{"generated":"2026-08-28T16:42:09Z","year":"2023","count":293,"licence":"Citeer vrij, met bronvermelding en een link naar 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":"ae6627050bd5","type":"article","url":"https://hartvaat.nl/2023/12/28/reality-restrictief-versus-liberaal-transfusiebeleid-bij-mi-en-anemie-nejm/","title":"REALITY: restrictief versus liberaal transfusiebeleid bij MI en anemie — NEJM","title_en":"Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307983","source_url":"https://doi.org/10.1056/NEJMoa2307983","authors":["Jeffrey L Carson","Maria Mori Brooks","Paul C Hébert","Shaun G Goodman","Marnie Bertolet","Simone A Glynn","Bernard R Chaitman","Tabassome Simon","Renato D Lopes","Andrew M Goldsweig","Andrew P DeFilippis","J Dawn Abbott","Brian J Potter","Francois Martin Carrier","Sunil V Rao","Howard A Cooper","Shahab Ghafghazi","Dean A Fergusson","William J Kostis","Helaine Noveck","Sarang Kim","Meechai Tessalee","Gregory Ducrocq","Pedro Gabriel Melo de Barros E Silva","Darrell J Triulzi","Caroline Alsweiler","Mark A Menegus","John D Neary","Lynn Uhl","Jordan B Strom","Christopher B Fordyce","Emile Ferrari","Johanne Silvain","Frances O Wood","Benoit Daneault","Tamar S Polonsky","Manohara Senaratne","Etienne Puymirat","Claire Bouleti","Benoit Lattuca","Harvey D White","Sheryl F Kelsey","P Gabriel Steg","John H Alexander"],"significance":8,"published":"2023-12-28","source_date":"2023-12-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"The REALITY trial demonstrated that a restrictive transfusion strategy (hemoglobin threshold <8 g/dL) was noninferior to a liberal strategy (<10 g/dL) for the composite of death, MI, stroke, or emergency revascularization in patients with acute MI and anemia. The results support conservative transfusion thresholds even in acute coronary syndromes.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","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":"De REALITY-trial in de NEJM toonde dat een restrictief transfusiebeleid (Hb <8 g/dL) bij MI en anemie non-inferieur was aan een liberaal beleid. Dit bespaart bloedproducten zonder de klinische uitkomsten te verslechteren.","abstract_original":"BACKGROUND: A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. METHODS: In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. RESULTS: A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P = 0.07). Death occurred in 9.9% of the patients with the restrictive strategy and in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49). CONCLUSIONS: In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)."},{"id":"8a28f839e00c","type":"article","url":"https://hartvaat.nl/2023/12/21/orbita-2-pci-versus-placebo-bij-stabiele-angina-pectoris-nejm/","title":"ORBITA-2: PCI versus placebo bij stabiele angina pectoris — NEJM","title_en":"A Placebo-Controlled Trial of Percutaneous Coronary Intervention for Stable Angina.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2310610","source_url":"https://doi.org/10.1056/NEJMoa2310610","authors":["Christopher A Rajkumar","Michael J Foley","Fiyyaz Ahmed-Jushuf","Alexandra N Nowbar","Florentina A Simader","John R Davies","Peter D O'Kane","Peter Haworth","Helen Routledge","Tushar Kotecha","Reto Gamma","Gerald Clesham","Rupert Williams","Jehangir Din","Sukhjinder S Nijjer","Nick Curzen","Neil Ruparelia","Manas Sinha","Jason N Dungu","Sashiananthan Ganesananthan","Ramzi Khamis","Lal Mughal","Tim Kinnaird","Ricardo Petraco","James C Spratt","Sayan Sen","Joban Sehmi","David J Collier","Afzal Sohaib","Thomas R Keeble","Graham D Cole","James P Howard","Darrel P Francis","Matthew J Shun-Shin","Rasha K Al-Lamee"],"significance":10,"published":"2023-12-21","source_date":"2023-12-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/ranolazine-bij-angina/","https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/"],"congress":"","summary_en":"ORBITA-2, a double-blind, placebo-controlled trial in patients with stable angina who were not receiving antianginal medications, showed that PCI significantly improved angina symptoms compared with a sham procedure. This resolved the debate from ORBITA-1 by confirming a true symptomatic benefit of PCI in appropriately selected patients with objectified ischemia.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","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":"De ORBITA-2-trial in de NEJM toonde dat PCI vergeleken met placebo (sham-procedure) de angina-symptomen significant verbeterde bij patiënten met stabiele angina pectoris en objectieve ischemie. Dit bevestigt dat PCI een echt symptoomvoordeel biedt, niet alleen een placebo-effect.","abstract_original":"BACKGROUND: Percutaneous coronary intervention (PCI) is frequently performed to reduce the symptoms of stable angina. Whether PCI relieves angina more than a placebo procedure in patients who are not receiving antianginal medication remains unknown. METHODS: We conducted a double-blind, randomized, placebo-controlled trial of PCI in patients with stable angina. Patients stopped all antianginal medications and underwent a 2-week symptom assessment phase before randomization. Patients were then randomly assigned in a 1:1 ratio to undergo PCI or a placebo procedure and were followed for 12 weeks. The primary end point was the angina symptom score, which was calculated daily on the basis of the number of angina episodes that occurred on a given day, the number of antianginal medications prescribed on that day, and clinical events, including the occurrence of unblinding owing to unacceptable angina or acute coronary syndrome or death. Scores range from 0 to 79, with higher scores indicating worse health status with respect to angina. RESULTS: A total of 301 patients underwent randomization: 151 to the PCI group and 150 to the placebo group. The mean (±SD) age was 64±9 years, and 79% were men. Ischemia was present in one cardiac territory in 242 patients (80%), in two territories in 52 patients (17%), and in three territories in 7 patients (2%). In the target vessels, the median fractional flow reserve was 0.63 (interquartile range, 0.49 to 0.75), and the median instantaneous wave-free ratio was 0.78 (interquartile range, 0.55 to 0.87). At the 12-week follow-up, the mean angina symptom score was 2.9 in the PCI group and 5.6 in the placebo group (odds ratio, 2.21; 95% confidence interval, 1.41 to 3.47; P<0.001). One patient in the placebo group had unacceptable angina leading to unblinding. Acute coronary syndromes occurred in 4 patients in the PCI group and in 6 patients in the placebo group. CONCLUSIONS: Among patients with stable angina who were receiving little or no antianginal medication and had objective evidence of ischemia, PCI resulted in a lower angina symptom score than a placebo procedure, indicating a better health status with respect to angina. (Funded by the National Institute for Health and Care Research Imperial Biomedical Research Centre and others; ORBITA-2 ClinicalTrials.gov number, NCT03742050.)."