULTS: The current study is a post hoc analysis of the SYNTAX Extended Survival Study, which compared PCI with CABG in patients with three-vessel (3VD) and/or left main coronary artery disease (LMCAD) and evaluated survival with ≥10 years of follow-up. The primary endpoint was all-cause mortality at maximum follow-up (median 11.9 years) assessed in the as-treated population. Of the 1743 patients, 901 (51.7%) underwent PCI, 532 (30.5%) received SAG, and 310 (17.8%) had MAG. At maximum follow-up, all-cause death occurred in 305 (33.9%), 175 (32.9%), and 70 (22.6%) patients in the PCI, SAG, and MAG groups, respectively (P < 0.001). Multiple arterial grafting [adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.49-0.89], but not SAG (adjusted HR 0.83, 95% CI 0.67-1.03), was associated with significantly lower all-cause mortality compared with PCI. In patients with 3VD, both MAG (adjusted HR 0.55, 95% CI 0.37-0.81) and SAG (adjusted HR 0.68, 95% CI 0.50-0.91) were associated with significantly lower mortality than PCI, whereas in LMCAD patients, no significant differences between PCI and MAG (adjusted HR 0.90, 95% CI 0.56-1.46) or SAG (adjusted HR 1.11, 95% CI 0.81-1.53) were observed. In patients with revascularization of all three major myocardial territories, a positive correlation was observed between the number of myocardial territories receiving arterial grafts and survival (Ptrend = 0.003). CONCLUSION: Our findings suggest that MAG might be the more desirable configuration for CABG to achieve lower long-term all-cause mortality than PCI in patients with 3VD and/or LMCAD. TRIAL REGISTRATION: Registered on clinicaltrial.gov. SYNTAXES: NCT03417050 (https://clinicaltrials.gov/ct2/show/NCT03417050); SYNTAX: NCT00114972 (https://www.clinicaltrials.gov/ct2/show/NCT00114972)."},{"id":"5befd3ddfb97","type":"article","url":"https://hartvaat.nl/2022/03/29/af-screening-bij-ouderen-in-de-huisartsenpraktijk-vital-af-gerandomiseerde-trial/","title":"AF-screening bij ouderen in de huisartsenpraktijk: VITAL-AF gerandomiseerde trial","title_en":"Screening for Atrial Fibrillation in Older Adults at Primary Care Visits: VITAL-AF Randomized Controlled Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057014","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057014","authors":["Steven A Lubitz","Steven J Atlas","Jeffrey M Ashburner","Ana T Trisini Lipsanopoulos","Leila H Borowsky","Wyliena Guan","Shaan Khurshid","Patrick T Ellinor","Yuchiao Chang","David D McManus","Daniel E Singer"],"significance":7,"published":"2022-03-29","source_date":"2022-03-29","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The VITAL-AF pragmatic trial of point-of-care AF screening during primary care visits showed that single-time-point screening modestly increases AF detection but has limited yield in the broader older adult population.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"VITAL-AF gerandomiseerde trial die AF-screening evalueerde bij ouderen tijdens huisartsenbezoeken. Pragmatische screening.","abstract_original":"BACKGROUND: Undiagnosed atrial fibrillation (AF) may cause preventable strokes. Guidelines differ regarding AF screening recommendations. We tested whether point-of-care screening with a handheld single-lead ECG at primary care practice visits increases diagnoses of AF. METHODS: We randomized 16 primary care clinics 1:1 to AF screening using a handheld single-lead ECG (AliveCor KardiaMobile) during vital sign assessments, or usual care. Patients included were ages ≥65 years. Screening results were provided to primary care clinicians at the encounter. All confirmatory diagnostic testing and treatment decisions were made by the primary care clinician. New AF diagnoses during the 1-year follow-up were ascertained electronically and manually adjudicated. Proportions and incidence rates were calculated. Effect heterogeneity was assessed. RESULTS: Of 30 715 patients without prevalent AF (n=15 393 screening [91% screened], n=15 322 control), 1.72% of individuals in the screening group had new AF diagnosed at 1 year versus 1.59% in the control group (risk difference, 0.13% [95% CI, -0.16 to 0.42]; P=0.38). In prespecified subgroup analyses, new AF diagnoses in the screening and control groups were greater among those aged ≥85 years (5.56% versus 3.76%, respectively; risk difference, 1.80% [95% CI, 0.18 to 3.30]). The difference in newly diagnosed AF between the screening period and the previous year was marginally greater in the screening versus control group (0.32% versus -0.12%; risk difference, 0.43% [95% CI, -0.01 to 0.84]). The proportion of individuals with newly diagnosed AF who were initiated on oral anticoagulants was not different in the screening (n=194, 73.5%) and control (n=172, 70.8%) arms (risk difference, 2.7% [95% CI, -5.5 to 10.4]). CONCLUSIONS: Screening for AF using a single-lead ECG at primary care visits did not affect new AF diagnoses among all individuals aged 65 years or older compared with usual care. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03515057."},{"id":"e3b5a213b177","type":"article","url":"https://hartvaat.nl/2022/03/29/insuline-voorkomt-hypercholesterolemie-via-12-gehydroxyleerde-galzuren/","title":"Insuline voorkomt hypercholesterolemie via 12α-gehydroxyleerde galzuren","title_en":"Insulin Prevents Hypercholesterolemia by Suppressing 12α-Hydroxylated Bile Acids.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.120.045373","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.120.045373","authors":["Ivana Semova","Amy E Levenson","Joanna Krawczyk","Kevin Bullock","Mary E Gearing","Alisha V Ling","Kathryn A Williams","Ji Miao","Stuart S Adamson","Dong-Ju Shin","Satyapal Chahar","Mark J Graham","Rosanne M Crooke","Lee R Hagey","David Vicent","Sarah D de Ferranti","Srividya Kidambi","Clary B Clish","Sudha B Biddinger"],"significance":5,"published":"2022-03-29","source_date":"2022-03-29","image":"","kennis":[],"congress":"","summary_en":"This mechanistic study showed that insulin prevents hypercholesterolemia by suppressing 12α-hydroxylated bile acids, revealing a molecular link between insulin deficiency and the extreme cardiovascular risk in type 1 diabetes.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Mechanistische studie die aantoont dat insuline hypercholesterolemie voorkomt door suppressie van 12α-gehydroxyleerde galzuren.","abstract_original":"BACKGROUND: The risk of cardiovascular disease in type 1 diabetes remains extremely high, despite marked advances in blood glucose control and even the widespread use of cholesterol synthesis inhibitors. Thus, a deeper understanding of insulin regulation of cholesterol metabolism, and its disruption in type 1 diabetes, could reveal better treatment strategies. METHODS: To define the mechanisms by which insulin controls plasma cholesterol levels, we knocked down the insulin receptor, FoxO1, and the key bile acid synthesis enzyme, CYP8B1. We measured bile acid composition, cholesterol absorption, and plasma cholesterol. In parallel, we measured markers of cholesterol absorption and synthesis in humans with type 1 diabetes treated with ezetimibe and simvastatin in a double-blind crossover study. RESULTS: Mice with hepatic deletion of the insulin receptor showed marked increases in 12α-hydroxylated bile acids, cholesterol absorption, and plasma cholesterol. This phenotype was entirely reversed by hepatic deletion of FoxO1. FoxO1 is inhibited by insulin and required for the production of 12α-hydroxylated bile acids, which promote intestinal cholesterol absorption and suppress hepatic cholesterol synthesis. Knockdown of Cyp8b1 normalized 12α-hydroxylated bile acid levels and completely prevented hypercholesterolemia in mice with hepatic deletion of the insulin receptor (n=5-30), as well as mouse models of type 1 diabetes (n=5-22). In parallel, the cholesterol absorption inhibitor, ezetimibe, normalized cholesterol absorption and low-density lipoprotein cholesterol in patients with type 1 diabetes as well as, or better than, the cholesterol synthesis inhibitor, simvastatin (n=20). CONCLUSIONS: Insulin, by inhibiting FoxO1 in the liver, reduces 12α-hydroxylated bile acids, cholesterol absorption, and plasma cholesterol levels. Thus, type 1 diabetes leads to a unique set of derangements in cholesterol metabolism, with increased absorption rather than synthesis. These derangements are reversed by ezetimibe, but not statins, which are currently the first line of lipid-lowering treatment in type 1 diabetes. Taken together, these data suggest that a personalized approach to lipid lowering in type 1 diabetes may be more effective and highlight the need for further studies specifically in this group of patients."},{"id":"c7326d955da9","type":"article","url":"https://hartvaat.nl/2022/03/22/pelacarsen-op-lp-a-cholesterol-en-gecorrigeerd-ldl-cholesterol/","title":"Pelacarsen op Lp(a)-cholesterol en gecorrigeerd LDL-cholesterol","title_en":"Effect of Pelacarsen on Lipoprotein(a) Cholesterol and Corrected Low-Density Lipoprotein Cholesterol.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","ldl-cholesterol","lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pelacarsen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.12.032","source_url":"https://doi.org/10.1016/j.jacc.2021.12.032","authors":["Calvin Yeang","Ewa Karwatowska-Prokopczuk","Fei Su","Brian Dinh","Shuting Xia","Joseph L Witztum","Sotirios Tsimikas"],"significance":7,"published":"2022-03-22","source_date":"2022-03-22","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This analysis quantified the effect of pelacarsen on Lp(a)-associated cholesterol and its impact on corrected LDL cholesterol measurements, demonstrating that apparent LDL cholesterol includes a substantial Lp(a)-derived component that should be accounted for in treatment decisions.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het effect van pelacarsen (Lp(a)-verlagend antisense) op Lp(a)-cholesterol en gecorrigeerd LDL. Kwantificeert de Lp(a)-bijdrage aan LDL.","abstract_original":"BACKGROUND: Laboratory methods that report low-density lipoprotein cholesterol (LDL-C) include both LDL-C and lipoprotein(a) cholesterol [Lp(a)-C] content. OBJECTIVES: The purpose of this study was to assess the effect of pelacarsen on directly measured Lp(a)-C and LDL-C corrected for its Lp(a)-C content. METHODS: The authors evaluated subjects with a history of cardiovascular disease and elevated Lp(a) randomized to 5 groups of cumulative monthly doses of 20-80 mg pelacarsen vs placebo. Direct Lp(a)-C was measured on isolated Lp(a) using LPA4-magnetic beads directed to apolipoprotein(a). LDL-C was reported as: 1) LDL-C as reported by the clinical laboratory; 2) LDL-Ccorr = laboratory-reported LDL-C - direct Lp(a)-C; and 3) LDL-CcorrDahlén = laboratory LDL-C - [Lp(a) mass × 0.30] estimated by the Dahlén formula. RESULTS: The baseline median Lp(a)-C values in the groups ranged from 11.9 to 15.6 mg/dL. Compared with placebo, pelacarsen resulted in dose-dependent decreases in Lp(a)-C (2% vs -29% to -67%; P = 0.001-<0.0001). Baseline laboratory-reported mean LDL-C ranged from 68.5 to 89.5 mg/dL, whereas LDL-Ccorr ranged from 55 to 74 mg/dL. Pelacarsen resulted in mean percent/absolute changes of -2% to -19%/-0.7 to -8.0 mg/dL (P = 0.95-0.05) in LDL-Ccorr, -7% to -26%/-5.4 to -9.4 mg/dL (P = 0.44-<0.0001) in laboratory-reported LDL-C, and 3.1% to 28.3%/0.1 to 9.5 mg/dL (P = 0.006-0.50) increases in LDL-CcorrDahlén. Total apoB declined by 3%-16% (P = 0.40-<0.0001), but non-Lp(a) apoB was not significantly changed. CONCLUSIONS: Pelacarsen significantly lowers direct Lp(a)-C and has neutral to mild lowering of LDL-Ccorr. In patients with elevated Lp(a), LDL-Ccorr provides a more accurate reflection of changes in LDL-C than either laboratory-reported LDL-C or the Dahlén formula."},{"id":"30d4dfc5dbd0","type":"article","url":"https://hartvaat.nl/2022/03/22/mri-hersenlaesies-en-cognitie-bij-af-na-laa-ablatie/","title":"MRI-hersenlaesies en cognitie bij AF na LAA-ablatie","title_en":"MRI-Detected Brain Lesions and Cognitive Function in Patients With Atrial Fibrillation Undergoing Left Atrial Catheter Ablation in the Randomized AXAFA-AFNET 5 Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056320","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056320","authors":["Karl Georg Haeusler","Felizitas A Eichner","Peter U Heuschmann","Jochen B Fiebach","Tobias Engelhorn","Benjamin Blank","David Callans","Arif Elvan","Massimo Grimaldi","Jim Hansen","Gerhard Hindricks","Hussein R Al-Khalidi","Lluis Mont","Jens Cosedis Nielsen","Jonathan P Piccini","Ulrich Schotten","Sakis Themistoclakis","Johan Vijgen","Luigi Di Biase","Paulus Kirchhof"],"significance":5,"published":"2022-03-22","source_date":"2022-03-22","image":"","kennis":[],"congress":"","summary_en":"This study assessed MRI-detected brain lesions and their association with cognitive function in AF patients undergoing left atrial catheter ablation, addressing the cerebral safety of this common arrhythmia procedure.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar MRI-gedetecteerde hersenlaesies en cognitieve functie bij AF-patiënten die LAA-ablatie ondergaan.","abstract_original":"BACKGROUND: We aimed to assess the prevalence of ischemic brain lesions detected by magnetic resonance imaging and their association with cognitive function 3 months after first-time ablation using continuous oral anticoagulation in patients with paroxysmal atrial fibrillation (AF). METHODS: We performed a prespecified analysis of the AXAFA-AFNET 5 trial (Anticoagulation Using the Direct Factor Xa Inhibitor Apixaban During Atrial Fibrillation Catheter Ablation: Comparison to Vitamin K Antagonist Therapy), which randomized 674 patients with AF 1:1 to uninterrupted apixaban or vitamin K antagonist therapy before first-time ablation. Brain magnetic resonance imaging using fluid-attenuated inversion recovery and high-resolution diffusion-weighted imaging was obtained within 3 to 48 hours after AF ablation in all eligible patients enrolled in 25 study centers in Europe and the United States. Patients underwent cognitive assessment 3 to 6 weeks before ablation and 3 months after ablation using the Montreal Cognitive Assessment (MoCA). RESULTS: In 84 (26.1%) of 321 patients with analyzable magnetic resonance imaging, high-resolution diffusion-weighted imaging detected at least 1 acute brain lesion, including 44 (27.2%) patients treated with apixaban and 40 (24.8%) patients treated with vitamin K antagonist (P=0.675). Median MoCA score was similar in patients with or without acute brain lesions at 3 months after ablation (28 [interquartile range (IQR), 26-29] versus 28 [IQR, 26-29]; P=0.948). Cerebral chronic white matter damage (defined as Wahlund score ≥4 points) detected by fluid-attenuated inversion recovery was present in 130 (40.5%) patients and associated with lower median MoCA scores before ablation (27 [IQR, 24-28] versus 27 [IQR, 25-29]; P=0.026) and 3 months after ablation (27 [IQR, 25-29] versus 28 [IQR, 26-29]; P=0.011). This association was no longer significant when adjusted for age and sex. Age was associated with lower MoCA scores before ablation (relative risk, 1.02 per 10 years [95% CI, 1.01-1.03]) and 3 months after ablation (relative risk, 1.02 per 10 years [95% CI, 1.01-1.03]). CONCLUSIONS: Chronic white matter damage as well as acute ischemic lesions detected by brain magnetic resonance imaging were found frequently after first-time ablation for paroxysmal AF using uninterrupted oral anticoagulation. Acute ischemic brain lesions detected by high-resolution diffusion-weighted imaging were not associated with cognitive function at 3 months after ablation. Lower MoCA scores before and after ablation were associated only with older age, highlighting the safety of AF ablation on uninterrupted oral anticoagulation. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02227550."},{"id":"472282216adf","type":"article","url":"https://hartvaat.nl/2022/03/21/vroege-ritmecontrole-bij-af-met-of-zonder-symptomen-east-afnet-4/","title":"Vroege ritmecontrole bij AF met of zonder symptomen: EAST-AFNET 4","title_en":"Systematic, early rhythm control strategy for atrial fibrillation in patients with or without symptoms: the EAST-AFNET 4 trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab593","source_url":"https://doi.org/10.1093/eurheartj/ehab593","authors":["Stephan Willems","Katrin Borof","Axel Brandes","Günter Breithardt","A John Camm","Harry J G M Crijns","Lars Eckardt","Nele Gessler","Andreas Goette","Laurent M Haegeli","Hein Heidbuchel","Josef Kautzner","G André Ng","Renate B Schnabel","Anna Suling","Lukasz Szumowski","Sakis Themistoclakis","Panos Vardas","Isabelle C van Gelder","Karl Wegscheider","Paulus Kirchhof"],"significance":8,"published":"2022-03-21","source_date":"2022-03-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"","summary_en":"This EAST-AFNET 4 analysis showed that early rhythm control improves outcomes in AF patients regardless of symptom status, expanding the indication beyond symptomatic patients. The finding challenged the guideline restriction of rhythm control to symptomatic AF.","created":"2026-07-03T10:29:40Z","updated":"2026-07-03T13:28:47Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EAST-AFNET 4 analyse die aantoont dat vroege ritmecontrole effectief is ongeacht symptoomstatus. Verruimt de indicatie.","abstract_original":"AIMS: Clinical practice guidelines restrict rhythm control therapy to patients with symptomatic atrial fibrillation (AF). The EAST-AFNET 4 trial demonstrated that early, systematic rhythm control improves clinical outcomes compared to symptom-directed rhythm control. METHODS AND RESULTS: This prespecified EAST-AFNET 4 analysis compared the effect of early rhythm control therapy in asymptomatic patients (EHRA score I) to symptomatic patients. Primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome, analyzed in a time-to-event analysis. At baseline, 801/2633 (30.4%) patients were asymptomatic [mean age 71.3 years, 37.5% women, mean CHA2DS2-VASc score 3.4, 169/801 (21.1%) heart failure]. Asymptomatic patients randomized to early rhythm control (395/801) received similar rhythm control therapies compared to symptomatic patients [e.g. AF ablation at 24 months: 75/395 (19.0%) in asymptomatic; 176/910 (19.3%) symptomatic patients, P = 0.672]. Anticoagulation and treatment of concomitant cardiovascular conditions was not different between symptomatic and asymptomatic patients. The primary outcome occurred in 79/395 asymptomatic patients randomized to early rhythm control and in 97/406 patients randomized to usual care (hazard ratio 0.76, 95% confidence interval [0.6; 1.03]), almost identical to symptomatic patients. At 24 months follow-up, change in symptom status was not different between randomized groups (P = 0.19). CONCLUSION: The clinical benefit of early, systematic rhythm control was not different between asymptomatic and symptomatic patients in EAST-AFNET 4. These results call for a shared decision discussing the benefits of rhythm control therapy in all patients with recently diagnosed AF and concomitant cardiovascular conditions (EAST-AFNET 4; ISRCTN04708680; NCT01288352; EudraCT2010-021258-20)."