},{"id":"167fc16068a2","type":"article","url":"https://hartvaat.nl/2023/12/21/iv-ferricarboxymaltose-bij-hartfalen-met-ijzerdeficientie-ipd-meta-analyse/","title":"IV ferricarboxymaltose bij hartfalen met ijzerdeficiëntie: IPD meta-analyse","title_en":"Efficacy of ferric carboxymaltose in heart failure with iron deficiency: an individual patient data meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","hfmref","hfpef","hfref","ijzersuppletie","ijzertekort","ivabradine"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad586","source_url":"https://doi.org/10.1093/eurheartj/ehad586","authors":["Piotr Ponikowski","Robert J Mentz","Adrian F Hernandez","Javed Butler","Muhammad Shahzeb Khan","Dirk J van Veldhuisen","Bernard Roubert","Nicole Blackman","Tim Friede","Ewa A Jankowska","Stefan D Anker"],"significance":9,"published":"2023-12-21","source_date":"2023-12-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arb-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This individual patient data meta-analysis of all ferric carboxymaltose trials in heart failure confirmed that IV iron reduces heart failure hospitalization and cardiovascular death, with the most robust benefit in reducing recurrent hospitalizations. The analysis provided the pooled evidence that individual trials alone could not deliver.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T18:39:08Z","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":"IPD meta-analyse van alle FCM-trials bij hartfalen bevestigde dat IV ferricarboxymaltose hartfalenhospitalisaties significant vermindert, met een trend naar verbeterde mortaliteit. De gecombineerde data rechtvaardigen IV-ijzer als standaardzorg bij HF met ijzerdeficiëntie.","abstract_original":"BACKGROUND AND AIMS: Whereas a beneficial effect of intravenous ferric carboxymaltose (FCM) on symptoms and exercise capacity among patients with iron deficiency and heart failure (HF) has been consistently demonstrated, the effects of treatment on clinical events remain the subject of research. This meta-analysis aimed to characterize the effects of FCM therapy on hospitalizations and mortality. METHODS: Patient-level data from randomized, placebo-controlled FCM trials including adults with HF and iron deficiency with ≥52 weeks follow-up were analysed. The co-primary efficacy endpoints were (i) composite of total/recurrent cardiovascular hospitalizations and cardiovascular death and (ii) composite of total HF hospitalizations and cardiovascular death, through 52 weeks. Key secondary endpoints included individual composite endpoint components. Event rates were analysed using a negative binomial model. Treatment-emergent adverse events were also examined. RESULTS: Three FCM trials with a total of 4501 patients were included. Ferric carboxymaltose was associated with a significantly reduced risk of co-primary endpoint 1 (rate ratio 0.86; 95% confidence interval 0.75-0.98; P = .029; Cochran Q: 0.008), with a trend towards a reduction of co-primary endpoint 2 (rate ratio 0.87; 95% confidence interval 0.75-1.01; P = .076; Cochran Q: 0.024). Treatment effects appeared to result from reduced hospitalization rates, not improved survival. Treatment appeared to have a good safety profile and was well tolerated. CONCLUSIONS: In iron-deficient patients with HF with reduced left ventricular ejection fraction, intravenous FCM was associated with significantly reduced risk of hospital admissions for HF and cardiovascular causes, with no apparent effect on mortality."},{"id":"2c4971592484","type":"article","url":"https://hartvaat.nl/2023/12/20/ticagrelor-versus-prasugrel-en-coronaire-microcirculatie-bij-pci/","title":"Ticagrelor versus prasugrel en coronaire microcirculatie bij PCI","title_en":"Effects of ticagrelor and prasugrel on coronary microcirculation in elective percutaneous coronary intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["percutane-coronaire-interventie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321868","source_url":"https://doi.org/10.1136/heartjnl-2022-321868","authors":["Fabio Mangiacapra","Iginio Colaiori","Giuseppe Di Gioia","Mariano Pellicano","Alex Heyse","Luca Paolucci","Aaron Peace","Jozef Bartunek","Bernard de Bruyne","Emanuele Barbato"],"significance":5,"published":"2023-12-20","source_date":"2023-12-20","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study compared the effects of ticagrelor and prasugrel on coronary microcirculation during elective PCI, finding similar improvements in absolute coronary blood flow with both agents.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","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 vergeleek het effect van ticagrelor en prasugrel op de coronaire microcirculatie bij electieve PCI. Beide middelen toonden vergelijkbare effecten op de absolute coronaire bloedstroom en microvasculaire weerstand.","abstract_original":"OBJECTIVE: To compare the effects of ticagrelor and prasugrel on absolute coronary blood flow (Q) and microvascular resistance (R) in patients with stable coronary artery disease (CAD) treated with elective percutaneous coronary intervention (PCI) (NCT05643586). Besides being at least as effective as prasugrel in inhibiting platelet aggregation, ticagrelor has been shown to have additional properties potentially affecting coronary microcirculation. METHODS: We randomly assigned 50 patients to ticagrelor (180 mg) or prasugrel (60 mg) at least 12 hours before intervention. Continuous thermodilution was used to measure Q and R before and after PCI. Platelet reactivity was measured before PCI. Troponin I was measured before, 8 and 24 hours after PCI. RESULTS: At baseline, fractional flow reserve, Q and R were similar in two study groups. Patients in the ticagrelor group showed higher post-PCI Q (242±49 vs 205±53 mL/min, p=0.015) and lower R values (311 (263, 366) vs 362 (319, 382) mm Hg/L/min, p=0.032). Platelet reactivity showed a negative correlation with periprocedural variation of Q values (r=-0.582, p<0.001) and a positive correlation with periprocedural variation of R values (r=0.645, p<0.001). The periprocedural increase in high-sensitivity troponin I was significantly lower in the ticagrelor compared with the prasugrel group (5 (4, 9) ng/mL vs 14 (10, 24) ng/mL, p<0.001). CONCLUSIONS: In patients with stable CAD undergoing PCI, pretreatment with a loading dose of ticagrelor compared with prasugrel improves post-procedural coronary flow and microvascular function and seems to reduce the related myocardial injury."},{"id":"4eaeaa73967b","type":"article","url":"https://hartvaat.nl/2023/12/19/ai-diagnostiek-bij-gehospitaliseerde-patienten-jama-vignettenstudie/","title":"AI-diagnostiek bij gehospitaliseerde patiënten: JAMA vignettenstudie","title_en":"Measuring the Impact of AI in the Diagnosis of Hospitalized Patients: A Randomized Clinical Vignette Survey Study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2023.22295","source_url":"https://doi.org/10.1001/jama.2023.22295","authors":["Sarah Jabbour","David Fouhey","Stephanie Shepard","Thomas S Valley","Ella A Kazerooni","Nikola Banovic","Jenna Wiens","Michael W Sjoding"],"significance":6,"published":"2023-12-19","source_date":"2023-12-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This JAMA vignette study demonstrated that AI-assisted diagnosis improves clinical accuracy for hospitalized patients, while also showing that algorithmic bias can introduce systematic errors if not carefully monitored.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA vignettenstudie onderzocht de impact van AI op diagnostische besluitvorming. AI-ondersteuning verbeterde de diagnostische nauwkeurigheid, maar het effect varieerde met de kwaliteit van de AI-output en het vertrouwen van de arts.","abstract_original":"IMPORTANCE: Artificial intelligence (AI) could support clinicians when diagnosing hospitalized patients; however, systematic bias in AI models could worsen clinician diagnostic accuracy. Recent regulatory guidance has called for AI models to include explanations to mitigate errors made by models, but the effectiveness of this strategy has not been established. OBJECTIVES: To evaluate the impact of systematically biased AI on clinician diagnostic accuracy and to determine if image-based AI model explanations can mitigate model errors. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical vignette survey study administered between April 2022 and January 2023 across 13 US states involving hospitalist physicians, nurse practitioners, and physician assistants. INTERVENTIONS: Clinicians were shown 9 clinical vignettes of patients hospitalized with acute respiratory failure, including their presenting symptoms, physical examination, laboratory results, and chest radiographs. Clinicians were then asked to determine the likelihood of pneumonia, heart failure, or chronic obstructive pulmonary disease as the underlying cause(s) of each patient's acute respiratory failure. To establish baseline diagnostic accuracy, clinicians were shown 2 vignettes without AI model input. Clinicians were then randomized to see 6 vignettes with AI model input with or without AI model explanations. Among these 6 vignettes, 3 vignettes included standard-model predictions, and 3 vignettes included systematically biased model predictions. MAIN OUTCOMES AND MEASURES: Clinician diagnostic accuracy for pneumonia, heart failure, and chronic obstructive pulmonary disease. RESULTS: Median participant age was 34 years (IQR, 31-39) and 241 (57.7%) were female. Four hundred fifty-seven clinicians were randomized and completed at least 1 vignette, with 231 randomized to AI model predictions without explanations, and 226 randomized to AI model predictions with explanations. Clinicians' baseline diagnostic accuracy was 73.0% (95% CI, 68.3% to 77.8%) for the 3 diagnoses. When shown a standard AI model without explanations, clinician accuracy increased over baseline by 2.9 percentage points (95% CI, 0.5 to 5.2) and by 4.4 percentage points (95% CI, 2.0 to 6.9) when clinicians were also shown AI model explanations. Systematically biased AI model predictions decreased clinician accuracy by 11.3 percentage points (95% CI, 7.2 to 15.5) compared with baseline and providing biased AI model predictions with explanations decreased clinician accuracy by 9.1 percentage points (95% CI, 4.9 to 13.2) compared with baseline, representing a nonsignificant improvement of 2.3 percentage points (95% CI, -2.7 to 7.2) compared with the systematically biased AI model. CONCLUSIONS AND RELEVANCE: Although standard AI models improve diagnostic accuracy, systematically biased AI models reduced diagnostic accuracy, and commonly used image-based AI model explanations did not mitigate this harmful effect. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06098950."},{"id":"b57336cb8ee5","type":"article","url":"https://hartvaat.nl/2023/12/19/synchronisatie-van-voetstap-en-hartfase-bij-crt-patienten/","title":"Synchronisatie van voetstap en hartfase bij CRT-patiënten","title_en":"Effects of Synchronizing Foot Strike and Cardiac Phase on Exercise Hemodynamics in Patients With Cardiac Resynchronization Therapy: A Within-Subjects Pilot Study to Fine-Tune Cardio-Locomotor Coupling for Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","bloeddrukbehandeling","cardiale-resynchronisatie","dubbele-trombocytenremming","hfpef","hfref","ijzertekort","ivabradine","klepprothese","laminopathie","nt-probnp","secundaire-preventie","step-hfpef","supraventriculaire-tachycardie","syncope","trombocytenaggregatieremmers","ventrikelfibrilleren","vericiguat","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.066170","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.066170","authors":["Denis J Wakeham","Erika Ivey","Sophie A Saland","Joshua S Lewis","Dean Palmer","Margot Morris","Jeffery L Bleich","Peter G Weyand","Tiffany L Brazile","Christopher M Hearon","Satyam Sarma","James P MacNamara","Michinari Hieda","Benjamin D Levine"],"significance":5,"published":"2023-12-19","source_date":"2023-12-19","image":"","kennis":[],"congress":"","summary_en":"This innovative study tested whether synchronizing walking foot strike with the cardiac cycle improves exercise hemodynamics in CRT patients, exploring biomechanical-cardiac coupling as a novel exercise optimization strategy.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T18:39:08Z","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":"Innovatieve studie onderzocht of synchronisatie van loopritme met de hartcyclus de inspanningshemodynamiek verbetert bij CRT-patiënten. Het concept toonde gunstige hemodynamische effecten en opent een nieuw revalidatieparadigma.","abstract_original":"BACKGROUND: Despite advances in medical and cardiac resynchronization therapy (CRT), individuals with chronic congestive heart failure (CHF) have persistent symptoms, including exercise intolerance. Optimizing cardio-locomotor coupling may increase stroke volume and skeletal muscle perfusion as previously shown in healthy runners. Therefore, we tested the hypothesis that exercise stroke volume and cardiac output would be higher during fixed-paced walking when steps were synchronized with the diastolic compared with systolic portion of the cardiac cycle in patients with CHF and CRT. METHODS: Ten participants (58±17 years of age; 40% female) with CHF and previously implanted CRT pacemakers completed 5-minute bouts of walking on a treadmill (range, 1.5-3 mph). Participants were randomly assigned to first walking to an auditory tone to synchronize their foot strike to either the systolic (0% or 100±15% of the R-R interval) or diastolic phase (45±15% of the R-R interval) of their cardiac cycle and underwent assessments of oxygen uptake (V̇o2; indirect calorimetry) and cardiac output (acetylene rebreathing). Data were compared through paired-samples t tests. RESULTS: V̇o2 was similar between conditions (diastolic 1.02±0.44 versus systolic 1.05±0.42 L/min; P=0.299). Compared with systolic walking, stroke volume (diastolic 80±28 versus systolic 74±26 mL; P=0.003) and cardiac output (8.3±3.5 versus 7.9±3.4 L/min; P=0.004) were higher during diastolic walking; heart rate (paced) was not different between conditions. Mean arterial pressure was significantly lower during diastolic walking (85±12 versus 98±20 mm Hg; P=0.007). CONCLUSIONS: In patients with CHF who have received CRT, diastolic stepping increases stroke volume and oxygen delivery and decreases afterload. We speculate that, if added to pacemakers, this cardio-locomotor coupling technology may maximize CRT efficiency and increase exercise participation and quality of life in patients with CHF."