},{"id":"eebbb2e3848d","type":"article","url":"https://hartvaat.nl/2022/03/15/5-jaars-ifr-versus-ffr-geleide-pci-define-flair-ifr-swedeheart/","title":"5-jaars iFR versus FFR-geleide PCI: DEFINE-FLAIR/iFR-SWEDEHEART","title_en":"5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.12.030","source_url":"https://doi.org/10.1016/j.jacc.2021.12.030","authors":["Matthias Götberg","Karolina Berntorp","Rebecca Rylance","Evald H Christiansen","Troels Yndigegn","Ingibjörg J Gudmundsdottir","Sasha Koul","Lennart Sandhall","Mikael Danielewicz","Lars Jakobsen","Sven-Erik Olsson","Hans Olsson","Elmir Omerovic","Fredrik Calais","Pontus Lindroos","Michael Maeng","Dimitrios Venetsanos","Stefan K James","Amra Kåregren","Jörg Carlsson","Jens Jensen","Ann-Charlotte Karlsson","David Erlinge","Ole Fröbert"],"significance":7,"published":"2022-03-15","source_date":"2022-03-15","image":"","kennis":[],"congress":"","summary_en":"Five-year results confirmed that iFR-guided PCI maintains noninferior outcomes compared with FFR-guided PCI over long-term follow-up, providing sustained evidence for the adenosine-free physiological assessment as a standard approach.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"5-jaarsresultaten van iFR versus FFR-geleide PCI. Langetermijnbevestiging van non-inferioriteit.","abstract_original":"BACKGROUND: Instantaneous wave-free ratio (iFR) is a coronary physiology index used to assess the severity of coronary artery stenosis to guide revascularization. iFR has previously demonstrated noninferior short-term outcome compared to fractional flow reserve (FFR), but data on longer-term outcome have been lacking. OBJECTIVES: The purpose of this study was to investigate the prespecified 5-year follow-up of the primary composite outcome of all-cause mortality, myocardial infarction, and unplanned revascularization of the iFR-SWEDEHEART trial comparing iFR vs FFR in patients with chronic and acute coronary syndromes. METHODS: iFR-SWEDEHEART was a multicenter, controlled, open-label, registry-based randomized clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2,037 patients were randomized to undergo revascularization guided by iFR or FFR. RESULTS: No patients were lost to follow-up. At 5 years, the rate of the primary composite endpoint was 21.5% in the iFR group and 19.9% in the FFR group (HR: 1.09; 95% CI: 0.90-1.33). The rates of all-cause death (9.4% vs 7.9%; HR: 1.20; 95% CI: 0.89-1.62), nonfatal myocardial infarction (5.7% vs 5.8%; HR: 1.00; 95% CI: 0.70-1.44), and unplanned revascularization (11.6% vs 11.3%; HR: 1.02; 95% CI: 0.79-1.32) were also not different between the 2 groups. The outcomes were consistent across prespecified subgroups. CONCLUSIONS: In patients with chronic or acute coronary syndromes, an iFR-guided revascularization strategy was associated with no difference in the 5-year composite outcome of death, myocardial infarction, and unplanned revascularization compared with an FFR-guided revascularization strategy. (Evaluation of iFR vs FFR in Stable Angina or Acute Coronary Syndrome [iFR SWEDEHEART]; NCT02166736)."},{"id":"82bec070f8ea","type":"article","url":"https://hartvaat.nl/2022/03/15/leeftijd-en-uitkomsten-van-katheterablatie-versus-medicatie-bij-af-cabana/","title":"Leeftijd en uitkomsten van katheterablatie versus medicatie bij AF: CABANA","title_en":"Association Between Age and Outcomes of Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: Results From the CABANA Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.055297","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.055297","authors":["Tristram D Bahnson","Anna Giczewska","Daniel B Mark","Andrea M Russo","Kristi H Monahan","Hussein R Al-Khalidi","Adam P Silverstein","Jeanne E Poole","Kerry L Lee","Douglas L Packer"],"significance":6,"published":"2022-03-15","source_date":"2022-03-15","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/ritmestoornissen/katheterablatie-vt/"],"congress":"","summary_en":"This CABANA analysis showed that the benefit of catheter ablation versus medical therapy for AF varies by age, with younger patients potentially deriving greater benefit from ablation.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CABANA analyse naar leeftijdsafhankelijke uitkomsten van katheterablatie versus medicamenteuze therapie bij AF.","abstract_original":"BACKGROUND: Observational data suggest that catheter ablation may be safe and effective to treat younger and older patients with atrial fibrillation. No large, randomized trial has examined this issue. This report describes outcomes according to age at entry in the CABANA trial (Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation). METHODS: Patients with atrial fibrillation ≥65 years of age, or <65 with ≥1 risk factor for stroke, were randomly assigned to catheter ablation versus drug therapy. The primary outcome was a composite of death, disabling stroke, serious bleeding, or cardiac arrest. Secondary outcomes included all-cause mortality, the composite of mortality or cardiovascular hospitalization, and recurrence of atrial fibrillation. Treatment effect estimates were adjusted for baseline covariables using proportional hazards regression models. RESULTS: Of 2204 patients randomly assigned in CABANA, 766 (34.8%) were <65 years of age, 1130 (51.3%) were 65 to 74 years of age, and 308 (14.0%) were ≥75 years of age. Catheter ablation was associated with a 43% reduction in the primary outcome for patients <65 years of age (adjusted hazard ratio [aHR], 0.57 [95% CI, 0.30-1.09]), a 21% reduction for 65 to 74 years of age (aHR, 0.79 [95% CI, 0.54-1.16]), and an indeterminate effect for age ≥75 years of age (aHR, 1.39 [95% CI, 0.75-2.58]). Four-year event rates for ablation versus drug therapy across age groups, respectively, were 3.2% versus 7.8%, 7.8% versus 9.6%, and 14.8% versus 9.0%. For every 10-year increase in age, the primary outcome aHR increased (ie, less favorable to ablation) an average of 27% (interaction P value=0.215). A similar pattern was seen with all-cause mortality: for every 10-year increase in age, the aHR increased an average of 46% (interaction P value=0.111). Atrial fibrillation recurrence rates were lower with ablation than with drug therapy across age subgroups (aHR 0.47, 0.58, and 0.49, respectively). Treatment-related complications were infrequent for both arms (<3%) regardless of age. CONCLUSIONS: We found age-based variations in clinical outcomes for catheter ablation compared with drug therapy, with the largest relative and absolute benefits of catheter ablation in younger patients. No prognostic benefits for ablation were seen in the oldest patients. No differences were found by age in treatment-related complications or in the relative effectiveness of catheter ablation in preventing recurrent atrial arrhythmias. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT00911508."},{"id":"69a6a3a3c2df","type":"article","url":"https://hartvaat.nl/2022/03/08/periodieke-repolarisatiedynamiek-identificeert-icd-responders-bij-nicm-danish/","title":"Periodieke repolarisatiedynamiek identificeert ICD-responders bij NICM: DANISH","title_en":"Periodic Repolarization Dynamics Identifies ICD Responders in Nonischemic Cardiomyopathy: A DANISH Substudy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["iaso-dcm"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056464","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056464","authors":["Rune Boas","Nikolay Sappler","Lukas von Stülpnagel","Mathias Klemm","Ulrik Dixen","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","Jacob Tfelt-Hansen","Axel Bauer","Konstantinos D Rizas"],"significance":6,"published":"2022-03-08","source_date":"2022-03-08","image":"","kennis":[],"congress":"","summary_en":"This DANISH substudy showed that periodic repolarization dynamics, an ECG-based marker of sympathetic activity, identifies patients with nonischemic cardiomyopathy who benefit from prophylactic ICD implantation, improving patient selection.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DANISH substudie die periodieke repolarisatiedynamiek identificeert als voorspeller van ICD-respons bij niet-ischemische cardiomyopathie.","abstract_original":"BACKGROUND: Identification of patients with nonischemic cardiomyopathy who may benefit from prophylactic implantation of a cardioverter-defibrillator. We hypothesized that periodic repolarization dynamics (PRD), a marker of repolarization instability associated with sympathetic activity, could be used to identify patients who will benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation. METHODS: We performed a post hoc analysis of DANISH (Danish ICD Study in Patients With Dilated Cardiomyopathy), in which patients with nonischemic cardiomyopathy, left ventricular ejection fraction (LVEF) ≤35%, and elevated NT-proBNP (N-terminal probrain natriuretic peptides) were randomized to ICD implantation or control group. Patients were included in the PRD substudy if they had a 24-hour Holter monitor recording at baseline with technically acceptable ECG signals during the night hours (00:00-06:00). PRD was assessed using wavelet analysis according to previously validated methods. The primary end point was all-cause mortality. Cox regression models were adjusted for age, sex, NT-proBNP, estimated glomerular filtration rate, LVEF, atrial fibrillation, ventricular pacing, diabetes, cardiac resynchronization therapy, and mean heart rate. We proposed PRD ≥10 deg2 as an exploratory cut-off value for ICD implantation. RESULTS: A total of 748 of the 1116 patients in DANISH qualified for the PRD substudy. During a mean follow-up period of 5.1±2.0 years, 82 of 385 patients died in the ICD group and 85 of 363 patients died in the control group (P=0.40). In Cox regression analysis, PRD was independently associated with mortality (hazard ratio [HR], 1.28 [95% CI, 1.09-1.50] per SD increase; P=0.003). PRD was significantly associated with mortality in the control group (HR, 1.51 [95% CI, 1.25-1.81]; P<0.001) but not in the ICD group (HR, 1.04 [95% CI, 0.83-1.54]; P=0.71). There was a significant interaction between PRD and the effect of ICD implantation on mortality (P=0.008), with patients with higher PRD having greater benefit in terms of mortality reduction. ICD implantation was associated with an absolute mortality reduction of 17.5% in the 280 patients with PRD ≥10 deg2 (HR, 0.54 [95% CI, 0.34-0.84]; P=0.006; number needed to treat=6), but not in the 468 patients with PRD <10 deg2 (HR, 1.17 [95% CI, 0.77-1.78]; P=0.46; P for interaction=0.01). CONCLUSIONS: Increased PRD identified patients with nonischemic cardiomyopathy in whom prophylactic ICD implantation led to significant mortality reduction."},{"id":"413d6d23a3b4","type":"article","url":"https://hartvaat.nl/2022/03/08/amulet-versus-watchman-voor-laa-sluiting-swiss-apero-gerandomiseerde-trial/","title":"Amulet versus Watchman voor LAA-sluiting: SWISS-APERO gerandomiseerde trial","title_en":"Amulet or Watchman Device for Percutaneous Left Atrial Appendage Closure: Primary Results of the SWISS-APERO Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["linkerhartoorsluiting"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057859","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057859","authors":["Roberto Galea","Federico De Marco","Nicolas Meneveau","Adel Aminian","Frédéric Anselme","Christoph Gräni","Adrian T Huber","Emmanuel Teiger","Xavier Iriart","Flora Babongo Bosombo","Dik Heg","Anna Franzone","Pascal Vranckx","Urs Fischer","Giovanni Pedrazzini","Francesco Bedogni","Lorenz Räber","Marco Valgimigli"],"significance":7,"published":"2022-03-08","source_date":"2022-03-08","image":"","kennis":[],"congress":"","summary_en":"The SWISS-APERO randomized trial compared the Amulet with the Watchman FLX device for percutaneous LAA closure, providing the first head-to-head comparison of these leading LAA occlusion technologies.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SWISS-APERO gerandomiseerde trial die het Amulet device vergeleek met het Watchman device voor percutane LAA-sluiting.","abstract_original":"BACKGROUND: No study has so far compared Amulet with the new Watchman FLX in terms of residual left atrial appendage (LAA) patency or clinical outcomes in patients undergoing percutaneous LAA closure. METHODS: In the investigator-initiated SWISS APERO trial (Comparison of Amulet Versus Watchman/FLX Device in Patients Undergoing Left Atrial Appendage Closure), patients undergoing LAA closure were randomly assigned (1:1) open label to receive Amulet or Watchman 2.5 or FLX (Watchman) across 8 European centers. The primary end point was the composite of justified crossover to a nonrandomized device during LAA closure procedure or residual LAA patency detected by cardiac computed tomography angiography (CCTA) at 45 days. The secondary end points included procedural complications, device-related thrombus, peridevice leak at transesophageal echocardiography, and clinical outcomes at 45 days. RESULTS: Between June 2018 and May 2021, 221 patients were randomly assigned to Amulet (111 [50.2%]) or Watchman (110 [49.8%]), of whom 25 (22.7%) patients included before October 2019 received Watchman 2.5, and 85 (77.3%) patients received Watchman FLX. The primary end point was assessable in 205 (92.8%) patients and occurred in 71 (67.6%) patients receiving Amulet and 70 (70.0%) patients receiving Watchman, respectively (risk ratio, 0.97 [95% CI, 0.80-1.16]; P=0.713). A single justified crossover occurred in a patient with Amulet who fulfilled LAA patency criteria at 45-day CCTA. Major procedure-related complications occurred more frequently in the Amulet group (9.0% versus 2.7%; P=0.047) because of more frequent bleeding (7.2% versus 1.8%). At 45 days, the peridevice leak rate at transesophageal echocardiography was higher with Watchman than with Amulet (27.5% versus 13.7%, P=0.020), albeit none was major (ie, >5 mm), whereas device-related thrombus was detected in 1 (0.9%) patient with Amulet and 3 (3.0%) patients with Watchman at CCTA and in 2 (2.1%) and 5 (5.5%) patients at transesophageal echocardiography, respectively. Clinical outcomes at 45 days did not differ between the groups. CONCLUSIONS: Amulet was not associated with a lower rate of the composite of crossover or residual LAA patency compared with Watchman at 45-day CCTA. Amulet, however, was associated with lower peridevice leak rates at transesophageal echocardiography, higher procedural complications, and similar clinical outcomes at 45 days compared with Watchman. The clinical relevance of CCTA-detected LAA patency requires further investigation. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03399851."},{"id":"601bce516b49","type":"article","url":"https://hartvaat.nl/2022/03/07/geleide-versus-potente-p2y12-therapie-bij-acs-netwerkmeta-analyse-van-61-898-pat/","title":"Geleide versus potente P2Y12-therapie bij ACS: netwerkmeta-analyse van 61.898 patiënten","title_en":"Comparative effects of guided vs. potent P2Y12 inhibitor therapy in acute coronary syndrome: a network meta-analysis of 61 898 patients from 15 randomized trials.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab836","source_url":"https://doi.org/10.1093/eurheartj/ehab836","authors":["Mattia Galli","Stefano Benenati","Francesco Franchi","Fabiana Rollini","Davide Capodanno","Giuseppe Biondi-Zoccai","Giovanni Maria Vescovo","Larisa H Cavallari","Behnood Bikdeli","Jurrien Ten Berg","Roxana Mehran","Charles Michael Gibson","Filippo Crea","Naveen L Pereira","Dirk Sibbing","Dominick J Angiolillo"],"significance":8,"published":"2022-03-07","source_date":"2022-03-07","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This network meta-analysis of nearly 62,000 ACS patients compared guided de-escalation with potent P2Y12 inhibitor therapy, finding that guided approaches reduce bleeding without increasing ischemic events. The comprehensive analysis supported precision antiplatelet strategies as a superior alternative.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerkmeta-analyse van geleide versus potente P2Y12-remmertherapie bij ACS over 61.898 patiënten. Vergelijkende effectiviteit van alle de-escalatiestrategieën.","abstract_original":"AIMS: Guidelines recommend the use of potent P2Y12 inhibitors over clopidogrel for the reduction of ischaemic events in patients with acute coronary syndrome (ACS). However, this comes at the expense of increased bleeding. A guided selection of P2Y12 inhibiting therapy has the potential to overcome this limitation. We aimed at evaluating the comparative safety and efficacy of guided vs. routine selection of potent P2Y12 inhibiting therapy in patients with ACS. METHODS AND RESULTS: We performed a network meta-analysis of randomized controlled trials (RCTs) comparing different oral P2Y12 inhibitors currently recommended for the treatment of patients with ACS (clopidogrel, prasugrel, and ticagrelor). RCTs including a guided approach (i.e. platelet function or genetic testing) vs. standard selection of P2Y12 inhibitors among patients with ACS were also included. Incidence rate ratios (IRR) and associated 95% confidence intervals (CIs) were estimated. P-scores were used to estimate hierarchies of efficacy and safety. The primary efficacy endpoint was major adverse cardiovascular events (MACE) and the primary safety endpoint was all bleeding. A total of 61 898 patients from 15 RCTs were included. Clopidogrel was used as reference treatment. A guided approach was the only strategy associated with reduced MACE (IRR: 0.80, 95% CI: 0.65-0.98) without any significant trade-off in all bleeding (IRR: 1.22, 95% CI: 0.96-1.55). A guided approach and prasugrel were associated with reduced myocardial infarction. A guided approach, prasugrel, and ticagrelor were associated with reduced stent thrombosis. Ticagrelor was also associated with reduced total and cardiovascular mortality. Prasugrel was associated with increased major bleeding. Prasugrel and ticagrelor were associated with increased minor bleeding. The incidence of stroke did not differ between treatments. CONCLUSION: In patients with an ACS, compared with routine selection of potent P2Y12 inhibiting therapy (prasugrel or ticagrelor), a guided selection of P2Y12 inhibiting therapy is associated with the most favourable balance between safety and efficacy. These findings support a broader adoption of guided approach for the selection of P2Y12 inhibiting therapy in patients with ACS. STUDY REGISTRATION NUMBER: This study is registered in PROSPERO (CRD42021258603). KEY QUESTION: A guided selection of P2Y12 inhibiting therapy using platelet function or genetic testing improves outcomes among patients undergoing percutaneous coronary intervention. Nevertheless, the comparative safety and efficacy of a guided versus routine selection of potent P2Y12-inhibiting therapy in acute coronary syndrome has not been explored. KEY FINDING: In a comprehensive network meta-analysis including the totality of available evidence and using clopidogrel as treatment reference, a guided approach was the only strategy associated with reduced major adverse cardiovascular events without any significant trade-off in bleeding. Prasugrel and ticagrelor increased bleeding and only ticagrelor reduced mortality. TAKE HOME MESSAGE: A guided selection of P2Y12-inhibiting therapy represents the strategy associated with the most favourable balance between safety and efficacy. These findings support a broader adoption of guided P2Y12 inhibiting therapy in patients with acute coronary syndrome."