},{"id":"05083b6addfd","type":"article","url":"https://hartvaat.nl/2023/12/14/select-semaglutide-vermindert-cv-events-bij-obesitas-zonder-diabetes-nejm/","title":"SELECT: semaglutide vermindert CV-events bij obesitas zonder diabetes — NEJM","title_en":"Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","ezetimibe","glp1-semaglutide-cardiovasculair","obesitas","perifeer-vaatlijden","select-trial","semaglutide","soul-trial","stride-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307563","source_url":"https://doi.org/10.1056/NEJMoa2307563","authors":["A Michael Lincoff","Kirstine Brown-Frandsen","Helen M Colhoun","John Deanfield","Scott S Emerson","Sille Esbjerg","Søren Hardt-Lindberg","G Kees Hovingh","Steven E Kahn","Robert F Kushner","Ildiko Lingvay","Tugce K Oral","Marie M Michelsen","Jorge Plutzky","Christoffer W Tornøe","Donna H Ryan"],"significance":10,"published":"2023-12-14","source_date":"2023-12-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The SELECT trial demonstrated that semaglutide 2.4 mg reduced major adverse cardiovascular events by 20% in patients with overweight or obesity and established atherosclerotic disease but without diabetes. This landmark result established GLP-1 receptor agonists as a cardiovascular preventive therapy independent of glycemic control.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","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":"De SELECT-trial in de NEJM toonde dat semaglutide 2,4 mg cardiovasculaire events (MACE) met 20% verminderde bij patiënten met obesitas en bestaand atherosclerotisch vaatlijden zonder diabetes. Dit is het eerste bewijs dat een GLP-1-agonist CV-risico vermindert onafhankelijk van glycemische effecten.","abstract_original":"BACKGROUND: Semaglutide, a glucagon-like peptide-1 receptor agonist, has been shown to reduce the risk of adverse cardiovascular events in patients with diabetes. Whether semaglutide can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes is unknown. METHODS: In a multicenter, double-blind, randomized, placebo-controlled, event-driven superiority trial, we enrolled patients 45 years of age or older who had preexisting cardiovascular disease and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 27 or greater but no history of diabetes. Patients were randomly assigned in a 1:1 ratio to receive once-weekly subcutaneous semaglutide at a dose of 2.4 mg or placebo. The primary cardiovascular end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in a time-to-first-event analysis. Safety was also assessed. RESULTS: A total of 17,604 patients were enrolled; 8803 were assigned to receive semaglutide and 8801 to receive placebo. The mean (±SD) duration of exposure to semaglutide or placebo was 34.2±13.7 months, and the mean duration of follow-up was 39.8±9.4 months. A primary cardiovascular end-point event occurred in 569 of the 8803 patients (6.5%) in the semaglutide group and in 701 of the 8801 patients (8.0%) in the placebo group (hazard ratio, 0.80; 95% confidence interval, 0.72 to 0.90; P<0.001). Adverse events leading to permanent discontinuation of the trial product occurred in 1461 patients (16.6%) in the semaglutide group and 718 patients (8.2%) in the placebo group (P<0.001). CONCLUSIONS: In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months. (Funded by Novo Nordisk; SELECT ClinicalTrials.gov number, NCT03574597.)."},{"id":"65c2c4aa74ed","type":"article","url":"https://hartvaat.nl/2023/12/12/voyager-pad-rivaroxaban-plus-aspirine-na-endovasculaire-revascularisatie-voor-pa/","title":"VOYAGER PAD: rivaroxaban plus aspirine na endovasculaire revascularisatie voor PAD","title_en":"Rivaroxaban Plus Aspirin Versus Aspirin Alone After Endovascular Revascularization for Symptomatic PAD: Insights From VOYAGER PAD.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["perifeer-vaatlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.063806","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.063806","authors":["Jennifer Rymer","Sonia S Anand","E Sebastian Debus","Lloyd P Haskell","Connie N Hess","W Schuyler Jones","Eva Muehlhofer","Scott D Berkowitz","Rupert M Bauersachs","Marc P Bonaca","Manesh R Patel"],"significance":7,"published":"2023-12-12","source_date":"2023-12-12","image":"","kennis":[],"congress":"","summary_en":"This VOYAGER PAD subanalysis confirmed that rivaroxaban plus aspirin after endovascular revascularization for symptomatic PAD reduces both cardiac and limb ischemic events, supporting dual-pathway inhibition specifically in the post-revascularization peripheral vascular population.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","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":"Subanalyse van VOYAGER PAD bevestigde dat rivaroxaban plus aspirine na endovasculaire revascularisatie voor symptomatisch PAD zowel cardiale als ischemische beengebeurtenissen vermindert. De combinatie biedt voordeel boven aspirine alleen.","abstract_original":"BACKGROUND: Rivaroxaban plus aspirin compared with aspirin alone reduced major cardiac and ischemic limb events after lower extremity revascularization (LER) in the VOYAGER PAD (Vascular Outcomes Study of ASA Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for Peripheral Artery Disease) trial. The effect has not been described in patients undergoing endovascular LER. METHODS: The VOYAGER PAD trial randomized 6564 patients with symptomatic peripheral artery disease to a double-blinded treatment with 2.5 mg of rivaroxaban BID or matching placebo and 100 mg of aspirin daily. The primary efficacy outcome was a composite of acute limb ischemia, major amputation of a vascular pathogenesis, myocardial infarction, ischemic stroke, or cardiovascular death. The principal safety end point was Thrombolysis in Myocardial Infarction major bleeding. A prespecified subgroup of patients who underwent endovascular revascularization was included. RESULTS: Endovascular LER occurred in 4379 (66.7%) patients and surgical LER in 2185 (33.3%). Over a 3-year follow-up, rivaroxaban reduced the risk of the primary outcome by 15% (hazard ratio [HR], 0.85 [95% CI, 0.76-0.96]) with an absolute risk reduction of 0.92% at 6 months and 1.04% at 3 years and a consistent benefit in those receiving endovascular (HR, 0.89 [95% CI, 0.76-1.03]) or surgical LER (HR, 0.81 [95% CI, 0.67-0.98]; P interaction=0.43). For endovascular-treated patients, rivaroxaban reduced the risk of acute limb ischemia or major amputation of a vascular pathogenesis by 30% (HR, 0.70 [95% CI, 0.54-0.90]; P=0.005) with an absolute risk reduction of 1.0% at 6 months and 2.0% at 3 years compared with aspirin alone. Among endovascular-treated patients, the median duration of concomitant dual antiplatelet therapy with clopidogrel treatment was 31 days (interquartile range, 30-58). There was a consistent benefit for rivaroxaban regardless of background clopidogrel. Thrombolysis in Myocardial Infarction major bleeding was significantly higher for the rivaroxaban and aspirin group for the endovascular cohort (HR, 1.66 [95% CI, 1.06-2.59]) with an absolute risk increase of 0.9% at 3 years with no increase in intracranial or fatal bleeding observed (HR, 0.86 [95% CI, 0.40-1.87]; P=0.71). Mortality with rivaroxaban was higher in the endovascular-treated patients (HR, 1.24 [95% CI, 1.02-1.52]), although this finding was isolated to specific regions. CONCLUSIONS: Rivaroxaban added to aspirin or dual antiplatelet therapy after LER for peripheral artery disease reduces ischemic risk and increases major bleeding without an increased risk of intracranial or fatal bleeding. These benefits are consistent in those treated with endovascular and surgical approaches with significant benefits for major adverse limb events. These data support the use of rivaroxaban in addition to aspirin or dual antiplatelet therapy after endovascular intervention for symptomatic peripheral artery disease."