},{"id":"4a93d2ccde82","type":"article","url":"https://hartvaat.nl/2022/03/02/kenmerken-van-patienten-met-atriale-high-rate-episodes-bij-icd-crt/","title":"Kenmerken van patiënten met atriale high-rate episodes bij ICD/CRT","title_en":"Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices.","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/euab186","source_url":"https://doi.org/10.1093/europace/euab186","authors":["Kazuo Miyazawa","Daniele Pastori","David T Martin","Wassim K Choucair","Jonathan L Halperin","Gregory Y H Lip"],"significance":5,"published":"2022-03-02","source_date":"2022-03-02","image":"","kennis":[],"congress":"","summary_en":"This analysis characterized patients with device-detected atrial high-rate episodes, identifying clinical features that distinguish AHRE patients from those with clinical AF and informing anticoagulation decisions.","created":"2026-07-03T10:29:39Z","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":"Analyse van kenmerken van patiënten met atriale high-rate episodes gedetecteerd door ICD en CRT-devices.","abstract_original":"AIMS: Atrial high rate episodes (AHREs) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied. METHODS AND RESULTS: This was an ancillary analysis of the multicentre, randomized IMPACT trial. In the present analysis, we classified patients according to the duration of AHRE ≤6 min, >6 min to ≤6 h, >6 to ≤24 h and >24 h, and investigated the association between clinical factors and the development of each duration of AHRE. Of 2718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 5.4/100, 12.0/100, 6.8/100, and 3.3/100 patient-years, respectively. The incidence rates of AHRE >6 h were significantly higher in patients at high risk of thromboembolism (CHADS2 score ≥3) compared to those at low risk (CHADS2 score 1 or 2). Using Cox regression analysis, age ≥65 years and history of atrial fibrillation (AF) and/or atrial flutter (AFL) were risk factors for AHRE >6 min. In addition, hypertension was associated with AHRE >24 h (hazard ratio 2.13, 95% confidence interval 1.24-3.65, P = 0.006). CONCLUSION: Atrial high rate episode >6 min to ≤6 h were most prevalent among all AHRE duration categories. Longer AHREs were more common in patients at risk of thromboembolism. Age and history of AF/AFL were risk factors for AHRE >6 min. Furthermore, hypertension showed a strong impact on the development of AHRE >24 h rather than age."},{"id":"39d4057c2269","type":"article","url":"https://hartvaat.nl/2022/03/02/frequentiecontrolemiddelen-verschillen-in-preventie-van-af-progressie/","title":"Frequentiecontrolemiddelen verschillen in preventie van AF-progressie","title_en":"Rate control drugs differ in the prevention of progression of atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["hartrevalidatie","lichamelijke-inactiviteit","primaire-preventie"],"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/euab191","source_url":"https://doi.org/10.1093/europace/euab191","authors":["Tim Koldenhof","Petra E P J Wijtvliet","Nikki A H A Pluymaekers","Michiel Rienstra","Richard J Folkeringa","Patrick Bronzwaer","Arif Elvan","Jan Elders","Raymond Tukkie","Justin G L M Luermans","Sander M J van Kuijk","Jan G P Tijssen","Isabelle C van Gelder","Harry J G M Crijns","Robert G Tieleman"],"significance":6,"published":"2022-03-02","source_date":"2022-03-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/frequentiecontrole-af/"],"congress":"","summary_en":"This study showed that different rate control drugs (verapamil, beta-blockers, digoxin) have differential effects on preventing AF progression from paroxysmal to persistent, supporting verapamil as potentially protective against disease advancement.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat verschillende frequentiecontrolemiddelen verschillend presteren in het voorkomen van AF-progressie.","abstract_original":"AIMS: We hypothesize that in patients with paroxysmal atrial fibrillation (AF), verapamil is associated with lower AF progression compared to beta blockers or no rate control. METHODS AND RESULTS: In this pre-specified post hoc analysis of the RACE 4 randomized trial, the effect of rate control medication on AF progression in paroxysmal AF was analysed. Patients using Vaughan-Williams Class I or III antiarrhythmic drugs were excluded. The primary outcome was a composite of first electrical cardioversion (ECV), chemical cardioversion (CCV), or atrial ablation. Event rates are displayed using Kaplan-Meier curves and multivariable Cox regression analyses are used to adjust for baseline differences. Out of 666 patients with paroxysmal AF, 47 used verapamil, 383 used beta blockers, and 236 did not use rate control drugs. The verapamil group was significantly younger than the beta blocker group and contained more men than the no rate control group. Over a mean follow-up of 37 months, the primary outcome occurred in 17% in the verapamil group, 33% in the beta blocker group, and 33% in the no rate control group (P = 0.038). After adjusting for baseline characteristics, patients using verapamil have a significantly lower chance of receiving ECV, CCV, or atrial ablation compared to patients using beta blockers [hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.19-0.83] and no rate control (HR 0.64, 95% CI 0.44-0.93). CONCLUSION: In patients with newly diagnosed paroxysmal AF, verapamil was associated with less AF progression, as compared to beta blockers and no rate control."},{"id":"62b50ca2ec86","type":"article","url":"https://hartvaat.nl/2022/03/01/edoxaban-15-mg-naar-nierfunctie-bij-zeer-oude-af-eldercare-subanalyse/","title":"Edoxaban 15 mg naar nierfunctie bij zeer oude AF: ELDERCARE subanalyse","title_en":"Efficacy and Safety of Edoxaban 15 mg According to Renal Function in Very Elderly Patients With Atrial Fibrillation: A Subanalysis of the ELDERCARE-AF Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["sacubitril-valsartan"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057190","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057190","authors":["Tetsuro Yoshida","Akihiro Nakamura","Junichi Funada","Mari Amino","Wataru Shimizu","Masayuki Fukuzawa","Saori Watanabe","Takuya Hayashi","Takeshi Yamashita","Ken Okumura","Masaharu Akao"],"significance":6,"published":"2022-03-01","source_date":"2022-03-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This ELDERCARE subanalysis confirmed that low-dose edoxaban (15 mg) maintains its favorable efficacy-safety profile across different levels of renal function in very elderly AF patients.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ELDERCARE subanalyse van edoxaban 15 mg gestratificeerd naar nierfunctie bij zeer oude AF-patiënten.","abstract_original":""},{"id":"a20ff4a5a85e","type":"article","url":"https://hartvaat.nl/2022/03/01/orale-antihypertensiva-bij-niet-ernstige-zwangerschapshypertensie-netwerkmeta-an/","title":"Orale antihypertensiva bij niet-ernstige zwangerschapshypertensie: netwerkmeta-analyse","title_en":"Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18415","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18415","authors":["Jeffrey N Bone","Akshdeep Sandhu","Edgardo D Abalos","Asma Khalil","Joel Singer","Sarina Prasad","Shazmeen Omar","Marianne Vidler","Peter von Dadelszen","Laura A Magee"],"significance":6,"published":"2022-03-01","source_date":"2022-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"This network meta-analysis evaluated oral antihypertensives for non-severe pregnancy hypertension, comparing different drug classes to identify the most effective and safe agents for blood pressure control during pregnancy.","created":"2026-07-03T10:29:38Z","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":"Netwerkmeta-analyse van orale antihypertensiva bij niet-ernstige hypertensie in de zwangerschap.","abstract_original":"BACKGROUND: We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future sample size estimates for definitive evidence. METHODS: Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: https://www.crd.york.ac.uk/PROSPERO/; unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria/preeclampsia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. RESULTS: Of 1246 publications identified, 72 trials were included; 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria/preeclampsia (odds ratio, 0.73 [95% credible interval, 0.54-0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30-0.98]) compared with placebo/no therapy, and proteinuria/preeclampsia compared with methyldopa (odds ratio, 0.66 [0.44-0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41-0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to >15 000/arm (fetal/newborn death) would be required to provide definitive evidence. CONCLUSIONS: In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria/preeclampsia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive sample sizes are required for definitive evidence. Real-world data are needed to individualize care."},{"id":"7154764fed65","type":"article","url":"https://hartvaat.nl/2022/03/01/bloeddruk-hypertensie-en-risico-op-aortadissectie-j-sch-en-uk-biobank/","title":"Bloeddruk, hypertensie en risico op aortadissectie: J-SCH en UK Biobank","title_en":"Blood Pressure, Hypertension, and the Risk of Aortic Dissection Incidence and Mortality: Results From the J-SCH Study, the UK Biobank Study, and a Meta-Analysis of Cohort Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["abelacimab","bloeddrukbehandeling","ras-remmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056546","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056546","authors":["Makoto Hibino","Yoichiro Otaki","Elsa Kobeissi","Han Pan","Hiromi Hibino","Henock Taddese","Azeem Majeed","Subodh Verma","Tsuneo Konta","Kunihiro Yamagata","Shouichi Fujimoto","Kazuhiko Tsuruya","Ichiei Narita","Masato Kasahara","Yugo Shibagaki","Kunitoshi Iseki","Toshiki Moriyama","Masahide Kondo","Koichi Asahi","Tsuyoshi Watanabe","Tetsu Watanabe","Masafumi Watanabe","Dagfinn Aune"],"significance":7,"published":"2022-03-01","source_date":"2022-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This large prospective Japanese study demonstrated a continuous positive relationship between blood pressure levels and the risk of aortic dissection incidence and mortality, reinforcing the importance of blood pressure control for aortic protection.","created":"2026-07-03T10:29:38Z","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":"Analyse naar het verband tussen bloeddruk, hypertensie en het risico op aortadissectie-incidentie en -mortaliteit.","abstract_original":"BACKGROUND: Hypertension or elevated blood pressure (BP) is an important risk factor for aortic dissection (AD); however, few prospective studies on this topic have been published. We investigated the association between hypertension/elevated BP and AD in 2 cohorts and conducted a meta-analysis of published prospective studies, including these 2 studies. METHODS: We analyzed data from the J-SHC study (Japan-Specific Health Checkups) and UK Biobank, which prospectively followed up 534 378 and 502 424 participants, respectively. Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for the association of hypertension/elevated BP with AD incidence in the UK Biobank and AD mortality in the J-SHC Study. In the meta-analysis, summary relative risks were calculated with random-effects models. A potential nonlinear dose-response relationship between BP and AD was tested with fractional polynomial models, and the best-fitting second-order fractional polynomial regression model was determined. RESULTS: In the J-SHC study and UK Biobank, there were 84 and 182 ADs during the 4- and 9-year follow-up, and the adjusted hazard ratios of AD were 3.57 (95% CI, 2.17-6.11) and 2.68 (95% CI, 1.78-4.04) in hypertensive individuals, 1.33 (95% CI, 1.05-1.68) and 1.27 (95% CI, 1.11-1.48) per 20-mm Hg increase in systolic BP (SBP), and 1.67 (95% CI, 1.40-2.00) and 1.66 (95% CI, 1.46-1.89) per 10-mm Hg increase in diastolic BP (DBP), respectively. In the meta-analysis, the summary relative risks were 3.07 (95% CI, 2.15-4.38, I2=76.7%, n=7 studies, 2818 ADs, 4 563 501 participants) for hypertension and 1.39 (95% CI, 1.16-1.66, I2=47.7%, n=3) and 1.79 (95% CI: 1.51-2.12, I2 = 57.0%, n=3) per 20-mm Hg increase in SBP and per 10-mm Hg increase in DBP, respectively. The AD risk showed a strong, positive dose-response relationship with SBP and even more so with DBP. The risk of AD in the nonlinear dose-response analysis was significant at SBP >132 mm Hg and DBP >75 mm Hg. CONCLUSIONS: Hypertension and elevated SBP and DBP are associated with a high risk of AD. The risk of AD was positively dose dependent, even within the normal BP range. These findings provide further evidence for the optimization of BP to prevent AD."},{"id":"db76c6e3de9f","type":"article","url":"https://hartvaat.nl/2022/02/22/temporaire-ruggenmergstimulatie-ter-preventie-van-postoperatief-af/","title":"Temporaire ruggenmergstimulatie ter preventie van postoperatief AF","title_en":"Temporary Spinal Cord Stimulation to Prevent Postcardiac Surgery Atrial Fibrillation: 30-Day Safety and Efficacy Outcomes.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["aspirine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.08.078","source_url":"https://doi.org/10.1016/j.jacc.2021.08.078","authors":["Alexander Romanov","Vladimir Lomivorotov","Alexander Chernyavskiy","Vladimir Murtazin","Elena Kliver","Dmitry Ponomarev","Igor Mikheenko","Alexander Yakovlev","Marina Yakovleva","Jonathan S Steinberg"],"significance":5,"published":"2022-02-22","source_date":"2022-02-22","image":"","kennis":[],"congress":"","summary_en":"This study tested temporary spinal cord stimulation for preventing post-cardiac surgery AF, exploring neuromodulation as a novel approach to this common post-operative complication.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar temporaire ruggenmergstimulatie voor preventie van AF na hartchirurgie.","abstract_original":""},{"id":"bc04ccf98425","type":"article","url":"https://hartvaat.nl/2022/02/19/faricimab-bij-diabetisch-maculaoedeem-met-verlengde-dosering-lancet/","title":"Faricimab bij diabetisch maculaoedeem met verlengde dosering: Lancet","title_en":"Efficacy, durability, and safety of intravitreal faricimab with extended dosing up to every 16 weeks in patients with diabetic macular oedema (YOSEMITE and RHINE): two randomised, double-masked, phase 3 trials.","category":"preventie","category_label":"Preventie","professions":["internist"],"tags":["soul-trial"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)00018-6","source_url":"https://doi.org/10.1016/S0140-6736(22)00018-6","authors":["Charles C Wykoff","Francis Abreu","Anthony P Adamis","Karen Basu","David A Eichenbaum","Zdenka Haskova","Hugh Lin","Anat Loewenstein","Shaun Mohan","Ian A Pearce","Taiji Sakamoto","Patricio G Schlottmann","David Silverman","Jennifer K Sun","John A Wells","Jeffrey R Willis","Ramin Tadayoni"],"significance":6,"published":"2022-02-19","source_date":"2022-02-19","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial of faricimab, a bispecific anti-VEGF/anti-angiopoietin-2 antibody, in diabetic macular edema showed efficacy with extended dosing up to every 16 weeks, reducing treatment burden for this common diabetic eye complication.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet trial van faricimab bij diabetisch maculaoedeem met verlengde dosering tot elke 16 weken.","abstract_original":"BACKGROUND: To reduce treatment burden and optimise patient outcomes in diabetic macular oedema, we present 1-year results from two phase 3 trials of faricimab, a novel angiopoietin-2 and vascular endothelial growth factor-A bispecific antibody. METHODS: YOSEMITE and RHINE were randomised, double-masked, non-inferiority trials across 353 sites worldwide. Adults with vision loss due to centre-involving diabetic macular oedema were randomly assigned (1:1:1) to intravitreal faricimab 6·0 mg every 8 weeks, faricimab 6·0 mg per personalised treatment interval (PTI), or aflibercept 2·0 mg every 8 weeks up to week 100. PTI dosing intervals were extended, maintained, or reduced (every 4 weeks up to every 16 weeks) based on disease activity at active dosing visits. The primary endpoint was mean change in best-corrected visual acuity at 1 year, averaged over weeks 48, 52, and 56. Efficacy analyses included the intention-to-treat population (non-inferiority margin 4 Early Treatment Diabetic Retinopathy Study [ETDRS] letters); safety analyses included patients with at least one dose of study treatment. These trials are registered with ClinicalTrials.gov (YOSEMITE NCT03622580 and RHINE NCT03622593). FINDINGS: 3247 patients were screened for eligibility in YOSEMITE (n=1532) and RHINE (n=1715). After exclusions, 940 patients were enrolled into YOSEMITE between Sept 5, 2018, and Sept 19, 2019, and 951 patients were enrolled into RHINE between Oct 9, 2018, and Sept 20, 2019. These 1891 patients were randomly assigned to faricimab every 8 weeks (YOSEMITE n=315, RHINE n=317), faricimab PTI (n=313, n=319), or aflibercept every 8 weeks (n=312, n=315). Non-inferiority for the primary endpoint was achieved with faricimab every 8 weeks (adjusted mean vs aflibercept every 8 weeks in YOSEMITE 10·7 ETDRS letters [97·52% CI 9·4 to 12·0] vs 10·9 ETDRS letters [9·6 to 12·2], difference -0·2 ETDRS letters [-2·0 to 1·6]; RHINE 11·8 ETDRS letters [10·6 to 13·0] vs 10·3 ETDRS letters [9·1 to 11·4] letters, difference 1·5 ETDRS letters [-0·1 to 3·2]) and faricimab PTI (YOSEMITE 11·6 ETDRS letters [10·3 to 12·9], difference 0·7 ETDRS letters [-1·1 to 2·5]; RHINE 10·8 ETDRS letters [9·6 to 11·9], difference 0·5 ETDRS letters [-1·1 to 2·1]). Incidence of ocular adverse events was comparable between faricimab every 8 weeks (YOSEMITE n=98 [31%], RHINE n=137 [43%]), faricimab PTI (n=106 [34%], n=119 [37%]), and aflibercept every 8 weeks (n=102 [33%], n=113 [36%]). INTERPRETATION: Robust vision gains and anatomical improvements with faricimab were achieved with adjustable dosing up to every 16 weeks, demonstrating the potential for faricimab to extend the durability of treatment for patients with diabetic macular oedema. FUNDING: F Hoffmann-La Roche."},{"id":"175deea1f4be","type":"article","url":"https://hartvaat.nl/2022/02/10/finerenon-cv-en-renale-uitkomsten-bij-diabetes-met-ckd-fidelity-gepoolde-analyse/","title":"Finerenon CV en renale uitkomsten bij diabetes met CKD: FIDELITY gepoolde analyse","title_en":"Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anemie-ckd","cardiorenal-behandelstrategie","chronische-nierziekte","credence-trial","diabetes-en-hart","fidelio-dkd","fidelity","figaro-dkd","finerenon-hartfalen-nierziekte","flow-trial","soul-trial","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab777","source_url":"https://doi.org/10.1093/eurheartj/ehab777","authors":["Rajiv Agarwal","Gerasimos Filippatos","Bertram Pitt","Stefan D Anker","Peter Rossing","Amer Joseph","Peter Kolkhof","Christina Nowack","Martin Gebel","Luis M Ruilope","George L Bakris"],"significance":9,"published":"2022-02-10","source_date":"2022-02-10","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"The FIDELITY pooled analysis combined FIDELIO-DKD and FIGARO-DKD data to demonstrate consistent cardiovascular and kidney benefits of finerenone across the full spectrum of CKD severity in patients with type 2 diabetes. This definitive analysis established finerenone's position in the cardiorenal protection armamentarium.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"FIDELITY gepoolde analyse van FIDELIO-DKD en FIGARO-DKD naar cardiovasculaire en renale uitkomsten met finerenon. Definitieve klasse-effectanalyse.","abstract_original":"AIMS: The complementary studies FIDELIO-DKD and FIGARO-DKD in patients with type 2 diabetes and chronic kidney disease (CKD) examined cardiovascular and kidney outcomes in different, overlapping stages of CKD. The purpose of the FIDELITY analysis was to perform an individual patient-level prespecified pooled efficacy and safety analysis across a broad spectrum of CKD to provide more robust estimates of safety and efficacy of finerenone compared with placebo. METHODS AND RESULTS: For this prespecified analysis, two phase III, multicentre, double-blind trials involving patients with CKD and type 2 diabetes, randomized 1:1 to finerenone or placebo, were combined. Main time-to-event efficacy outcomes were a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for heart failure, and a composite of kidney failure, a sustained ≥57% decrease in estimated glomerular filtration rate from baseline over ≥4 weeks, or renal death. Among 13 026 patients with a median follow-up of 3.0 years (interquartile range 2.3-3.8 years), the composite cardiovascular outcome occurred in 825 (12.7%) patients receiving finerenone and 939 (14.4%) receiving placebo [hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.78-0.95; P = 0.0018]. The composite kidney outcome occurred in 360 (5.5%) patients receiving finerenone and 465 (7.1%) receiving placebo (HR, 0.77; 95% CI, 0.67-0.88; P = 0.0002). Overall safety outcomes were generally similar between treatment arms. Hyperkalaemia leading to permanent treatment discontinuation occurred more frequently in patients receiving finerenone (1.7%) than placebo (0.6%). CONCLUSION: Finerenone reduced the risk of clinically important cardiovascular and kidney outcomes vs. placebo across the spectrum of CKD in patients with type 2 diabetes. KEY QUESTION: Does finerenone, a novel selective, nonsteroidal mineralocorticoid receptor antagonist, added to maximum tolerated renin-angiotensin system inhibition reduce cardiovascular disease and kidney disease progression over a broad range of chronic kidney disease in patients with type 2 diabetes? KEY FINDING: In a prespecified, pooled individual-level analysis from two randomized trials, we found reductions both in cardiovascular events and kidney failure outcomes with finerenone. Because 40% of the patients had an estimated glomerular filtration rate of >60 mL/min/1.73m2 they were identified solely on the basis of albuminuria. TAKE HOME MESSAGE: Finerenone reduces the risk of clinical cardiovascular outcomes and kidney disease progression in a broad range of patients with chronic kidney disease and type 2 diabetes. Screening for albuminuria to identify at-risk patients among patients with type 2 diabetes facilitates reduction of both cardiovascular and kidney disease burden."},{"id":"b76115c0faf1","type":"article","url":"https://hartvaat.nl/2022/02/10/propionaat-vermindert-atherosclerose-via-immuunregulatie-van-intestinaal-cholest/","title":"Propionaat vermindert atherosclerose via immuunregulatie van intestinaal cholesterolmetabolisme","title_en":"Propionate attenuates atherosclerosis by immune-dependent regulation of intestinal cholesterol metabolism.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","pcsk9-remmers","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab644","source_url":"https://doi.org/10.1093/eurheartj/ehab644","authors":["Arash Haghikia","Friederike Zimmermann","Paul Schumann","Andrzej Jasina","Johann Roessler","David Schmidt","Philipp Heinze","Johannes Kaisler","Vanasa Nageswaran","Annette Aigner","Uta Ceglarek","Roodline Cineus","Ahmed N Hegazy","Emiel P C van der Vorst","Yvonne Döring","Christopher M Strauch","Ina Nemet","Valentina Tremaroli","Chinmay Dwibedi","Nicolle Kränkel","David M Leistner","Markus M Heimesaat","Stefan Bereswill","Geraldine Rauch","Ute Seeland","Oliver Soehnlein","Dominik N Müller","Ralf Gold","Fredrik Bäckhed","Stanley L Hazen","Aiden Haghikia","Ulf Landmesser"],"significance":6,"published":"2022-02-10","source_date":"2022-02-10","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that propionate, a short-chain fatty acid produced by gut bacteria, attenuates atherosclerosis through immune-dependent regulation of intestinal cholesterol metabolism, advancing the microbiome-cardiovascular connection.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat propionaat (korte-keten vetzuur) atherosclerose vermindert via immuun-afhankelijke regulatie van intestinaal cholesterolmetabolisme.","abstract_original":"AIMS: Atherosclerotic cardiovascular disease (ACVD) is a major cause of mortality and morbidity worldwide, and increased low-density lipoproteins (LDLs) play a critical role in development and progression of atherosclerosis. Here, we examined for the first time gut immunomodulatory effects of the microbiota-derived metabolite propionic acid (PA) on intestinal cholesterol metabolism. METHODS AND RESULTS: Using both human and animal model studies, we demonstrate that treatment with PA reduces blood total and LDL cholesterol levels. In apolipoprotein E-/- (Apoe-/-) mice fed a high-fat diet (HFD), PA reduced intestinal cholesterol absorption and aortic atherosclerotic lesion area. Further, PA increased regulatory T-cell numbers and interleukin (IL)-10 levels in the intestinal microenvironment, which in turn suppressed the expression of Niemann-Pick C1-like 1 (Npc1l1), a major intestinal cholesterol transporter. Blockade of IL-10 receptor signalling attenuated the PA-related reduction in total and LDL cholesterol and augmented atherosclerotic lesion severity in the HFD-fed Apoe-/- mice. To translate these preclinical findings to humans, we conducted a randomized, double-blinded, placebo-controlled human study (clinical trial no. NCT03590496). Oral supplementation with 500 mg of PA twice daily over the course of 8 weeks significantly reduced LDL [-15.9 mg/dL (-8.1%) vs. -1.6 mg/dL (-0.5%), P = 0.016], total [-19.6 mg/dL (-7.3%) vs. -5.3 mg/dL (-1.7%), P = 0.014] and non-high-density lipoprotein cholesterol levels [PA vs. placebo: -18.9 mg/dL (-9.1%) vs. -0.6 mg/dL (-0.5%), P = 0.002] in subjects with elevated baseline LDL cholesterol levels. CONCLUSION: Our findings reveal a novel immune-mediated pathway linking the gut microbiota-derived metabolite PA with intestinal Npc1l1 expression and cholesterol homeostasis. The results highlight the gut immune system as a potential therapeutic target to control dyslipidaemia that may introduce a new avenue for prevention of ACVDs."},{"id":"6fdbda374461","type":"article","url":"https://hartvaat.nl/2022/02/08/1-jaars-cv-events-bij-restrictieve-versus-liberale-transfusie-na-acuut-mi-realit/","title":"1-jaars CV-events bij restrictieve versus liberale transfusie na acuut MI: REALITY","title_en":"One-Year Major Cardiovascular Events After Restrictive Versus Liberal Blood Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057909","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057909","authors":["Jose R Gonzalez-Juanatey","Gilles Lemesle","Etienne Puymirat","Gregory Ducrocq","Marine Cachanado","Joan Albert Arnaiz","Manuel Martínez-Sellés","Johanne Silvain","Albert Ariza-Solé","Emile Ferrari","Gonzalo Calvo","Nicolas Danchin","Cristina Avendano-Solá","Alexandra Rousseau","Eric Vicaut","Teba Gonzalez-Ferrero","Philippe Gabriel Steg","Tabassome Simon"],"significance":6,"published":"2022-02-08","source_date":"2022-02-08","image":"","kennis":[],"congress":"","summary_en":"One-year REALITY results confirmed that a restrictive transfusion strategy (hemoglobin threshold <8 g/dL) is safe and noninferior to liberal transfusion after acute MI, with sustained comparable outcomes.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"REALITY 1-jaarsresultaten van restrictief versus liberaal transfusiebeleid na acuut MI.","abstract_original":""},{"id":"8f84823da58e","type":"article","url":"https://hartvaat.nl/2022/02/08/stress-cardiale-biomarkers-en-cv-renale-uitkomsten-bij-canagliflozine/","title":"Stress cardiale biomarkers en CV/renale uitkomsten bij canagliflozine","title_en":"Stress Cardiac Biomarkers, Cardiovascular and Renal Outcomes, and Response to Canagliflozin.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.11.027","source_url":"https://doi.org/10.1016/j.jacc.2021.11.027","authors":["Muthiah Vaduganathan","Naveed Sattar","Jialin Xu","Javed Butler","Kenneth W Mahaffey","Bruce Neal","Wayne Shaw","Norman Rosenthal","Michael Pfeifer","Michael K Hansen","James L Januzzi"],"significance":5,"published":"2022-02-08","source_date":"2022-02-08","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"This analysis showed that stress cardiac biomarkers (NT-proBNP, troponin) predict both cardiovascular-renal outcomes and response to canagliflozin in diabetes, supporting biomarker-guided SGLT2 inhibitor therapy.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar stress cardiale biomarkers en hun voorspellende waarde voor CV en renale uitkomsten bij canagliflozinegebruik.","abstract_original":"BACKGROUND: Circulating biomarkers reflecting different mechanistic pathways may identify at-risk individuals with diabetes who may benefit from sodium-glucose cotransporter-2 (SGLT2) inhibitors. OBJECTIVES: The purpose of this study was to determine if high-sensitivity cardiac troponin T (hs-cTnT), soluble suppression of tumorigenesis-2 (sST2), and insulin-like growth factor binding protein 7 (IGFBP7) levels, either alone or in combination, may modify the treatment benefits of canagliflozin. METHODS: In the CANVAS (CANagliflozin cardioVascular Assessment Study) biomarker substudy, we evaluated the prognostic significance of baseline biomarker measurements, the long-term trajectory of each, and response to canagliflozin on key cardiovascular and kidney outcomes. RESULTS: Among the 4,330 study participants, baseline hs-cTnT, sST2, and IGFBP7 were available in 3,503 (81%), 3,084 (71%), and 3,577 (83%). In total, 39% had elevated hs-cTnT ≥14 pg/mL, 6% had sST2 >35 ng/mL, and 49% had IGFBP7 >96.5 ng/mL. Canagliflozin significantly slowed increases of hs-cTnT (P = 0.027) and sST2 (P = 0.033) through 6 years. Each biomarker was significantly associated with cardiovascular and kidney outcomes, independent of clinical covariates. Canagliflozin reduced heart failure and kidney events regardless of baseline biomarker concentration. Patients with hs-cTnT ≥14 ng/L and those with sST2 >35 ng/mL derived greater relative benefit for major adverse cardiovascular events (MACE) (both Pinteraction ≤0.05). A panel of all 3 biomarkers predicted each cardiac and kidney outcome evaluated; participants with an increasing number of abnormal circulating biomarkers appeared to have greater relative reductions in MACE from canagliflozin treatment (Pinteraction trend = 0.005). CONCLUSIONS: Canagliflozin delays longitudinal rise in hs-cTnT and sST2 compared with placebo out to 6 years. Canagliflozin reduced heart failure and kidney events regardless of baseline biomarker concentration. Elevated cardiovascular biomarkers, either alone or in combination, may identify individuals who may derive greater MACE benefit from SGLT2 inhibition. CANVAS (CANagliflozin cardioVascular Assessment Study; NCT01032629)."},{"id":"dd7b3417bfff","type":"article","url":"https://hartvaat.nl/2022/02/08/antitrombotische-therapie-bij-af-na-acs-of-pci-jacc-overzicht/","title":"Antitrombotische therapie bij AF na ACS of PCI: JACC overzicht","title_en":"Antithrombotic Therapy in Patients With Atrial Fibrillation After Acute Coronary Syndromes or Percutaneous Intervention.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.11.035","source_url":"https://doi.org/10.1016/j.jacc.2021.11.035","authors":["Ralf E Harskamp","Alexander C Fanaroff","Renato D Lopes","Daniel M Wojdyla","Shaun G Goodman","Laine E Thomas","Ronald Aronson","Stephan Windecker","Roxana Mehran","Christopher B Granger","John H Alexander"],"significance":7,"published":"2022-02-08","source_date":"2022-02-08","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This JACC overview of antithrombotic therapy in AF patients after ACS or PCI synthesized the evidence from AUGUSTUS, RE-DUAL PCI, and ENTRUST-AF PCI, confirming dual therapy with a DOAC and P2Y12 inhibitor as the preferred approach.","created":"2026-07-03T10:29:38Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JACC overzicht van antitrombotische therapie bij AF-patiënten na ACS of PCI.","abstract_original":"BACKGROUND: The use of apixaban instead of vitamin K antagonists (VKA) as well as dropping aspirin results in less bleeding and comparable ischemic events in patients with atrial fibrillation and acute coronary syndrome and/or percutaneous coronary intervention treated with a P2Y12 inhibitor. OBJECTIVES: The authors assessed the safety and efficacy of antithrombotic regimens according to HAS-BLED and CHA2DS2-VASc scores in AUGUSTUS (The Open-Label, 2 × 2 Factorial, Randomized, Controlled Clinical Trial to Evaluate the Safety of Apixaban vs. Vitamin K Antagonist and Aspirin vs. Placebo in Patients with Atrial Fibrillation and Acute Coronary Syndrome and/or Percutaneous Coronary Intervention). METHODS: In AUGUSTUS, 4,614 patients were randomized in a 2-by-2 factorial design to open-label apixaban or VKA and blinded aspirin or placebo. The primary endpoint was major or clinically relevant nonmajor bleeding over 6 months of follow-up. Cox proportional hazards models were used to assess treatment effects by baseline HAS-BLED (≤2 vs ≥3) and CHA2DS2-VASc (≤2 vs ≥3) scores. RESULTS: Of 4,386 (95.1%) patients with calculable scores, 66.8% had HAS-BLED ≥3 and 81.7% had CHA2DS2-VASc ≥3. Bleeding rates were lower with apixaban than VKA irrespective of baseline risk (HR: 0.57; 95% CI: 0.41-0.78 [HAS-BLED ≤2]; HR: 0.72; 95% CI: 0.59-0.88 [HAS-BLED ≥3]; interaction P = 0.23). Aspirin increased bleeding irrespective of baseline risk (HR: 1.86; 95% CI: 1.36-2.56 [HAS-BLED ≤2]; HR: 1.81; 95% CI: 1.47-2.23 [HAS-BLED ≥3]; interaction P = 0.88). Apixaban resulted in a lower risk of death or hospitalization than VKA without a significant interaction with baseline stroke risk (HR: 0.92; 95% CI: 0.67-1.25 [CHA2DS2-VASc ≤2]; HR: 0.82; 95% CI: 0.73-0.94 [CHA2DS2-VASc ≥3]; interaction P = 0.53). CONCLUSIONS: Our findings support the use of apixaban and a P2Y12 inhibitor without aspirin for most patients with atrial fibrillation and acute coronary syndrome and/or percutaneous coronary intervention, irrespective of a patient's baseline bleeding and stroke risk (NCT02415400)."},{"id":"e731da2ff404","type":"article","url":"https://hartvaat.nl/2022/02/08/finerenon-vermindert-incident-hf-bij-ckd-met-diabetes-fidelity/","title":"Finerenon vermindert incident HF bij CKD met diabetes: FIDELITY","title_en":"Finerenone Reduces Risk of Incident Heart Failure in Patients With Chronic Kidney Disease and Type 2 Diabetes: Analyses From the FIGARO-DKD Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","chronische-nierziekte","credence-trial","dapagliflozine","diabetes-en-hart","diabetische-nefropathie","fidelio-dkd","fidelity","figaro-dkd","finerenon-hartfalen-nierziekte","ijzertekort","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.057983","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.057983","authors":["Gerasimos Filippatos","Stefan D Anker","Rajiv Agarwal","Luis M Ruilope","Peter Rossing","George L Bakris","Christoph Tasto","Amer Joseph","Peter Kolkhof","Andrea Lage","Bertram Pitt"],"significance":8,"published":"2022-02-08","source_date":"2022-02-08","image":"","kennis":[],"congress":"","summary_en":"This FIDELITY pooled analysis demonstrated that finerenone reduces the risk of new-onset heart failure in patients with CKD and type 2 diabetes, adding heart failure prevention to the established renal and cardiovascular benefits of nonsteroidal mineralocorticoid receptor antagonism.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"FIDELITY gepoolde analyse die aantoont dat finerenon het risico op incident hartfalen vermindert bij CKD met diabetes type 2.","abstract_original":"BACKGROUND: Chronic kidney disease and type 2 diabetes are independently associated with heart failure (HF), a leading cause of morbidity and mortality. In the FIDELIO-DKD (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) and FIGARO-DKD (Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease) trials, finerenone (a selective, nonsteroidal mineralocorticoid receptor antagonist) improved cardiovascular outcomes in patients with albuminuric chronic kidney disease and type 2 diabetes. These prespecified analyses from FIGARO-DKD assessed the effect of finerenone on clinically important HF outcomes. METHODS: Patients with type 2 diabetes and albuminuric chronic kidney disease (urine albumin-to-creatinine ratio ≥30 to <300 mg/g and estimated glomerular filtration rate ≥25 to ≤90 mL per min per 1.73 m2, or urine albumin-to-creatinine ratio ≥300 to ≤5000 mg/g and estimated glomerular filtration rate ≥60 mL per min per 1.73 m2), without symptomatic HF with reduced ejection fraction, were randomized to finerenone or placebo. Time-to-first-event outcomes included new-onset HF (first hospitalization for HF [HHF] in patients without a history of HF at baseline); cardiovascular death or first HHF; HF-related death or first HHF; first HHF; cardiovascular death or total (first or recurrent) HHF; HF-related death or total HHF; and total HHF. Outcomes were evaluated in the overall population and in prespecified subgroups categorized by baseline HF history (as reported by the investigators). RESULTS: Overall, 7352 patients were included in these analyses; 571 (7.8%) had a history of HF at baseline. New-onset HF was significantly reduced with finerenone versus placebo (1.9% versus 2.8%; hazard ratio [HR], 0.68 [95% CI, 0.50-0.93]; P=0.0162). In the overall population, the incidences of all HF outcomes analyzed were significantly lower with finerenone than placebo, including an 18% lower risk of cardiovascular death or first HHF (HR, 0.82 [95% CI, 0.70-0.95]; P=0.011), a 29% lower risk of first HHF (HR, 0.71 [95% CI, 0.56-0.90]; P=0.0043) and a 30% lower rate of total HHF (rate ratio, 0.70 [95% CI, 0.52-0.94]). The effects of finerenone on improving HF outcomes were not modified by a history of HF. The incidence of treatment-emergent adverse events was balanced between treatment groups. CONCLUSIONS: The results from these FIGARO-DKD analyses demonstrate that finerenone reduces new-onset HF and improves other HF outcomes in patients with chronic kidney disease and type 2 diabetes, irrespective of a history of HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02545049."},{"id":"c5a8bffe204f","type":"article","url":"https://hartvaat.nl/2022/02/02/cryoballon-versus-rf-bij-persisterend-af-noorse-no-pers-af-gerandomiseerde-trial/","title":"Cryoballon versus RF bij persisterend AF: Noorse NO-PERS AF gerandomiseerde trial","title_en":"Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study).","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/euab281","source_url":"https://doi.org/10.1093/europace/euab281","authors":["Li-Bin Shi","Ole Rossvoll","Pål Tande","Peter Schuster","Eivind Solheim","Jian Chen"],"significance":6,"published":"2022-02-02","source_date":"2022-02-02","image":"","kennis":[],"congress":"","summary_en":"The NO-PERS AF Norwegian randomized study compared cryoballoon with radiofrequency ablation specifically for persistent AF, providing head-to-head data in this more challenging arrhythmia phenotype.