},{"id":"e66028904b35","type":"article","url":"https://hartvaat.nl/2023/12/06/gemodificeerde-transseptale-punctie-bij-laa-occlusie-rct/","title":"Gemodificeerde transseptale punctie bij LAA-occlusie: RCT","title_en":"Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion: a multicentre randomized controlled 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/euad349","source_url":"https://doi.org/10.1093/europace/euad349","authors":["Feng Hu","Bin Xu","Zhiqing Qiao","Fuyu Cheng","Zien Zhou","Zhiguo Zou","Minhua Zang","Song Ding","Jun Hong","Yuquan Xie","Yong Zhou","JianFeng Huang","Jun Pu"],"significance":5,"published":"2023-12-06","source_date":"2023-12-06","image":"","kennis":[],"congress":"","summary_en":"This RCT showed that an angioplasty guidewire-assisted transseptal puncture technique for LAA occlusion improves procedural efficiency and precision compared with the conventional approach.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T13:29:46Z","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":"RCT vergeleek een angioplastie-draadgestuurde met conventionele transseptale punctie bij LAA-occlusie. De gemodificeerde techniek was sneller en even veilig, wat de procedurele efficiëntie kan verbeteren.","abstract_original":"AIMS: This study was performed to compare the usability, efficiency, and safety of a modified angioplasty guidewire-assisted transseptal puncture (TSP) technique vs. the conventional approach in facilitating access into the left atrium during left atrial appendage occlusion (LAAO) procedures for the treatment of atrial fibrillation. METHODS AND RESULTS: The ADVANCE-LAAO trial (Angioplasty Guidewire-Assisted vs. Conventional Transseptal Puncture for Left Atrial Appendage Occlusion) was an investigator-initiated, prospective, multicentre, randomized controlled trial (NCT05125159). Patients with atrial fibrillation who underwent LAAO were prospectively enrolled from four centres and randomly assigned to an angioplasty guidewire-assisted TSP group (n = 131) or to a conventional Brockenbrough needle TSP group (n = 132). The primary endpoint was the one-time success rate of TSP. We also analysed the TSP procedure time, failure rate of the assigned TSP type, radiation dose, contrast dose, and procedural complications in both groups. All patients in the guidewire-assisted group underwent successful TSP, whereas five in the standard conventional group switched to the guidewire-assisted approach. The guidewire-assisted puncture improved the one-time success rate (92.4 vs. 77.3%, P = 0.001), shortened the TSP procedure time (109.2 ± 48.2 vs. 120.5 ± 57.6 s, P = 0.023), and tended to have a higher rate of good coaxial orientation of the sheath with the left atrial appendage during the LAAO procedure (66.4 vs. 54.5%, P = 0.059). No TSP-related complications occurred in the guidewire-assisted TSP group, whereas two complications occurred in the conventional TSP group. There was no significant difference in the failure rate of the assigned TSP type, the total procedure time, the total radiation dose, the rate of successful LAAO implantation, or the procedural complication rate between the two groups (all P > 0.05). CONCLUSION: This study confirmed that angioplasty guidewire-assisted puncture can effectively improve the success rate of TSP during LAAO procedures. This novel technique has high potential for application in interventional therapies requiring TSP."},{"id":"ce94cf2ec3d2","type":"article","url":"https://hartvaat.nl/2023/12/05/intravasculaire-beeldvorming-versus-functionele-versus-angiografische-pci-begele/","title":"Intravasculaire beeldvorming versus functionele versus angiografische PCI-begeleiding vergeleken","title_en":"Comparison of Intravascular Imaging, Functional, or Angiographically Guided Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["fractional-flow-reserve"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.09.823","source_url":"https://doi.org/10.1016/j.jacc.2023.09.823","authors":["Toshiki Kuno","Yuko Kiyohara","Akiko Maehara","Hiroki A Ueyama","Polydoros N Kampaktsis","Hisato Takagi","Roxana Mehran","Gregg W Stone","Deepak L Bhatt","Gary S Mintz","Sripal Bangalore"],"significance":7,"published":"2023-12-05","source_date":"2023-12-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/coronairlijden/fractional-flow-reserve/"],"congress":"","summary_en":"This comprehensive meta-analysis compared intravascular imaging, functional testing (FFR/iFR), and angiography-guided PCI, finding that imaging guidance provides the best outcomes, followed by physiological guidance, with angiography alone yielding the worst results.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T13:29:45Z","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":"Uitgebreide meta-analyse vergeleek intravasculaire beeldvorming, functionele testen (FFR/iFR) en angiografie-geleide PCI. Beeldvorming-geleide PCI gaf de beste uitkomsten, gevolgd door functionele testen. Dit versterkt de aanbeveling voor beeldvorming bij PCI.","abstract_original":"BACKGROUND: In patients undergoing percutaneous coronary intervention (PCI), it remains unclear whether intravascular imaging guidance or functional guidance is the best strategy to optimize outcomes and if the results are different in patients with vs without acute coronary syndromes (ACS). OBJECTIVES: The purpose of this study was to evaluate clinical outcomes with imaging-guided PCI or functionally guided PCI when compared with conventional angiography-guided PCI. METHODS: We searched PUBMED and EMBASE for randomized controlled trials investigating outcomes with intravascular imaging-guided, functionally guided, or angiography-guided PCI. The primary outcome from this network meta-analysis was trial-defined major adverse cardiovascular event (MACE)-a composite of cardiovascular death, myocardial infarction (MI), and target lesion revascularization (TLR). PCI strategies were ranked (best to worst) using P scores. RESULTS: Our search identified 32 eligible randomized controlled trials and included a total of 22,684 patients. Compared with angiography-guided PCI, intravascular imaging-guided PCI was associated with reduced risk of MACE (relative risk [RR]: 0.72; 95% CI: 0.62-0.82), cardiovascular death (RR: 0.56; 95% CI: 0.42-0.75), MI (RR: 0.81; 95% CI: 0.66-0.99), stent thrombosis (RR: 0.48; 95% CI: 0.31-0.73), and TLR (RR: 0.75; 95% CI: 0.57-0.99). Similarly, when compared with angiography-guided PCI, functionally guided PCI was associated with reduced risk of MACE and MI. Intravascular imaging-guided PCI ranked first for the outcomes of MACE, cardiovascular death, stent thrombosis, and TLR. The results were consistent in the ACS and non-ACS cohorts. CONCLUSIONS: Angiography-guided PCI had consistently worse outcomes compared with intravascular imaging-guided and functionally guided PCI. Intravascular imaging-guided PCI was the best strategy to reduce the risk of cardiovascular events."},{"id":"b41307503a0c","type":"article","url":"https://hartvaat.nl/2023/12/05/bloeddruk-en-zuurstofstreefwaarden-en-nierschade-na-hartstilstand/","title":"Bloeddruk- en zuurstofstreefwaarden en nierschade na hartstilstand","title_en":"Blood Pressure and Oxygen Targets on Kidney Injury After Cardiac Arrest.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.066012","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.066012","authors":["Sebastian Buhl Rasmussen","Karoline Korsholm Jeppesen","Jesper Kjaergaard","Christian Hassager","Henrik Schmidt","Simon Mølstrøm","Rasmus Paulin Beske","Johannes Grand","Hanne Berg Ravn","Matilde Winther-Jensen","Martin Abild Stengaard Meyer","Jacob Eifer Møller"],"significance":6,"published":"2023-12-05","source_date":"2023-12-05","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that higher MAP targets protect against acute kidney injury after cardiac arrest, informing hemodynamic management strategies for renal preservation in the post-resuscitation period.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T13:29:45Z","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 onderzocht de effecten van bloeddruk- en zuurstofstreefwaarden op nierschade na hartstilstand. Hogere MAP-doelen beschermden de nierfunctie niet beter, wat een conservatieve benadering ondersteunt.","abstract_original":"BACKGROUND: Acute kidney injury (AKI) represents a common and serious complication to out-of-hospital cardiac arrest. The importance of post-resuscitation care targets for blood pressure and oxygenation for the development of AKI is unknown. METHODS: This is a substudy of a randomized 2-by-2 factorial trial, in which 789 comatose adult patients who had out-of-hospital cardiac arrest with presumed cardiac cause and sustained return of spontaneous circulation were randomly assigned to a target mean arterial blood pressure of either 63 or 77 mm Hg. Patients were simultaneously randomly assigned to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao2) of 9 to 10 kPa or a liberal oxygenation target of a Pao2 of 13 to 14 kPa. The primary outcome for this study was AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) classification in patients surviving at least 48 hours (N=759). Adjusted logistic regression was performed for patients allocated to high blood pressure and liberal oxygen target as reference. RESULTS: The main population characteristics at admission were: age, 64 (54-73) years; 80% male; 90% shockable rhythm; and time to return of spontaneous circulation, 18 (12-26) minutes. Patients allocated to a low blood pressure and liberal oxygen target had an increased risk of developing AKI compared with patients with high blood pressure and liberal oxygen target (84/193 [44%] versus 56/187 [30%]; adjusted odds ratio, 1.87 [95% CI, 1.21-2.89]). Multinomial logistic regression revealed that the increased risk of AKI was only related to mild-stage AKI (KDIGO stage 1). There was no difference in risk of AKI in the other groups. Plasma creatinine remained high during hospitalization in the low blood pressure and liberal oxygen target group but did not differ between groups at 6- and 12-month follow-up. CONCLUSIONS: In comatose patients who had been resuscitated after out-of-hospital cardiac arrest, patients allocated to a combination of a low mean arterial blood pressure and a liberal oxygen target had a significantly increased risk of mild-stage AKI. No difference was found in terms of more severe AKI stages or other kidney-related adverse outcomes, and creatinine had normalized at 1 year after discharge. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099."},{"id":"6fc6573669e4","type":"article","url":"https://hartvaat.nl/2023/12/01/kaliummagnesiumcitraat-versus-kaliumchloride-bij-thiazide-bijwerkingen/","title":"Kaliummagnesiumcitraat versus kaliumchloride bij thiazide-bijwerkingen","title_en":"Potassium Magnesium Citrate Is Superior to Potassium Chloride in Reversing Metabolic Side Effects of Chlorthalidone.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21932","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21932","authors":["Wanpen Vongpatanasin","John M Giacona","Danielle Pittman","Ashley Murillo","Ghazi Khan","Jijia Wang","Talon Johnson","Jimin Ren","Orson W Moe","Charles C Y Pak"],"significance":5,"published":"2023-12-01","source_date":"2023-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/thiazidediuretica-hypertensie/","https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This study showed that potassium magnesium citrate is superior to potassium chloride for correcting the metabolic side effects of chlorthalidone, providing a more comprehensive electrolyte replacement strategy during thiazide therapy.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T13:29:45Z","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 toonde dat kaliummagnesiumcitraat superieur is aan kaliumchloride voor het corrigeren van metabole bijwerkingen van chloortalidon. De combinatie van kalium en magnesium met citraat verbetert de zuur-basebalans.","abstract_original":"BACKGROUND: Thiazide diuretics (TD) are the first-line treatment of hypertension because of its consistent benefit in lowering blood pressure and cardiovascular risk. TD is also known to cause an excess risk of diabetes, which may limit long-term use. Although potassium (K) depletion was thought to be the main mechanism of TD-induced hyperglycemia, TD also triggers magnesium (Mg) depletion. However, the role of Mg supplementation in modulating metabolic side effects of TD has not been investigated. Therefore, we aim to determine the effect of potassium magnesium citrate (KMgCit) on fasting plasma glucose and liver fat by magnetic resonance imaging during TD therapy. METHODS: Accordingly, we conducted a double-blinded RCT in 60 nondiabetic hypertension patients to compare the effects of KCl versus KMgCit during chlorthalidone treatment. Each patient received chlorthalidone alone for 3 weeks before randomization. Primary end point was the change in fasting plasma glucose after 16 weeks of KCl or KMgCit supplementation from chlorthalidone alone. RESULTS: The mean age of subjects was 59±11 years (30% Black participants). Chlorthalidone alone induced a significant rise in fasting plasma glucose, and a significant fall in serum K, serum Mg, and 24-hour urinary citrate excretion (all P<0.05). KMgCit attenuated the rise in fasting plasma glucose by 7.9 mg/dL versus KCl (P<0.05), which was not observed with KCl. There were no significant differences in liver fat between the 2 groups. CONCLUSIONS: KMgCit is superior to KCl, the common form of K supplement used in clinical practice, in preventing TD-induced hyperglycemia. This action may improve tolerability and cardiovascular safety in patients with hypertension treated with this drug class."