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NO-PERS AF Noorse gerandomiseerde studie die cryoballon vergeleek met RF-ablatie bij persisterend AF.","abstract_original":"AIMS: Pulmonary vein isolation (PVI) is still regarded as a cornerstone for treatment of persistent atrial fibrillation (AF). This study evaluated the effectiveness of PVI performed with cryoballoon ablation (CBA) in comparison with radiofrequency ablation (RFA) in patients with persistent AF. METHODS AND RESULTS: A total of 101 patients with symptomatic persistent AF were enrolled and randomized (1:1) to CBA or RFA groups and followed up for 12 months. The primary endpoint was any documented recurrent atrial tachyarrhythmia (ATA) lasting longer than 30 s following a 3-month blanking period. Secondary endpoints were procedure-related complications, procedure and ablation duration, and fluoroscopy time. The ATA-free survival curves were estimated by Kaplan-Meier method and analysed by the log-rank test. According to intention-to-treat analysis, freedom from ATA was achieved in 36 out of 52 patients in the CBA group and 30 out of 49 patients in the RFA group (69.2% vs. 61.2%, P = 0.393). No difference in AF recurrence was found between the two groups (27.5% in CBA vs. 38.0% in RFA, P = 0.258), and less atrial flutter recurrence was documented in the CBA group compared with the RFA group (3.9% vs. 18.0%, P = 0.020). The procedure and ablation duration were significantly shorter in the CBA group (160 ± 31 vs. 197 ± 38 min, P < 0.0001; 36.7 ± 9.5 vs. 55.3 ± 16.7 min, P < 0.0001). There was no difference regarding fluoroscopy time (21.5 ± 7.8 vs. 23.4 ± 11.2 min, P > 0.05). CONCLUSION: Compared with RFA, PVI performed by CBA led to shorter procedure and ablation duration, with less atrial flutter recurrence and similar freedom from ATA at 12-month follow-up."},{"id":"29c539ce823f","type":"article","url":"https://hartvaat.nl/2022/02/02/remote-monitoring-en-klinische-uitkomsten-bij-europese-hf-met-icd-langetermijn/","title":"Remote monitoring en klinische uitkomsten bij Europese HF met ICD: langetermijn","title_en":"Effect of remote monitoring on clinical outcomes in European heart failure patients with an implantable cardioverter-defibrillator: secondary results of the REMOTE-CIED randomized trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euab221","source_url":"https://doi.org/10.1093/europace/euab221","authors":["Cheyenne S L Chiu","Ivy Timmermans","Henneke Versteeg","Edgar Zitron","Philippe Mabo","Susanne S Pedersen","Mathias Meine"],"significance":5,"published":"2022-02-02","source_date":"2022-02-02","image":"","kennis":[],"congress":"","summary_en":"This long-term analysis of remote monitoring in European heart failure patients with ICDs evaluated whether sustained RPM reduces clinical events and healthcare utilization over extended follow-up.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnanalyse van remote monitoring op klinische uitkomsten bij Europese HF-patiënten met ICD.","abstract_original":"AIMS: Remote patient monitoring (RPM) systems offer a promising alternative to conventional In-Clinic check-ups, hereby reducing unnecessary clinic visits. Especially with the rise of the COVID-19 pandemic, this reduction is of paramount importance. Regarding the association between RPM and clinical outcomes, findings of previous studies have been inconsistent. The aim of this study is to elucidate the effect of partly substituting In-Clinic visits by RPM on clinical outcomes in implantable cardioverter-defibrillator (ICD) patients. METHODS AND RESULTS: The study included 595 heart failure patients (LVEF ≤35%; NYHA Class II/III) implanted with an ICD compatible with the Boston Scientific LATITUDE™ system. Participants were randomized to RPM plus an annual In-Clinic visit or 3-6 months In-Clinic check-ups alone. The investigated endpoints after 2 years of follow-up included a composite of all-cause mortality and cardiac hospitalization, mortality and cardiac hospitalization as independent endpoints and ICD therapy. The incidence of mortality and hospitalization did not differ significantly as independent, nor as composite endpoint between the RPM and In-Clinic group (all Ps <0.05). The results were similar regarding ICD therapy, except for appropriate ICD therapy (odds ratio 0.50; 95% confidence interval 0.26-0.98; P = 0.04). Exploratory subgroup analyses indicated that the effect of RPM differs between patients with specific characteristics, i.e. ≥60 years and permanent atrial fibrillation (all Ps < 0.05). CONCLUSION: RPM is non-inferior to conventional In-Clinic visits regarding clinical outcomes. Routine In-Clinic follow-up may partly be substituted by RPM without jeopardizing safety and efficiency, and thus reducing unnecessary In-Clinic visits. CLINICALTRIALS.GOV IDENTIFIER: NCT01691586."},{"id":"10041c0f81c5","type":"article","url":"https://hartvaat.nl/2022/02/02/thuismonitoring-temporele-trends-en-baseline-risico-voor-hf-voorspelling-bij-icd/","title":"Thuismonitoring temporele trends en baseline risico voor HF-voorspelling bij ICD","title_en":"Combining home monitoring temporal trends from implanted defibrillators and baseline patient risk profile to predict heart failure hospitalizations: results from the SELENE HF 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/euab170","source_url":"https://doi.org/10.1093/europace/euab170","authors":["Antonio D'Onofrio","Francesco Solimene","Leonardo Calò","Valeria Calvi","Miguel Viscusi","Donato Melissano","Vitantonio Russo","Antonio Rapacciuolo","Andrea Campana","Fabrizio Caravati","Paolo Bonfanti","Gabriele Zanotto","Edoardo Gronda","Antonello Vado","Vittorio Calzolari","Giovanni Luca Botto","Massimo Zecchin","Luca Bontempi","Daniele Giacopelli","Alessio Gargaro","Luigi Padeletti"],"significance":5,"published":"2022-02-02","source_date":"2022-02-02","image":"","kennis":[],"congress":"","summary_en":"This study developed and validated an algorithm combining remote monitoring temporal trends from implanted defibrillators with baseline patient risk profiles to predict heart failure hospitalizations.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar combinatie van thuismonitoringtrends en baseline risicoprofiel voor HF-voorspelling bij ICD-patiënten.","abstract_original":"AIMS: We developed and validated an algorithm for prediction of heart failure (HF) hospitalizations using remote monitoring (RM) data transmitted by implanted defibrillators. METHODS AND RESULTS: The SELENE HF study enrolled 918 patients (median age 69 years, 81% men, median ejection fraction 30%) with cardiac resynchronization therapy (44%), dual-chamber (38%), or single-chamber defibrillators with atrial diagnostics (18%). To develop a predictive algorithm, temporal trends of diurnal and nocturnal heart rates, ventricular extrasystoles, atrial tachyarrhythmia burden, heart rate variability, physical activity, and thoracic impedance obtained by daily automatic RM were combined with a baseline risk-stratifier (Seattle HF Model) into one index. The primary endpoint was the first post-implant adjudicated HF hospitalization. After a median follow-up of 22.5 months since enrolment, patients were randomly allocated to the algorithm derivation group (n = 457; 31 endpoints) or algorithm validation group (n = 461; 29 endpoints). In the derivation group, the index showed a C-statistics of 0.89 [95% confidence interval (CI): 0.83-0.95] with 2.73 odds ratio (CI 1.98-3.78) for first HF hospitalization per unitary increase of index value (P < 0.001). In the validation group, sensitivity of predicting primary endpoint was 65.5% (CI 45.7-82.1%), median alerting time 42 days (interquartile range 21-89), and false (or unexplained) alert rate 0.69 (CI 0.64-0.74) [or 0.63 (CI 0.58-0.68)] per patient-year. Without the baseline risk-stratifier, the sensitivity remained 65.5% and the false/unexplained alert rates increased by ≈10% to 0.76/0.71 per patient-year. CONCLUSION: With the developed algorithm, two-thirds of first post-implant HF hospitalizations could be predicted timely with only 0.7 false alerts per patient-year."},{"id":"3578a7af8a6c","type":"article","url":"https://hartvaat.nl/2022/02/01/matige-hypothermie-versus-normothermie-bij-cardiogene-shock-met-va-ecmo-jama-hyp/","title":"Matige hypothermie versus normothermie bij cardiogene shock met VA-ECMO: JAMA HYPERION2","title_en":"Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.24776","source_url":"https://doi.org/10.1001/jama.2021.24776","authors":["Bruno Levy","Nicolas Girerd","Julien Amour","Emmanuel Besnier","Nicolas Nesseler","Julie Helms","Clément Delmas","Romain Sonneville","Catherine Guidon","Bertrand Rozec","Helène David","David Bougon","Oussama Chaouch","Oulehri Walid","Dupont Hervé","Nicolas Belin","Lucie Gaide-Chevronnay","Patrick Rossignol","Antoine Kimmoun","Kevin Duarte","Arthur S Slutsky","Daniel Brodie","Jean-Luc Fellahi","Alexandre Ouattara","Alain Combes"],"significance":7,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The HYPERION2 trial showed that moderate hypothermia did not improve 30-day mortality compared with normothermia in patients with cardiogenic shock receiving VA-ECMO, a negative result for temperature management in this setting.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA HYPERION2 trial die matige hypothermie vergeleek met normothermie op 30-daags mortaliteit bij cardiogene shock met VA-ECMO.","abstract_original":"IMPORTANCE: The optimal approach to the use of venoarterial extracorporeal membrane oxygenation (ECMO) during cardiogenic shock is uncertain. OBJECTIVE: To determine whether early use of moderate hypothermia (33-34 °C) compared with strict normothermia (36-37 °C) improves mortality in patients with cardiogenic shock receiving venoarterial ECMO. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial of patients (who were eligible if they had been endotracheally intubated and were receiving venoarterial ECMO for cardiogenic shock for <6 hours) conducted in the intensive care units at 20 French cardiac shock care centers between October 2016 and July 2019. Of 786 eligible patients, 374 were randomized. Final follow-up occurred in November 2019. INTERVENTIONS: Early moderate hypothermia (33-34 °C; n = 168) for 24 hours or strict normothermia (36-37 °C; n = 166). MAIN OUTCOMES AND MEASURES: The primary outcome was mortality at 30 days. There were 31 secondary outcomes including mortality at days 7, 60, and 180; a composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at days 30, 60, and 180; and days without requiring a ventilator or kidney replacement therapy at days 30, 60, and 180. Adverse events included rates of severe bleeding, sepsis, and number of units of packed red blood cells transfused during venoarterial ECMO. RESULTS: Among the 374 patients who were randomized, 334 completed the trial (mean age, 58 [SD, 12] years; 24% women) and were included in the primary analysis. At 30 days, 71 patients (42%) in the moderate hypothermia group had died vs 84 patients (51%) in the normothermia group (adjusted odds ratio, 0.71 [95% CI, 0.45 to 1.13], P = .15; risk difference, -8.3% [95% CI, -16.3% to -0.3%]). For the composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at day 30, the adjusted odds ratio was 0.61 (95% CI, 0.39 to 0.96; P = .03) for the moderate hypothermia group compared with the normothermia group and the risk difference was -11.5% (95% CI, -23.2% to 0.2%). Of the 31 secondary outcomes, 30 were inconclusive. The incidence of moderate or severe bleeding was 41% in the moderate hypothermia group vs 42% in the normothermia group. The incidence of infections was 52% in both groups. The incidence of bacteremia was 20% in the moderate hypothermia group vs 30% in the normothermia group. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial involving patients with refractory cardiogenic shock treated with venoarterial ECMO, early application of moderate hypothermia for 24 hours did not significantly increase survival compared with normothermia. However, because the 95% CI was wide and included a potentially important effect size, these findings should be considered inconclusive. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02754193."},{"id":"621cb998867d","type":"article","url":"https://hartvaat.nl/2022/02/01/economische-uitkomsten-van-revalidatie-bij-ouderen-met-acuut-hf-rehab-hf/","title":"Economische uitkomsten van revalidatie bij ouderen met acuut HF: REHAB-HF","title_en":"Economic Outcomes of Rehabilitation Therapy in Older Patients With Acute Heart Failure in the REHAB-HF Trial: A Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["farmaco-economie","hartrevalidatie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.4836","source_url":"https://doi.org/10.1001/jamacardio.2021.4836","authors":["Derek S Chew","Yanhong Li","Michel Zeitouni","David J Whellan","Dalane Kitzman","Robert J Mentz","Pamela Duncan","Amy M Pastva","Gordon R Reeves","M Benjamin Nelson","Haiying Chen","Shelby D Reed"],"significance":6,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":[],"congress":"","summary_en":"This REHAB-HF economic analysis showed that rehabilitation therapy in older acute heart failure patients is cost-effective, with the functional improvement translating to acceptable healthcare economic value.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology REHAB-HF economische analyse van revalidatie bij oudere patiënten met acuut hartfalen.","abstract_original":"IMPORTANCE: In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a novel 12-week rehabilitation intervention demonstrated significant improvements in validated measures of physical function, quality of life, and depression, but no significant reductions in rehospitalizations or mortality compared with a control condition during the 6-month follow up. The economic implications of these results are important given the increasing pressures for cost containment in health care. OBJECTIVE: To report the economic outcomes of the REHAB-HF trial and estimate the potential cost-effectiveness of the intervention. DESIGN, SETTING, PARTICIPANTS: The multicenter REHAB-HF trial randomized 349 patients 60 years or older who were hospitalized for acute decompensated heart failure to rehabilitation intervention or a control group; patients were enrolled from September 17, 2014, through September 19, 2019. For this preplanned secondary analysis of the economic outcomes, data on medical resource use and quality of life (via the 5-level EuroQol 5-Dimension scores converted to health utilities) were collected. Medical resource use and medication costs were estimated using 2019 US Medicare payments and the Federal Supply Schedule, respectively. Cost-effectiveness was estimated using the validated Tools for Economic Analysis of Patient Management Interventions in Heart Failure Cost-Effectiveness Model, which uses an individual-patient simulation model informed by the prospectively collected trial data. Data were analyzed from March 24, 2019, to December 1, 2020. INTERVENTIONS: Rehabilitation intervention or control. MAIN OUTCOMES AND MEASURES: Costs, quality-adjusted life-years (QALYs), and the lifetime estimated cost per QALY gained (incremental cost-effectiveness ratio). RESULTS: Among the 349 patients included in the analysis (183 women [52.4%]; mean [SD] age, 72.7 [8.1] years; 176 non-White [50.4%] and 173 White [49.6%]), mean (SD) cumulative costs per patient were $26 421 ($38 955) in the intervention group (excluding intervention costs) and $27 650 ($30 712) in the control group (difference, -$1229; 95% CI, -$8159 to $6394; P = .80). The mean (SD) cost of the intervention was $4204 ($2059). Quality of life gains were significantly greater in the intervention vs control group during 6 months (mean utility difference, 0.074; P = .001) and sustained beyond the 12-week intervention. Incremental cost-effectiveness ratios were estimated at $58 409 and $35 600 per QALY gained for the full cohort and in patients with preserved ejection fraction, respectively. CONCLUSIONS AND RELEVANCE: These analyses suggest that longer-term benefits of this novel rehabilitation intervention, particularly in the subgroup of patients with preserved ejection fraction, may yield good value to the health care system. However, long-term cost-effectiveness is currently uncertain and dependent on the assumption that benefits are sustained beyond study follow-up, which needs to be corroborated in future trials in this patient population."},{"id":"c128f3c0ddb5","type":"article","url":"https://hartvaat.nl/2022/02/01/optimalisatie-van-trainingsrespons-voor-vrouwen-in-hartrevalidatie-jama-cardiolo/","title":"Optimalisatie van trainingsrespons voor vrouwen in hartrevalidatie: JAMA Cardiology","title_en":"Optimizing Training Response for Women in Cardiac Rehabilitation: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["atleten","farmaco-economie","gepersonaliseerde-geneeskunde","hartrevalidatie","ouderen","pathfinder-trial","secundaire-preventie","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.4822","source_url":"https://doi.org/10.1001/jamacardio.2021.4822","authors":["Sherrie Khadanga","Patrick D Savage","Anton Pecha","Jason Rengo","Philip A Ades"],"significance":6,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that optimizing training intensity and modality specifically for women in cardiac rehabilitation significantly improves peak aerobic capacity, addressing the sex-based response gap in standard rehabilitation programs.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial naar optimalisatie van trainingsrespons voor vrouwen in hartrevalidatie.","abstract_original":"IMPORTANCE: Despite lower baseline fitness levels, women in cardiac rehabilitation (CR) do not typically improve peak aerobic exercise capacity (defined as peak oxygen uptake [peak Vo2]) compared with men in CR. OBJECTIVE: To evaluate the effect of high-intensity interval training (HIIT) and intensive lower extremity resistance training (RT) compared with standard moderate intensity continuous training (MCT) on peak Vo2 among women in CR. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial conducted from July 2017 to February 2020 included women from a community-based cardiac rehabilitation program affiliated with a university hospital in Vermont. A total of 56 women (mean [SD] age, 65 [11] years; range 43-98 years) participating in CR enrolled in the study. INTERVENTIONS: MCT (70% to 85% of peak heart rate [HR]) with moderate intensive RT or HIIT (90% to 95% of peak HR) along with higher-intensity lower extremity RT 3 times per week over 12 weeks. MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in change in peak Vo2 (L/min) from baseline to 12 weeks. RESULTS: Peak Vo2 increased to a greater degree in the HIIT group (+23%) than in the control group (+7%) (mean [SD] increase, 0.3 [0.2] L/min vs 0.1 [0.2] L/min; P = .03). Similarly, the change in leg strength was greater in the HIIT-RT group compared with the control group (mean [SD] increase, 15.3 [0.3] kg vs 6.4 [1.1] kg; P = .004). CONCLUSIONS AND RELEVANCE: An exercise protocol combining HIIT and intensive lower extremity RT enhanced exercise training response for women in CR compared with standard CR exercise training. Women randomized to HIIT experienced significantly greater improvements in both peak Vo2 and leg strength during CR. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03438968."},{"id":"e056ce12034a","type":"article","url":"https://hartvaat.nl/2022/02/01/geindividualiseerde-triggerstudies-bij-paroxysmaal-af-jama-i-stop-afib/","title":"Geïndividualiseerde triggerstudies bij paroxysmaal AF: JAMA I-STOP-AFib","title_en":"Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation: The I-STOP-AFib Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.5010","source_url":"https://doi.org/10.1001/jamacardio.2021.5010","authors":["Gregory M Marcus","Madelaine Faulkner Modrow","Christopher H Schmid","Kathi Sigona","Gregory Nah","Jiabei Yang","Tzu-Chun Chu","Sean Joyce","Shiffen Gettabecha","Kelsey Ogomori","Vivian Yang","Xochitl Butcher","Mellanie True Hills","Debbe McCall","Kathleen Sciarappa","Ida Sim","Mark J Pletcher","Jeffrey E Olgin"],"significance":7,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":[],"congress":"","summary_en":"The I-STOP-AFib trial investigated whether individualized identification and avoidance of patient-reported AF triggers (alcohol, caffeine, exercise, sleep deprivation) reduces AF episode frequency, exploring a personalized behavioral approach to rhythm management.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA I-STOP-AFib gerandomiseerde trial naar geïndividualiseerde identificatie en vermijding van AF-triggers.","abstract_original":"IMPORTANCE: Atrial fibrillation (AF) is the most common arrhythmia. Although patients have reported that various exposures determine when and if an AF event will occur, a prospective evaluation of patient-selected triggers has not been conducted, and the utility of characterizing presumed AF-related triggers for individual patients remains unknown. OBJECTIVE: To test the hypothesis that n-of-1 trials of self-selected AF triggers would enhance AF-related quality of life. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial lasting a minimum of 10 weeks tested a smartphone mobile application used by symptomatic patients with paroxysmal AF who owned a smartphone and were interested in testing a presumed AF trigger. Participants were screened between December 22, 2018, and March 29, 2020. INTERVENTIONS: n-of-1 Participants received instructions to expose or avoid self-selected triggers in random 1-week blocks for 6 weeks, and the probability their trigger influenced AF risk was then communicated. Controls monitored their AF over the same time period. MAIN OUTCOMES AND MEASURES: AF was assessed daily by self-report and using a smartphone-based electrocardiogram recording device. The primary outcome comparing n-of-1 and control groups was the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) score at 10 weeks. All participants could subsequently opt for additional trigger testing. RESULTS: Of 446 participants who initiated (mean [SD] age, 58 [14] years; 289 men [58%]; 461 White [92%]), 320 (72%) completed all study activities. Self-selected triggers included caffeine (n = 53), alcohol (n = 43), reduced sleep (n = 31), exercise (n = 30), lying on left side (n = 17), dehydration (n = 10), large meals (n = 7), cold food or drink (n = 5), specific diets (n = 6), and other customized triggers (n = 4). No significant differences in AFEQT scores were observed between the n-of-1 vs AF monitoring-only groups. In the 4-week postintervention follow-up period, significantly fewer daily AF episodes were reported after trigger testing compared with controls over the same time period (adjusted relative risk, 0.60; 95% CI, 0.43- 0.83; P < .001). In a meta-analysis of the individualized trials, only exposure to alcohol was associated with significantly heightened risks of AF events. CONCLUSIONS AND RELEVANCE: n-of-1 Testing of AF triggers did not improve AF-associated quality of life but was associated with a reduction in AF events. Acute exposure to alcohol increased AF risk, with no evidence that other exposures, including caffeine, more commonly triggered AF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03323099."},{"id":"8538749fa2b2","type":"article","url":"https://hartvaat.nl/2022/02/01/luseogliflozine-en-geschat-plasmavolume-bij-hfpef/","title":"Luseogliflozine en geschat plasmavolume bij HFpEF","title_en":"Effects of luseogliflozin on estimated plasma volume in patients with heart failure with preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13683","source_url":"https://doi.org/10.1002/ehf2.13683","authors":["Mitsutaka Nakashima","Toru Miyoshi","Kentaro Ejiri","Hajime Kihara","Yoshiki Hata","Toshihiko Nagano","Atsushi Takaishi","Hironobu Toda","Seiji Nanba","Yoichi Nakamura","Satoshi Akagi","Satoru Sakuragi","Taro Minagawa","Yusuke Kawai","Nobuhiro Nishii","Soichiro Fuke","Masaki Yoshikawa","Kazufumi Nakamura","Hiroshi Ito"],"significance":5,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that luseogliflozin reduces estimated plasma volume in HFpEF patients, demonstrating the diuretic-natriuretic mechanism of SGLT2 inhibition in the preserved ejection fraction phenotype.","created":"2026-07-03T10:29:37Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de effecten van luseogliflozine op geschat plasmavolume bij HFpEF.","abstract_original":"AIMS: Sodium glucose co-transporter 2 inhibitors have diuretic effects in both patients with glycosuria and with natriuresis. We sought to assess the effect of luseogliflozin on estimated plasma volume (ePV) in patients with type 2 diabetes and heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: This study was a post-hoc analysis of the MUSCAT-HF trial (UMIN000018395), a multicentre, prospective, open-label, randomized controlled trial that assessed the effect of 12 weeks of luseogliflozin (2.5 mg, once daily, n = 83) as compared with voglibose (0.2 mg, three times daily, n = 82) on the reduction in brain natriuretic peptide (BNP) in patients with type 2 diabetes and HFpEF. The analysis compared the change in ePV calculated by the Straus formula from baseline to Weeks 4, 12, and 24, using a mixed-effects model for repeated measures. We also estimated the association between changes in ePV and changes in other clinical parameters, including BNP levels. Luseogliflozin significantly reduced ePV as compared to voglibose at Week 4 {adjusted mean group-difference -6.43% [95% confidence interval (CI): -9.11 to -3.74]}, at Week 12 [-8.73% (95%CI: -11.40 to -6.05)], and at Week 24 [-11.02% (95%CI: -13.71 to -8.33)]. The effect of luseogliflozin on these parameters was mostly consistent across various patient clinical characteristics. The change in ePV at Week 12 was significantly associated with log-transformed BNP (r = 0.197, P = 0.015) and left atrial volume index (r = 0.283, P = 0.019). CONCLUSIONS: Luseogliflozin significantly reduced ePV in patients with type 2 diabetes and HFpEF, as compared with voglibose. The reduction of intravascular volume by luseogliflozin may provide clinical benefits to patients with type 2 diabetes and HFpEF."},{"id":"00a61992503f","type":"article","url":"https://hartvaat.nl/2022/02/01/myocardiale-mechanica-bij-hypertensieve-zwangerschapsaandoeningen-meta-analyse/","title":"Myocardiale mechanica bij hypertensieve zwangerschapsaandoeningen: meta-analyse","title_en":"Myocardial Mechanics in Hypertensive Disorders of Pregnancy: a Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18123","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18123","authors":["Jamie M O'Driscoll","Veronica Giorgione","Jamie J Edwards","Jonathan D Wiles","Rajan Sharma","Baskaran Thilaganathan"],"significance":5,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This meta-analysis evaluated myocardial mechanics (global longitudinal strain) in hypertensive disorders of pregnancy, showing that GLS detects subclinical cardiac dysfunction even when ejection fraction appears preserved.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse naar myocardiale mechanica bij hypertensieve zwangerschapsaandoeningen.","abstract_original":"Global longitudinal strain (GLS) is becoming routinely used to direct the medical management of various cardiac diseases, but its application in pregnancy is unclear. Our objective was to perform a meta-analysis and pool multiple study data to consolidate the evidence base for the role of GLS in the assessment of women with hypertensive disorders of pregnancy (HDP). Electronic database searches were performed in PubMed/Medline and EMBASE for research articles reporting GLS in pregnancies complicated by HDP and normotensive pregnancies that have been published up to September 2021. The meta-analysis included 17 studies with a pooled sample size of 1723 participants, which included 951 women with HDP, of which 680 were preeclamptic, and 772 controls. The primary random-effects pooled analysis demonstrated a statistically significant weighted mean difference in GLS between the HDP and control group (mean difference: 3.08% [CI, 2.33-3.82], P<0.001). When analyzed including only preeclamptic studies, there was also a statistically significant mean difference (mean difference: 2.98% [95% CI, 1.97-3.99], P<0.001). This meta-analysis demonstrates that HDP is associated with greater cardiac maladaptation, evidenced by a significantly reduced GLS compared with normal pregnancy. Echocardiography should be considered as a screening tool in women with HDP to enable early cardiovascular risk prevention through national initiatives."},{"id":"5f914314a968","type":"article","url":"https://hartvaat.nl/2022/02/01/sekse-en-gender-in-crt-studies-systematische-review/","title":"Sekse en gender in CRT-studies: systematische review","title_en":"Integrating sex and gender in studies of cardiac resynchronization therapy: a systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.13733","source_url":"https://doi.org/10.1002/ehf2.13733","authors":["Omar Dewidar","Irina Podinic","Victoria Barbeau","Dilan Patel","Alba Antequera","David Birnie","Vivian Welch","George A Wells"],"significance":5,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"This systematic review documented the underrepresentation and inconsistent reporting of sex and gender in cardiac resynchronization therapy studies, highlighting the need for sex-specific CRT evidence.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review naar de integratie van sekse en gender in studies van cardiale resynchronisatietherapie.","abstract_original":"AIMS: To examine the prevalence, temporal changes, and impact of the National Institute of Health (NIH) Sex as a Biological Variable (SABV) policy on sex and gender reporting and analysis in cardiac resynchronization therapy (CRT) cohort studies. METHODS AND RESULTS: We searched MEDLINE, EMBASE, and Web of Science for cohort studies reporting the effectiveness and safety of CRT in heart failure patients from January 2000 to June 2020, with no language restrictions. Segmented regression analysis was used for policy analysis. We included 253 studies. Fourteen per cent considered sex in the study design. Outcome data disaggregated by sex were only reported in 17% of the studies. Of the studies with statistical models (n = 173), 57% were adjusted for sex. Sixty-eight per cent of those reported an effect size for sex on the outcome. Sex-stratified analyses were conducted in 13% of the studies. Temporal analysis shows an increase in sex reporting in background, statistical models, study design, and discussion. Besides statistical models, NIH SABV policy analysis showed no significant change in the reporting of sex in study sections. Gender was not reported or analysed in any study. CONCLUSIONS: There is a need to improve the study design, analysis, and completeness of reporting of sex in CRT cohort studies. Inadequate sex integration in study design and analysis may potentially hinder progress in understanding sex disparities in CRT. Deficiencies in the integration of sex in studies could be overcome by implementing guidance that already exists."},{"id":"dfa67013e9c2","type":"article","url":"https://hartvaat.nl/2022/02/01/ccta-afgeleide-ffr-prognostische-waarde-meta-analyse/","title":"CCTA-afgeleide FFR: prognostische waarde — meta-analyse","title_en":"Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["fractional-flow-reserve"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319773","source_url":"https://doi.org/10.1136/heartjnl-2021-319773","authors":["Bjarne L Nørgaard","Sara Gaur","Timothy A Fairbairn","Pam S Douglas","Jesper M Jensen","Manesh R Patel","Abdul R Ihdayhid","Brian S H Ko","Stephanie L Sellers","Jonathan Weir-McCall","Hitoshi Matsuo","Niels Peter R Sand","Kristian A Øvrehus","Campbell Rogers","Sarah Mullen","Koen Nieman","Erik Parner","Jonathon Leipsic","Jawdat Abdulla"],"significance":6,"published":"2022-02-01","source_date":"2022-02-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-ct-angiografie/","https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"This meta-analysis evaluated the prognostic value of CT-derived fractional flow reserve (FFR-CT), showing that non-invasive physiological assessment of coronary stenoses predicts future cardiovascular events beyond anatomical assessment alone.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar de prognostische waarde van CT-afgeleide fractional flow reserve.","abstract_original":"OBJECTIVES: To obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD). METHODS: We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint. RESULTS: Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001). CONCLUSIONS: The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes."},{"id":"6b7ff9a253ea","type":"article","url":"https://hartvaat.nl/2022/01/25/screening-op-af-uspstf-geactualiseerde-evidence-report-2022/","title":"Screening op AF: USPSTF geactualiseerde evidence report 2022","title_en":"Screening for Atrial Fibrillation: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.21811","source_url":"https://doi.org/10.1001/jama.2021.21811","authors":["Leila C Kahwati","Gary N Asher","Zachary O Kadro","Susan Keen","Rania Ali","Emmanuel Coker-Schwimmer","Daniel E Jonas"],"significance":7,"published":"2022-01-25","source_date":"2022-01-25","image":"","kennis":[],"congress":"","summary_en":"This updated USPSTF evidence review evaluated current screening strategies for atrial fibrillation in asymptomatic adults, including wearable devices and single-lead ECG, assessing the evidence for population-level AF screening programs.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"USPSTF 2022 geactualiseerde evidence report over AF-screening.","abstract_original":"IMPORTANCE: Atrial fibrillation (AF), the most common arrhythmia, increases the risk of stroke. OBJECTIVE: To review the evidence on screening for AF in adults without prior stroke to inform the US Preventive Services Task Force. DATA SOURCES: PubMed, Cochrane Library, and trial registries through October 5, 2020; references, experts, and literature surveillance through October 31, 2021. STUDY SELECTION: Randomized clinical trials (RCTs) of screening among asymptomatic persons without known AF or prior stroke; test accuracy studies; RCTs of anticoagulation among persons with AF; systematic reviews; and observational studies reporting harms. DATA EXTRACTION AND SYNTHESIS: Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. MAIN OUTCOMES AND MEASURES: Detection of undiagnosed AF, test accuracy, mortality, stroke, stroke-related morbidity, and harms. RESULTS: Twenty-six studies (N = 113 784) were included. In 1 RCT (n = 28 768) of twice-daily electrocardiography (ECG) screening for 2 weeks, the likelihood of a composite end point (ischemic stroke, hemorrhagic stroke, systemic embolism, all-cause mortality, and hospitalization for bleeding) was lower in the screened group over 6.9 years (hazard ratio, 0.96 [95% CI, 0.92-1.00]; P = .045), but that study had numerous limitations. In 4 RCTs (n = 32 491), significantly more AF was detected with intermittent and continuous ECG screening compared with no screening (risk difference range, 1.0%-4.8%). Treatment with warfarin over a mean of 1.5 years in populations with clinical, mostly persistent AF was associated with fewer ischemic strokes (pooled risk ratio [RR], 0.32 [95% CI, 0.20-0.51]; 5 RCTs; n = 2415) and lower all-cause mortality (pooled RR, 0.68 [95% CI, 0.50-0.93]) compared with placebo. Treatment with direct oral anticoagulants was also associated with lower incidence of stroke (adjusted odds ratios range, 0.32-0.44) in indirect comparisons with placebo. The pooled RR for major bleeding for warfarin compared with placebo was 1.8 (95% CI, 0.85-3.7; 5 RCTs; n = 2415), and the adjusted odds ratio for major bleeding for direct oral anticoagulants compared with placebo or no treatment ranged from 1.38 to 2.21, but CIs did not exclude a null effect. CONCLUSIONS AND RELEVANCE: Although screening can detect more cases of unknown AF, evidence regarding effects on health outcomes is limited. Anticoagulation was associated with lower risk of first stroke and mortality but with increased risk of major bleeding, although estimates for this harm are imprecise; no trials assessed benefits and harms of anticoagulation among screen-detected populations."},{"id":"952715e5f2c9","type":"article","url":"https://hartvaat.nl/2022/01/25/screening-op-af-uspstf-aanbeveling-2022/","title":"Screening op AF: USPSTF aanbeveling 2022","title_en":"Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2021.23732","source_url":"https://doi.org/10.1001/jama.2021.23732","authors":["Karina W Davidson","Michael J Barry","Carol M Mangione","Michael Cabana","Aaron B Caughey","Esa M Davis","Katrina E Donahue","Chyke A Doubeni","John W Epling","Martha Kubik","Li Li","Gbenga Ogedegbe","Lori Pbert","Michael Silverstein","James Stevermer","Chien-Wen Tseng","John B Wong"],"significance":8,"published":"2022-01-25","source_date":"2022-01-25","image":"","kennis":[],"congress":"","summary_en":"The 2022 USPSTF reaffirmed the insufficient evidence ('I' statement) for ECG screening for atrial fibrillation in asymptomatic older adults, despite advancing wearable technology, due to the lack of randomized trials demonstrating that screening-detected AF treatment improves outcomes.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"USPSTF 2022 aanbeveling over ECG-screening op AF. Concludeert onvoldoende bewijs — 'I' statement.","abstract_original":"IMPORTANCE: Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence of AF increases with age, from less than 0.2% in adults younger than 55 years to about 10% in those 85 years or older, with a higher prevalence in men than in women. It is uncertain whether the prevalence of AF differs by race and ethnicity. Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter. OBJECTIVE: To update its 2018 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults. POPULATION: Adults 50 years or older without a diagnosis or symptoms of AF and without a history of transient ischemic attack or stroke. EVIDENCE ASSESSMENT: The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined. RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. (I statement)."