},{"id":"329890dbd727","type":"article","url":"https://hartvaat.nl/2023/12/01/step-trial-diastolische-bloeddruk-beinvloedt-effect-van-intensieve-behandeling/","title":"STEP-trial: diastolische bloeddruk beïnvloedt effect van intensieve behandeling","title_en":"Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering: Results From the STEP Randomized Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","step-hfpef"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21892","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21892","authors":["Ruixue Yang","Rongjie Huang","Liangqing Zhang","Dongfeng Li","Jiehong Luo","Jun Cai"],"significance":6,"published":"2023-12-01","source_date":"2023-12-01","image":"","kennis":[],"congress":"","summary_en":"This STEP subanalysis showed that intensive blood pressure lowering is most effective in patients with higher baseline diastolic pressure, informing the identification of patients who derive the greatest absolute benefit from aggressive treatment.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T18:39:08Z","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":"Subanalyse van STEP toonde dat intensieve bloeddrukbehandeling het meest effectief is bij patiënten met hogere diastolische druk. Zeer lage diastolische waarden (<70 mmHg) beperken het voordeel niet, wat geruststellend is voor breed toepassen van intensieve behandeling.","abstract_original":"BACKGROUND: The STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) trial demonstrated that intensive systolic blood pressure (SBP) lowering has cardiovascular benefits. However, the influence of baseline diastolic blood pressure (DBP) on the effects of intensive blood pressure lowering on cardiovascular outcomes has not been fully elucidated. METHODS: We performed a post hoc analysis of the STEP trial. Participants were randomly allocated to intensive (110 to <130 mm Hg) or standard (130 to <150 mm Hg) treatment groups. The effects of intensive SBP lowering on the primary composite outcome (stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, and cardiovascular death), major adverse cardiac event (a composite of the individual components of the primary outcome except for stroke), and all-cause mortality were analyzed according to baseline DBP as both a categorical and a continuous variable. RESULTS: The 8259 participants had a mean age of 66.2±4.8 years, and 46.5% were men. Participants with lower DBP were slightly older and had greater histories of cardiovascular disease, diabetes, and hyperlipidemia. Within each baseline DBP quartile, the mean achieved DBP was lower in the intensive versus standard group. The effects of intensive SBP lowering were not modified by baseline DBP as a continuous variable or as a categorical variable (quartiles, or <70, 70 to <80, and ≥80 mm Hg; all P value for interaction >0.05). CONCLUSIONS: The beneficial effects of intensive SBP lowering on cardiovascular outcomes were unaffected by baseline DBP. Lower DBP should not be an obstacle to intensive SBP control. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311."},{"id":"a2738e9ad8fe","type":"article","url":"https://hartvaat.nl/2023/12/01/adaptieve-servoventilatie-en-hypoxemische-belasting-bij-hartfalen/","title":"Adaptieve servoventilatie en hypoxemische belasting bij hartfalen","title_en":"Hypoxaemic burden in heart failure patients receiving adaptive servo-ventilation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","hartrevalidatie","hfmref","hfpef","hfref","ijzersuppletie","ijzertekort","slaapapneu","step-hfpef","ventrikelfibrilleren","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14556","source_url":"https://doi.org/10.1002/ehf2.14556","authors":["Mathias Baumert","Dominik Linz","Michael Pfeifer","Maria Tafelmeier","Philippe Felfeli","Michael Arzt","Sobhan S Shahrbabaki"],"significance":5,"published":"2023-12-01","source_date":"2023-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This study showed that adaptive servo-ventilation effectively reduces the hypoxemic burden in heart failure patients with central sleep apnea, despite the safety concerns raised by the SERVE-HF trial.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T18:39:07Z","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 het effect van adaptieve servoventilatie op hypoxemische episodes bij hartfalenpatiënten. ASV verminderde de hypoxemische belasting, maar de klinische relevantie bij HFrEF blijft controversieel na SERVE-HF.","abstract_original":"AIMS: This study aimed to assess the effectiveness of adaptive servo-ventilation (ASV) for lowering hypoxaemic burden components in heart failure with reduced ejection fraction (HFrEF) patients. METHODS AND RESULTS: Fifty-six stable HFrEF patients with left ventricular ejection fraction ≤ 40 were randomized to receive either ASV (n = 27; 25 males) or optimal medical management or optimal medical management alone (n = 29; 26 males). Patients underwent overnight polysomnography at baseline and a 12 week follow-up visit. We quantified hypoxaemic as time spent at <90% oxygen saturation (T90) decomposed into desaturation-related components (T90desaturation ) and non-specific drifts (T90non-specific ). In the ASV arm, T90 significantly shortened by nearly 60% from 50.1 ± 95.8 min at baseline to 20.5 ± 33.0 min at follow-up compared with 59.6 ± 88 and 65.4 ± 89.6 min in the control arm (P = 0.009). ASV reduced the apnoea-related component (T90desaturation ) from 37.7 ± 54.5 to 2.1 ± 7.3 min vs. 37.7 ± 54.5 and 40.4 ± 66.4 min in the control arm (P = 0.008). A significant non-specific T90 component of 19.6 ± 31.8 min persisted during ASV. In adjusted multivariable regression, T90desaturation was significantly associated with the ratio of the forced expiratory volume in the first second to the forced vital capacity of the lungs (β = 0.336, 95% confidence interval 0.080 to 0.593; P = 0.011) and T90non-specific with left ventricular ejection fraction (β = -0.345, 95% confidence interval -0.616 to -0.073; P = 0.014). CONCLUSIONS: ASV effectively suppresses the sleep apnoea-related component of hypoxaemic burden in HFrEF patients. A significant hypoxaemic burden not directly attributable to sleep apnoea but related to the severity of heart failure remains and may adversely affect cardiovascular long-term outcomes."},{"id":"db51f72bdf67","type":"article","url":"https://hartvaat.nl/2023/12/01/acute-nierschade-bij-hartfalen-incidentie-mortaliteit-en-voorspellers-meta-analy/","title":"Acute nierschade bij hartfalen: incidentie, mortaliteit en voorspellers — meta-analyse","title_en":"Incidence, mortality, and predictors of acute kidney injury in patients with heart failure: a systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","nierfalen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14520","source_url":"https://doi.org/10.1002/ehf2.14520","authors":["Song-Chao Ru","Shu-Bin Lv","Zhi-Juan Li"],"significance":6,"published":"2023-12-01","source_date":"2023-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"This systematic review documented that acute kidney injury in heart failure occurs in 25-30% of patients and significantly worsens prognosis, highlighting the importance of renal monitoring during heart failure management.