},{"id":"838d5faab644","type":"article","url":"https://hartvaat.nl/2022/01/25/doac-s-versus-warfarine-bij-af-patient-niveau-netwerkmeta-analyse-van-gerandomis/","title":"DOAC's versus warfarine bij AF: patiënt-niveau netwerkmeta-analyse van gerandomiseerde trials","title_en":"Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation: Patient-Level Network Meta-Analyses of Randomized Clinical Trials With Interaction Testing by Age and Sex.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulatie-kwetsbare-ouderen","doacs"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056355","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056355","authors":["Anthony P Carnicelli","Hwanhee Hong","Stuart J Connolly","John Eikelboom","Robert P Giugliano","David A Morrow","Manesh R Patel","Lars Wallentin","John H Alexander","M Cecilia Bahit","Alexander P Benz","Erin A Bohula","Tze-Fan Chao","Leanne Dyal","Michael Ezekowitz","Keith A A Fox","Baris Gencer","Jonathan L Halperin","Ziad Hijazi","Stefan H Hohnloser","Kaiyuan Hua","Elaine Hylek","Eri Toda Kato","Julia Kuder","Renato D Lopes","Kenneth W Mahaffey","Jonas Oldgren","Jonathan P Piccini","Christian T Ruff","Jan Steffel","Daniel Wojdyla","Christopher B Granger"],"significance":9,"published":"2022-01-25","source_date":"2022-01-25","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This patient-level network meta-analysis of all four DOACs versus warfarin in atrial fibrillation confirmed the class-wide superiority of DOACs for stroke prevention with less intracranial hemorrhage. The analysis also provided the first robust head-to-head indirect comparisons between individual DOACs.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Patiënt-niveau netwerkmeta-analyse die alle vier DOAC's vergeleek met warfarine en onderling bij AF. Definitieve vergelijkende analyse.","abstract_original":"BACKGROUND: Direct oral anticoagulants (DOACs) are preferred over warfarin for stroke prevention in atrial fibrillation. Meta-analyses using individual patient data offer substantial advantages over study-level data. METHODS: We used individual patient data from the COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) database, which includes all patients randomized in the 4 pivotal trials of DOACs versus warfarin in atrial fibrillation (RE-LY [Randomized Evaluation of Long-Term Anticoagulation Therapy], ROCKET AF [Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation], ARISTOTLE [Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation], and ENGAGE AF-TIMI 48 [Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48]), to perform network meta-analyses using a stratified Cox model with random effects comparing standard-dose DOAC, lower-dose DOAC, and warfarin. Hazard ratios (HRs [95% CIs]) were calculated for efficacy and safety outcomes. Covariate-by-treatment interaction was estimated for categorical covariates and for age as a continuous covariate, stratified by sex. RESULTS: A total of 71 683 patients were included (29 362 on standard-dose DOAC, 13 049 on lower-dose DOAC, and 29 272 on warfarin). Compared with warfarin, standard-dose DOACs were associated with a significantly lower hazard of stroke or systemic embolism (883/29 312 [3.01%] versus 1080/29 229 [3.69%]; HR, 0.81 [95% CI, 0.74-0.89]), death (2276/29 312 [7.76%] versus 2460/29 229 [8.42%]; HR, 0.92 [95% CI, 0.87-0.97]), and intracranial bleeding (184/29 270 [0.63%] versus 409/29 187 [1.40%]; HR, 0.45 [95% CI, 0.37-0.56]), but no statistically different hazard of major bleeding (1479/29 270 [5.05%] versus 1733/29 187 [5.94%]; HR, 0.86 [95% CI, 0.74-1.01]), whereas lower-dose DOACs were associated with no statistically different hazard of stroke or systemic embolism (531/13 049 [3.96%] versus 1080/29 229 [3.69%]; HR, 1.06 [95% CI, 0.95-1.19]) but a lower hazard of intracranial bleeding (55/12 985 [0.42%] versus 409/29 187 [1.40%]; HR, 0.28 [95% CI, 0.21-0.37]), death (1082/13 049 [8.29%] versus 2460/29 229 [8.42%]; HR, 0.90 [95% CI, 0.83-0.97]), and major bleeding (564/12 985 [4.34%] versus 1733/29 187 [5.94%]; HR, 0.63 [95% CI, 0.45-0.88]). Treatment effects for standard- and lower-dose DOACs versus warfarin were consistent across age and sex for stroke or systemic embolism and death, whereas standard-dose DOACs were favored in patients with no history of vitamin K antagonist use (P=0.01) and lower creatinine clearance (P=0.09). For major bleeding, standard-dose DOACs were favored in patients with lower body weight (P=0.02). In the continuous covariate analysis, younger patients derived greater benefits from standard-dose (interaction P=0.02) and lower-dose DOACs (interaction P=0.01) versus warfarin. CONCLUSIONS: Compared with warfarin, DOACs have more favorable efficacy and safety profiles among patients with atrial fibrillation."},{"id":"7012293817ce","type":"article","url":"https://hartvaat.nl/2022/01/18/2021-acc-aha-scai-richtlijn-voor-coronaire-revascularisatie-executive-summary/","title":"2021 ACC/AHA/SCAI richtlijn voor coronaire revascularisatie: executive summary","title_en":"2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.09.005","source_url":"https://doi.org/10.1016/j.jacc.2021.09.005","authors":["Jennifer S Lawton","Jacqueline E Tamis-Holland","Sripal Bangalore","Eric R Bates","Theresa M Beckie","James M Bischoff","John A Bittl","Mauricio G Cohen","J Michael DiMaio","Creighton W Don","Stephen E Fremes","Mario F Gaudino","Zachary D Goldberger","Michael C Grant","Jang B Jaswal","Paul A Kurlansky","Roxana Mehran","Thomas S Metkus","Lorraine C Nnacheta","Sunil V Rao","Frank W Sellke","Garima Sharma","Celina M Yong","Brittany A Zwischenberger"],"significance":10,"published":"2022-01-18","source_date":"2022-01-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"The 2021 ACC/AHA/SCAI coronary revascularization guideline executive summary integrated evidence from ISCHEMIA, EXCEL, NOBLE, and contemporary trials to update recommendations for PCI versus CABG decision-making. The document emphasized heart team consultation, functional ischemia testing, and patient-centered shared decision-making for complex coronary disease.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Executive summary van de 2021 ACC/AHA/SCAI richtlijn voor coronaire revascularisatie. Integreert ISCHEMIA, EXCEL, NOBLE en recente trials.","abstract_original":"AIM: The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. METHODS: A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline."},{"id":"332b27df6b1b","type":"article","url":"https://hartvaat.nl/2022/01/18/magnetisch-gecontroleerde-capsule-endoscopie-voor-antiplaatjestherapie-gi-schade/","title":"Magnetisch gecontroleerde capsule-endoscopie voor antiplaatjestherapie GI-schade","title_en":"Magnetically Controlled Capsule Endoscopy for Assessment of Antiplatelet Therapy-Induced Gastrointestinal Injury.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.10.028","source_url":"https://doi.org/10.1016/j.jacc.2021.10.028","authors":["Yaling Han","Zhuan Liao","Yi Li","Xianxian Zhao","Shuren Ma","Dan Bao","Miaohan Qiu","Jie Deng","Jinhai Wang","Peng Qu","Chunmeng Jiang","Shaobin Jia","Shaoqi Yang","Leisheng Ru","Jia Feng","Wei Gao","Yonghui Huang","Ling Tao","Ying Han","Kan Yang","Xiaoyan Wang","Wenjuan Zhang","Bangmao Wang","Yue Li","Youlin Yang","Junxia Li","Jiangqiu Sheng","Yitong Ma","Min Cui","Sicong Ma","Xiaozeng Wang","Zhaoshen Li","Gregg W Stone"],"significance":5,"published":"2022-01-18","source_date":"2022-01-18","image":"","kennis":[],"congress":"","summary_en":"This study used magnetically controlled capsule endoscopy to non-invasively assess antiplatelet therapy-induced gastrointestinal injury, providing a patient-friendly method for detecting subclinical GI damage.","created":"2026-07-03T10:29:36Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar magnetisch gecontroleerde capsule-endoscopie voor beoordeling van antiplaatjestherapie-geïnduceerde GI-schade.","abstract_original":"BACKGROUND: Gastrointestinal bleeding is the most frequent major complication of antiplatelet therapy. In patients at low bleeding risk, however, clinically overt gastrointestinal bleeding is relatively uncommon. OBJECTIVES: The authors sought to assess the effects of different antiplatelet regimens on gastrointestinal mucosal injury by means of a novel magnetically controlled capsule endoscopy system in patients at low bleeding risk. METHODS: Patients (n = 505) undergoing percutaneous coronary intervention in whom capsule endoscopy demonstrated no ulcerations or bleeding (although erosions were permitted) after 6 months of dual antiplatelet therapy (DAPT) were randomly assigned to aspirin plus placebo (n = 168), clopidogrel plus placebo (n = 169), or aspirin plus clopidogrel (n = 168) for an additional 6 months. The primary endpoint was the incidence of gastrointestinal mucosal injury (erosions, ulceration, or bleeding) at 6-month or 12-month capsule endoscopy. RESULTS: Gastrointestinal mucosal injury through 12 months was less with single antiplatelet therapy (SAPT) than with DAPT (94.3% vs 99.2%; P = 0.02). Aspirin and clopidogrel monotherapy had similar effects. Among 68 patients without any gastrointestinal injury at randomization (including no erosions), SAPT compared with DAPT caused less gastrointestinal injury (68.1% vs 95.2%; P = 0.006), including fewer new ulcers (8.5% vs 38.1%; P = 0.009). Clinical gastrointestinal bleeding from 6 to 12 months was less with SAPT than with DAPT (0.6% vs 5.4%; P = 0.001). CONCLUSIONS: Despite being at low risk of bleeding, nearly all patients receiving antiplatelet therapy developed gastrointestinal injury, although overt bleeding was infrequent. DAPT for 6 months followed by SAPT with aspirin or clopidogrel from 6 to 12 months resulted in less gastrointestinal mucosal injury and clinical bleeding compared with DAPT through 12 months. (OPT-PEACE [Optimal Antiplatelet Therapy for Prevention of Gastrointestinal Injury Evaluated by Ankon Magnetically Controlled Capsule Endoscopy]; NCT03198741)."},{"id":"594029179c19","type":"article","url":"https://hartvaat.nl/2022/01/13/ffr-geleide-pci-versus-cabg-nejm-fame-3/","title":"FFR-geleide PCI versus CABG: NEJM FAME 3","title_en":"Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2112299","source_url":"https://doi.org/10.1056/NEJMoa2112299","authors":["William F Fearon","Frederik M Zimmermann","Bernard De Bruyne","Zsolt Piroth","Albert H M van Straten","Laszlo Szekely","Giedrius Davidavičius","Gintaras Kalinauskas","Samer Mansour","Rajesh Kharbanda","Nikolaos Östlund-Papadogeorgos","Adel Aminian","Keith G Oldroyd","Nawwar Al-Attar","Nikola Jagic","Jan-Henk E Dambrink","Petr Kala","Oskar Angerås","Philip MacCarthy","Olaf Wendler","Filip Casselman","Nils Witt","Kreton Mavromatis","Steven E S Miner","Jaydeep Sarma","Thomas Engstrøm","Evald H Christiansen","Pim A L Tonino","Michael J Reardon","Di Lu","Victoria Y Ding","Yuhei Kobayashi","Mark A Hlatky","Kenneth W Mahaffey","Manisha Desai","Y Joseph Woo","Alan C Yeung","Nico H J Pijls"],"significance":9,"published":"2022-01-13","source_date":"2022-01-13","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The FAME 3 trial showed that FFR-guided PCI was not noninferior to CABG for the composite of death, MI, stroke, or repeat revascularization at 1 year in patients with three-vessel coronary artery disease. The result reinforced CABG as the preferred strategy for extensive multivessel disease.","created":"2026-07-03T10:29:35Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM FAME 3 trial die FFR-geleide PCI vergeleek met CABG bij drievatencoronairlijden. PCI niet non-inferieur aan CABG — bevestigt CABG-voorkeur bij uitgebreid coronairlijden.","abstract_original":"BACKGROUND: Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking. METHODS: In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed. RESULTS: A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (±SD) of 3.7±1.9 stents, and those assigned to undergo CABG received 3.4±1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval [CI], 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P = 0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group. CONCLUSIONS: In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. (Funded by Medtronic and Abbott Vascular; FAME 3 ClinicalTrials.gov number, NCT02100722.)."},{"id":"898f5a2d3d46","type":"article","url":"https://hartvaat.nl/2022/01/13/risicofactoren-voor-type-1-en-type-2-mi/","title":"Risicofactoren voor type 1 en type 2 MI","title_en":"Risk factors for type 1 and type 2 myocardial infarction.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab581","source_url":"https://doi.org/10.1093/eurheartj/ehab581","authors":["Ryan Wereski","Dorien M Kimenai","Anda Bularga","Caelan Taggart","David J Lowe","Nicholas L Mills","Andrew R Chapman"],"significance":6,"published":"2022-01-13","source_date":"2022-01-13","image":"","kennis":[],"congress":"","summary_en":"This study identified distinct risk factor profiles for type 1 versus type 2 myocardial infarction, showing that while type 1 MI is driven by traditional atherosclerotic risk factors, type 2 MI is associated with non-cardiac comorbidities.","created":"2026-07-03T10:29:35Z","updated":"2026-07-03T13:28:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de risicofactoren die type 1 en type 2 myocardinfarct onderscheiden.","abstract_original":"AIMS: Whilst the risk factors for type 1 myocardial infarction due to atherosclerotic plaque rupture and thrombosis are established, our understanding of the factors that predispose to type 2 myocardial infarction during acute illness is still emerging. Our aim was to evaluate and compare the risk factors for type 1 and type 2 myocardial infarction. METHODS AND RESULTS: We conducted a secondary analysis of a multi-centre randomized trial population of 48 282 consecutive patients attending hospital with suspected acute coronary syndrome. The diagnosis of myocardial infarction during the index presentation and all subsequent reattendances was adjudicated according to the Universal Definition of Myocardial Infarction. Cox regression was used to identify predictors of future type 1 and type 2 myocardial infarction during a 1-year follow-up period. Within 1 year, 1331 patients had a subsequent myocardial infarction, with 924 and 407 adjudicated as type 1 and type 2 myocardial infarction, respectively. Risk factors for type 1 and type 2 myocardial infarction were similar, with age, hyperlipidaemia, diabetes, abnormal renal function, and known coronary disease predictors for both (P < 0.05 for all). Whilst women accounted for a greater proportion of patients with type 2 as compared to type 1 myocardial infarction, after adjustment for other risk factors, sex was not a predictor of type 2 myocardial events [adjusted hazard ratio (aHR) 0.82, 95% confidence interval (CI) 0.66-1.01]. The strongest predictor of type 2 myocardial infarction was a prior history of type 2 events (aHR 6.18, 95% CI 4.70-8.12). CONCLUSIONS: Risk factors for coronary disease that are associated with type 1 myocardial infarction are also important predictors of type 2 events during acute illness. Treatment of these risk factors may reduce future risk of both type 1 and type 2 myocardial infarction."},{"id":"ca826f4dc6b8","type":"article","url":"https://hartvaat.nl/2022/01/04/4-jaars-laa-sluiting-versus-niet-warfarine-oac-bij-af/","title":"4-jaars LAA-sluiting versus niet-warfarine OAC bij AF","title_en":"4-Year Outcomes After Left Atrial Appendage Closure Versus Nonwarfarin Oral Anticoagulation for Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2021.10.023","source_url":"https://doi.org/10.1016/j.jacc.2021.10.023","authors":["Pavel Osmancik","Dalibor Herman","Petr Neuzil","Pavel Hala","Milos Taborsky","Petr Kala","Martin Poloczek","Josef Stasek","Ludek Haman","Marian Branny","Jan Chovancik","Pavel Cervinka","Jiri Holy","Tomas Kovarnik","David Zemanek","Stepan Havranek","Vlastimil Vancura","Petr Peichl","Petr Tousek","Veronika Lekesova","Jiri Jarkovsky","Martina Novackova","Klara Benesova","Petr Widimsky","Vivek Y Reddy"],"significance":7,"published":"2022-01-04","source_date":"2022-01-04","image":"","kennis":[],"congress":"","summary_en":"Four-year PRAGUE-17 results confirmed that left atrial appendage closure is noninferior to DOAC therapy for AF-related stroke prevention, providing the longest-term randomized comparison of structural versus pharmacological stroke prevention using contemporary anticoagulants.","created":"2026-07-03T10:29:35Z","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":"4-jaarsresultaten van linker-hartoorsluiting versus niet-warfarine OAC bij AF.","abstract_original":"BACKGROUND: The PRAGUE-17 (Left Atrial Appendage Closure vs Novel Anticoagulation Agents in Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) was noninferior to nonwarfarin direct oral anticoagulants (DOACs) for preventing major neurological, cardiovascular, or bleeding events in patients with atrial fibrillation (AF) who were at high risk. OBJECTIVES: This study sought to assess the prespecified long-term (4-year) outcomes in PRAGUE-17. METHODS: PRAGUE-17 was a randomized noninferiority trial comparing percutaneous LAAC (Watchman or Amulet) with DOACs (95% apixaban) in patients with nonvalvular AF and with a history of cardioembolism, clinically-relevant bleeding, or both CHA2DS2-VASc ≥3 and HASBLED ≥2. The primary endpoint was a composite of cardioembolic events (stroke, transient ischemic attack, or systemic embolism), cardiovascular death, clinically relevant bleeding, or procedure-/device-related complications (LAAC group only). The primary analysis was modified intention-to-treat. RESULTS: This study randomized 402 patients with AF (201 per group, age 73.3 ± 7.0 years, 65.7% male, CHA2DS2-VASc 4.7 ±1.5, HASBLED 3.1 ± 0.9). After 3.5 years median follow-up (1,354 patient-years), LAAC was noninferior to DOACs for the primary endpoint by modified intention-to-treat (subdistribution HR [sHR]: 0.81; 95% CI: 0.56-1.18; P = 0.27; P for noninferiority = 0.006). For the components of the composite endpoint, the corresponding sHRs were 0.68 (95% CI: 0.39-1.20; P = 0.19) for cardiovascular death, 1.14 (95% CI: 0.56-2.30; P = 0.72) for all-stroke/transient ischemic attack, 0.75 (95% CI: 0.44-1.27; P = 0.28) for clinically relevant bleeding, and 0.55 (95% CI: 0.31-0.97; P = 0.039) for nonprocedural clinically relevant bleeding. The primary endpoint outcomes were similar in the per-protocol (sHR: 0.80; 95% CI: 0.54-1.18; P = 0.25) and on-treatment (sHR: 0.82; 95% CI: 0.56-1.20; P = 0.30) analyses. CONCLUSIONS: In long-term follow-up of PRAGUE-17, LAAC remains noninferior to DOACs for preventing major cardiovascular, neurological, or bleeding events. Furthermore, nonprocedural bleeding was significantly reduced with LAAC. (PRAGUE-17 [Left Atrial Appendage Closure vs Novel Anticoagulation Agents in Atrial Fibrillation]; NCT02426944)."},{"id":"a9a655a59e50","type":"article","url":"https://hartvaat.nl/2022/01/04/sglt2-remmers-en-plotse-hartdood-ventriculaire-aritmie-meta-analyse/","title":"SGLT2-remmers en plotse hartdood/ventriculaire aritmie: meta-analyse","title_en":"Association between sodium-glucose cotransporter-2 inhibitors and risk of sudden cardiac death or ventricular arrhythmias: a meta-analysis of randomized controlled trials.","category":"preventie","category_label":"Preventie","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/euab177","source_url":"https://doi.org/10.1093/europace/euab177","authors":["Dimitrios Sfairopoulos","Nan Zhang","Yueying Wang","Ziliang Chen","Konstantinos P Letsas","Gary Tse","Guangping Li","Gregory Y H Lip","Tong Liu","Panagiotis Korantzopoulos"],"significance":7,"published":"2022-01-04","source_date":"2022-01-04","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"This meta-analysis found that SGLT2 inhibitors may reduce the risk of sudden cardiac death and ventricular arrhythmias in patients with type 2 diabetes and heart failure, suggesting an antiarrhythmic component to the cardiovascular benefit of SGLT2 inhibition.","created":"2026-07-03T10:29:35Z","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":"Meta-analyse naar de associatie van SGLT2-remmers met het risico op plotse hartdood of ventriculaire aritmieën.","abstract_original":"AIMS: Sudden cardiac death (SCD) and ventricular arrhythmias (VAs) are important causes of mortality in patients with type 2 diabetes mellitus (T2DM), heart failure (HF), or chronic kidney disease (CKD). We evaluated the effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors on SCD and VAs in these patients. METHODS AND RESULTS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that enrolled patients with T2DM and/or HF and/or CKD comparing SGLT2i and placebo or active control. PubMed and ClinicalTrials.gov were systematically searched until November 2020. A total of 19 RCTs with 55 ,590 participants were included. Sudden cardiac death events were reported in 9 RCTs (48 patients receiving SGLT2i and 57 placebo subjects). There was no significant association between SGLT2i therapy and SCD [risk ratio (RR) 0.74, 95% confidence interval (CI) 0.50-1.08; P = 0.12]. Ventricular arrhythmias were reported in 17 RCTs (126 patients receiving SGLT2i and 134 controls). SGLT2i therapy was not associated with a lower risk of VAs (RR 0.84, 95% CI 0.66-1.06; P = 0.14). Besides the subgroup of low-dosage SGLT2i therapy that demonstrated decreased VAs compared to control (RR 0.45, 95% CI 0.25-0.82; P = 0.009), or to placebo (RR 0.46, 95% CI 0.25-0.85; P = 0.01), further subgroup analysis did not demonstrate any significant differences. CONCLUSION: SGLT2i therapy was not associated with an overall lower risk of SCD or VAs in patients with T2DM and/or HF and/or CKD. However, further research is needed since the number of SCD and VA events were relatively few leading to wide confidence intervals, and the point estimates suggested potential benefits."},{"id":"2c06f8bce76b","type":"article","url":"https://hartvaat.nl/2022/01/04/enkele-freeze-cryoballonablatie-bij-af-ehra-systematische-review/","title":"Enkele freeze cryoballonablatie bij AF: EHRA systematische review","title_en":"Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis.","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/euab133","source_url":"https://doi.org/10.1093/europace/euab133","authors":["Michal Miroslaw Farkowski","Michal Karlinski","Sergio Barra","Rui Providencia","Dominik Golicki","Mariusz Pytkowski","Ante Anic","Julian Kyoung Ryul Chun","Carlo de Asmundis","Deirdre Anne Lane","Serge Boveda"],"significance":5,"published":"2022-01-04","source_date":"2022-01-04","image":"","kennis":[],"congress":"","summary_en":"This EHRA systematic review confirmed that a single cryoballoon freeze application per vein achieves comparable efficacy and safety to the standard double-freeze protocol, supporting procedural simplification for AF ablation.","created":"2026-07-03T10:29:35Z","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":"EHRA systematische review naar de effectiviteit en veiligheid van een enkele freeze cryoballonapplicatie bij AF-ablatie.","abstract_original":"To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double ('bonus') freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98-1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53-0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37-1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double ('bonus') freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696)."},{"id":"125bfe1d2791","type":"article","url":"https://hartvaat.nl/2022/01/01/sacubitril-valsartan-bij-gevorderd-hfref-jama-cardiology-life-gerandomiseerde-tr/","title":"Sacubitril/valsartan bij gevorderd HFrEF: JAMA Cardiology LIFE gerandomiseerde trial","title_en":"Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["answer-hf","dapa-hf","sacubitril-valsartan","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.4567","source_url":"https://doi.org/10.1001/jamacardio.2021.4567","authors":["Douglas L Mann","Michael M Givertz","Justin M Vader","Randall C Starling","Palak Shah","Steven E McNulty","Kevin J Anstrom","Kenneth B Margulies","Michael S Kiernan","Claudius Mahr","Divya Gupta","Margaret M Redfield","Anuradha Lala","Gregory D Lewis","Adam D DeVore","Patrice Desvigne-Nickens","Adrian F Hernandez","Eugene Braunwald"],"significance":7,"published":"2022-01-01","source_date":"2022-01-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"The LIFE trial showed that sacubitril-valsartan in patients with advanced (NYHA class IV) HFrEF is safe but does not provide significant clinical benefit beyond standard RAAS inhibition, defining the limits of ARNI therapy in end-stage heart failure.","created":"2026-07-03T10:29:35Z","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":"JAMA Cardiology LIFE trial van sacubitril/valsartan bij patiënten met gevorderd HFrEF.","abstract_original":"IMPORTANCE: The use of sacubitril/valsartan is not endorsed by practice guidelines for use in patients with New York Heart Association class IV heart failure with a reduced ejection fraction because of limited clinical experience in this population. OBJECTIVE: To compare treatment with sacubitril/valsartan treatment with valsartan in patients with advanced heart failure and a reduced ejection fraction and recent New York Heart Association class IV symptoms. DESIGN, SETTING, AND PARTICIPANTS: A double-blind randomized clinical trial was conducted; a total of 335 patients with advanced heart failure were included. The trial began on March 2, 2017, and was stopped early on March 23, 2020, owing to COVID-19 risk. INTERVENTION: Patients were randomized to receive sacubitril/valsartan (target dose, 200 mg twice daily) or valsartan (target dose, 160 mg twice daily) in addition to recommended therapy. MAIN OUTCOMES AND MEASURES: The area under the curve (AUC) for the ratio of N-terminal pro-brain natriuretic peptide (NT-proBNP) compared with baseline measured through 24 weeks of therapy. RESULTS: Of the 335 patients included in the analysis, 245 were men (73%); mean (SD) age was 59.4 (13.5) years. Seventy-two eligible patients (18%) were not able to tolerate sacubitril/valsartan, 100 mg/d, during the short run-in period, and 49 patients (29%) discontinued sacubitril/valsartan during the 24 weeks of the trial. The median NT-proBNP AUC for the valsartan treatment arm (n = 168) was 1.19 (IQR, 0.91-1.64), whereas the AUC for the sacubitril/valsartan treatment arm (n = 167) was 1.08 (IQR, 0.75-1.60). The estimated ratio of change in the NT-proBNP AUC was 0.95 (95% CI 0.84-1.08; P = .45). Compared with valsartan, treatment with sacubitril/valsartan did not improve the clinical composite of number of days alive, out of hospital, and free from heart failure events. Aside from a statistically significant increase in non-life-threatening hyperkalemia in the sacubitril/valsartan arm (28 [17%] vs 15 [9%]; P = .04), there were no observed safety concerns. CONCLUSIONS AND RELEVANCE: The findings of this trial showed that, in patients with chronic advanced heart failure with a reduced ejection fraction, there was no statistically significant difference between sacubitril/valsartan and valsartan with respect to reducing NT-proBNP levels. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02816736."},{"id":"68329be68ca9","type":"article","url":"https://hartvaat.nl/2022/01/01/omecamtiv-mecarbil-bij-ernstig-hf-galactic-hf-post-hoc-analyse/","title":"Omecamtiv mecarbil bij ernstig HF: GALACTIC-HF post-hoc analyse","title_en":"Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2021.4027","source_url":"https://doi.org/10.1001/jamacardio.2021.4027","authors":["G Michael Felker","Scott D Solomon","Brian Claggett","Rafael Diaz","John J V McMurray","Marco Metra","Inder Anand","Marisa G Crespo-Leiro","Ulf Dahlström","Eva Goncalvesova","Jonathan G Howlett","Peter MacDonald","Alexander Parkhomenko","János Tomcsányi","Siddique A Abbasi","Stephen B Heitner","Thomas Hucko","Stuart Kupfer","Fady I Malik","John R Teerlink"],"significance":6,"published":"2022-01-01","source_date":"2022-01-01","image":"","kennis":[],"congress":"","summary_en":"This GALACTIC-HF post-hoc analysis showed that omecamtiv mecarbil provides the greatest absolute benefit in patients with the most severe heart failure (lowest EF, highest NT-proBNP), identifying the target population for cardiac myosin activation.","created":"2026-07-03T10:29:35Z","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":"JAMA Cardiology GALACTIC-HF post-hoc analyse van omecamtiv mecarbil bij patiënten met ernstig hartfalen.","abstract_original":"IMPORTANCE: Heart failure with reduced ejection fraction is a progressive clinical syndrome, and many patients' condition worsen over time despite treatment. Patients with more severe disease are often intolerant of available medical therapies. OBJECTIVE: To evaluate the efficacy and safety of omecamtiv mecarbil for the treatment of patients with severe heart failure (HF) enrolled in the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) randomized clinical trial. DESIGN, SETTING, AND PARTICIPANTS: The GALACTIC-HF study was a global double-blind, placebo-controlled phase 3 randomized clinical trial that was conducted at multiple centers between January 2017 and August 2020. A total of 8232 patients with symptomatic HF (defined as New York Heart Association symptom class II-IV) and left ventricular ejection fraction of 35% or less were randomized to receive omecamtiv mecarbil or placebo and followed up for a median of 21.8 months (range, 15.4-28.6 months). The current post hoc analysis evaluated the efficacy and safety of omecamtiv mecarbil therapy among patients classified as having severe HF compared with patients without severe HF. Severe HF was defined as the presence of all of the following criteria: New York Heart Association symptom class III to IV, left ventricular ejection fraction of 30% or less, and hospitalization for HF within the previous 6 months. INTERVENTIONS: Participants were randomized at a 1:1 ratio to receive either omecamtiv mecarbil or placebo. MAIN OUTCOMES AND MEASURES: The primary end point was time to first HF event or cardiovascular (CV) death. Secondary end points included time to CV death and safety and tolerability. RESULTS: Among 8232 patients enrolled in the GALACTIC-HF clinical trial, 2258 patients (27.4%; mean [SD] age, 64.5 [11.6] years; 1781 men [78.9%]) met the specified criteria for severe HF. Of those, 1106 patients were randomized to the omecamtiv mecarbil group and 1152 to the placebo group. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit for the primary end point (hazard ratio [HR], 0.80; 95% CI, 0.71-0.90), whereas patients without severe HF had no significant treatment benefit (HR, 0.99; 95% CI, 0.91-1.08; P = .005 for interaction). For CV death, the results were similar (HR for patients with vs without severe HF: 0.88 [95% CI, 0.75-1.03] vs 1.10 [95% CI, 0.97-1.25]; P = .03 for interaction). Omecamtiv mecarbil therapy was well tolerated in patients with severe HF, with no significant changes in blood pressure, kidney function, or potassium level compared with placebo. CONCLUSIONS AND RELEVANCE: In this post hoc analysis of data from the GALACTIC-HF clinical trial, omecamtiv mecarbil therapy may have provided a clinically meaningful reduction in the composite end point of time to first HF event or CV death among patients with severe HF. These data support a potential role of omecamtiv mecarbil therapy among patients for whom current treatment options are limited. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02929329."},{"id":"3ba4a24e7de8","type":"article","url":"https://hartvaat.nl/2022/01/01/farmacologische-hypertensiebehandeling-bij-volwassenen-who-richtlijn-samenvattin/","title":"Farmacologische hypertensiebehandeling bij volwassenen: WHO-richtlijn samenvatting","title_en":"Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","bloeddrukbehandeling","ras-remmers","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.121.18192","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.121.18192","authors":["Akram Al-Makki","Donald DiPette","Paul K Whelton","M Hassan Murad","Reem A Mustafa","Shrish Acharya","Hind Mamoun Beheiry","Beatriz Champagne","Kenneth Connell","Marie Therese Cooney","Nnenna Ezeigwe","Thomas Andrew Gaziano","Agaba Gidio","Patricio Lopez-Jaramillo","Unab I Khan","Vindya Kumarapeli","Andrew E Moran","Margaret Mswema Silwimba","Brian Rayner","Apichard Sukonthasan","Jing Yu","Nizal Saraffzadegan","K Srinath Reddy","Taskeen Khan"],"significance":9,"published":"2022-01-01","source_date":"2022-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The WHO executive summary on pharmacological hypertension treatment provided practical, globally applicable recommendations including treatment initiation thresholds, drug class selection, and follow-up strategies for resource-limited settings where the burden of uncontrolled hypertension is greatest.","created":"2026-07-03T10:29:35Z","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":"Executive summary van de WHO-richtlijn voor farmacologische hypertensiebehandeling bij volwassenen. Wereldwijde aanbevelingen voor resource-beperkte settings.","abstract_original":"Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide."},{"id":"2e3e7e8ef8c1","type":"article","url":"https://hartvaat.nl/2022/01/01/sglt2-remmers-over-het-cv-ziektespectrum-overzicht/","title":"SGLT2-remmers over het CV-ziektespectrum: overzicht","title_en":"Benefits of sodium glucose cotransporter 2 inhibitors across the spectrum of cardiovascular diseases.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2021-319185","source_url":"https://doi.org/10.1136/heartjnl-2021-319185","authors":["Gaurav S Gulsin","Matthew P M Graham-Brown","Iain B Squire","Melanie J Davies","Gerry P McCann"],"significance":7,"published":"2022-01-01","source_date":"2022-01-01","image":"","kennis":[],"congress":"","summary_en":"This review summarized the cardiovascular benefits of SGLT2 inhibitors across the full spectrum of diseases — type 2 diabetes, heart failure (HFrEF and HFpEF), and CKD — providing a unified perspective on their therapeutic versatility.","created":"2026-07-03T10:29:35Z","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":"Overzicht van de voordelen van SGLT2-remmers over het volledige spectrum van cardiovasculaire ziekten.","abstract_original":"Sodium glucose cotransporter 2 inhibitors (SGLT2i) have emerged as a class of medications with positive cardiovascular (CV) effects across a spectrum of patients with and without type 2 diabetes (T2D). In heart failure with reduced ejection fraction, there is clear evidence that SGLT2i reduce hospitalisations and mortality regardless of the presence of diabetes, and they are now recognised as the fourth pillar of pharmacological management. Recent trial data also indicate promising effects in heart failure with preserved ejection fraction. In patients with T2D and atherosclerotic CV diseases, multiple CV outcomes trials have shown reductions in major adverse CV events. Meta-analysis of these trials also shows lower rates of incident and recurrent atrial fibrillation with SGLT2i. Concerns regarding utilisation in patients with chronic kidney disease have been allayed in trials showing SGLT2i in fact have renoprotective effects. Questions still remain regarding the safety of SGLT2i in the acute heart failure setting and immediately post myocardial infarction, as well as in patients with more advanced stages of chronic kidney disease. Furthermore, studies are underway evaluating SGLT2i in patients with heart valve disease, where positive effects on left ventricular remodelling may, for example, improve functional mitral regurgitation. In this review, we summarise the available evidence of recent CV outcomes trials of SGLT2i, focusing particularly on the application of these agents across various CV diseases. We detail evidence to support increased utilisation of these drugs, which in many cases will reduce mortality and improve quality of life in patients routinely encountered by the CV specialist physician."},{"id":"9883cb407c01","type":"article","url":"https://hartvaat.nl/2022/01/01/telomeerlengte-en-mortaliteit-bij-chronisch-hartfalen/","title":"Telomeerlengte en mortaliteit bij chronisch hartfalen","title_en":"Telomere length is independently associated with all-cause mortality in chronic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-318654","source_url":"https://doi.org/10.1136/heartjnl-2020-318654","authors":["Simon P R Romaine","Matthew Denniff","Veryan Codd","Mintu Nath","Andrea Koekemoer","Stefan D Anker","John G Cleland","Gerasimos Filippatos","Daniel Levin","Marco Metra","Ify R Mordi","Wouter Ouwerkerk","Jozine M Ter Maaten","Dirk J van Veldhuisen","Faiez Zannad","Leong L Ng","Pim van der Harst","Chim C Lang","Adriaan A Voors","Christopher P Nelson","Nilesh J Samani"],"significance":5,"published":"2022-01-01","source_date":"2022-01-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that leucocyte telomere length, a marker of biological aging, is independently associated with all-cause mortality in chronic heart failure, adding a measure of cellular senescence to HF risk stratification.","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":"Studie die telomeerlengte als onafhankelijke voorspeller van mortaliteit identificeerde bij chronisch HF.","abstract_original":"OBJECTIVE: Patients with heart failure have shorter mean leucocyte telomere length (LTL), a marker of biological age, compared with healthy subjects, but it is unclear whether this is of prognostic significance. We therefore sought to determine whether LTL is associated with outcomes in patients with heart failure. METHODS: We measured LTL in patients with heart failure from the BIOSTAT-CHF Index (n=2260) and BIOSTAT-CHF Tayside (n=1413) cohorts. Cox proportional hazards analyses were performed individually in each cohort and the estimates combined using meta-analysis. Our co-primary endpoints were all-cause mortality and heart failure hospitalisation. RESULTS: In age-adjusted and sex-adjusted analyses, shorter LTL was associated with higher all-cause mortality in both cohorts individually and when combined (meta-analysis HR (per SD decrease in LTL)=1.16 (95% CI 1.08 to 1.24); p=2.66×10-5), an effect equivalent to that of being four years older. The association remained significant after adjustment for the BIOSTAT-CHF clinical risk score to account for known prognostic factors (HR=1.12 (95% CI 1.05 to 1.20); p=1.04×10-3). Shorter LTL was associated with both cardiovascular (HR=1.09 (95% CI 1.00 to 1.19); p=0.047) and non-cardiovascular deaths (HR=1.18 (95% CI 1.05 to 1.32); p=4.80×10-3). There was no association between LTL and heart failure hospitalisation (HR=0.99 (95% CI 0.92 to 1.07); p=0.855). CONCLUSION: In patients with heart failure, shorter mean LTL is independently associated with all-cause mortality."}]}