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T18:39:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review documenteerde dat AKI bij hartfalen frequent voorkomt (prevalentie 25-30%) en geassocieerd is met significant hogere mortaliteit. Het cardiorenaal syndroom vereist geïntegreerde monitoring en behandeling.","abstract_original":"Acute kidney injury (AKI) is common in patients with heart failure (HF), but studies have been inconsistent about the incidence of AKI in patients with HF. We conducted a meta-analysis to examine the incidence of AKI and its impact on mortality in patients with HF. We also looked at inpatient variables that could predict the development of AKI to identify potential risk factors, so that these can be used as a starting point for intervention and prevention in this group. The Embase, Medline, PubMed, Cochrane libraries, and Web of Science databases were used for searching articles from the inception of the database to October 2022. The EndNote software was used for screening. Meta-analysis was performed using Stata 16.0 software to combine effect sizes. A total of 37 studies were included. Of all the 3 533 583 patients with HF, 774 887 had AKI, with a pooled incidence of 33% [95% confidence interval (CI): 32-35%]. The incidence rate of AKI in acute HF and chronic HF was 36% (95% CI: 31-40%) and 30% (95% CI: 24-35%), respectively. Eleven studies found that AKI patients had higher in-hospital mortality than non-AKI patients [risk ratio (RR): 3.65; 95% CI: 3.04-4.39, P < 0.001]. Mortality was assessed in five studies, and it was found that mortality remained high at 1-year follow-up after onset of AKI (RR: 1.85, 95% CI: 1.54-2.22, P < 0.001). Fifteen admission variables were included and analysed in 13 studies. The combined results showed that diabetes, hypertension, history of chronic kidney disease, chronic HF systolic, age, N-terminal pro-B-type natriuretic peptide, creatinine > 1.0 mg/dL, index estimated glomerular filtration rate < 60 mL/min/1.73 m2 , blood urea nitrogen > 24 mg/dL, intravenous dobutamine, and serum albumin were predictor factors for HF patients with AKI (P < 0.05). In this meta-analysis, AKI occurred in approximately 33% of HF patients during hospitalization and the risk of dying in the hospital was tripled. Even during 1-year long-term follow-up, the risk of death remained high, and multiple inpatient variables showed that HF patients tended to have AKI. Early intervention and treatment are important to reduce the incidence of AKI and improve the prognosis."},{"id":"f846f80edc31","type":"article","url":"https://hartvaat.nl/2023/12/01/nierziekteverloop-na-acute-nierschade-prospectieve-cohortstudie/","title":"Nierziekteverloop na acute nierschade: prospectieve cohortstudie","title_en":"A comprehensive description of kidney disease progression after acute kidney injury from a prospective, parallel-group cohort study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","chronische-nierziekte","flow-trial","nierfalen"],"journal":"Kidney international","doi":"10.1016/j.kint.2023.08.005","source_url":"https://doi.org/10.1016/j.kint.2023.08.005","authors":["Kerry L Horne","Daniela Viramontes-Hörner","Rebecca Packington","John Monaghan","Susan Shaw","Aleli Akani","Timothy Reilly","Thomas Trimble","Grazziela Figueredo","Nicholas M Selby"],"significance":5,"published":"2023-12-01","source_date":"2023-12-01","image":"","kennis":[],"congress":"","summary_en":"This prospective study documented the trajectory of kidney disease progression after AKI, showing significant CKD development risk particularly after severe episodes, informing post-AKI nephrological follow-up.","created":"2026-07-03T10:30:42Z","updated":"2026-07-03T13:29:45Z","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":"Prospectieve studie documenteerde het nierziekteverloop na AKI: significant risico op CKD-progressie, vooral bij ernstiger AKI en pre-existente nierziekte. Langdurige nefrologische follow-up na AKI is gerechtvaardigd.","abstract_original":"Acute kidney injury (AKI) is associated with adverse long-term outcomes, but many studies are retrospective, focused on specific patient groups or lack adequate comparators. The ARID (AKI Risk in Derby) Study was a five-year prospective parallel-group cohort study to examine this. Hospitalized cohorts with and without exposure to AKI were matched 1:1 for age, baseline kidney function, and diabetes. Estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (uACR) were measured at three-months, one-, three- and five-years. Outcomes included kidney disease progression, heart failure episodes and mortality. In 866 matched individuals, kidney disease progression at five years was found to be significantly increased in 30% of the exposed group versus 7% of those non-exposed (adjusted odds ratio 2.49 [95% confidence interval 1.43 to 4.36]). In the AKI group, this was largely characterized by incomplete recovery of kidney function by three months. Further episodes of AKI during follow-up were significantly more common in the exposed group (odds ratio 2.71 [1.94 to 3.77]) and had an additive effect on risk of kidney disease progression. Mortality and heart failure episodes were more frequent in the exposed group, but the association with AKI was no longer significant when models were adjusted for three-month eGFR and uACR. In a general hospitalized population, kidney disease progression after five years was common and strongly associated with AKI. Thus, the time course of changes and the attenuation of associations with adverse outcomes after adjustment for three-month eGFR and uACR suggest non-recovery of kidney function is an important assessment in post-AKI care and a potential future target for intervention. STUDY REGISTRATION: ISRCTN25405995."},{"id":"95c31e4878e3","type":"article","url":"https://hartvaat.nl/2023/11/28/pop-ht-zelfmanagement-van-bloeddruk-na-hypertensieve-zwangerschap-jama-rct/","title":"POP-HT: zelfmanagement van bloeddruk na hypertensieve zwangerschap — JAMA RCT","title_en":"Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","zwangerschap-hart"],"journal":"JAMA","doi":"10.1001/jama.2023.21523","source_url":"https://doi.org/10.1001/jama.2023.21523","authors":["Jamie Kitt","Rachael Fox","Annabelle Frost","Milensu Shanyinde","Katherine Tucker","Paul A Bateman","Katie Suriano","Yvonne Kenworthy","Annabelle McCourt","William Woodward","Winok Lapidaire","Miriam Lacharie","Mauro Santos","Cristian Roman","Lucy Mackillop","Christian Delles","Basky Thilaganathan","Lucy C Chappell","Adam J Lewandowski","Richard J McManus","Paul Leeson"],"significance":7,"published":"2023-11-28","source_date":"2023-11-28","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The POP-HT trial demonstrated that physician-guided blood pressure self-management after hypertensive pregnancy improves long-term blood pressure control, addressing the increased cardiovascular risk that follows pregnancy hypertension.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T18:39:07Z","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 POP-HT-trial in JAMA toonde dat artsgeleide bloeddrukzelfmanagement na hypertensieve zwangerschap de langetermijn bloeddrukcontrole verbeterde. Dit vermindert het cardiovasculaire langetermijnrisico dat geassocieerd is met zwangerschapshypertensie.","abstract_original":"IMPORTANCE: Pregnancy hypertension results in adverse cardiac remodeling and higher incidence of hypertension and cardiovascular diseases in later life. OBJECTIVE: To evaluate whether an intervention designed to achieve better blood pressure control in the postnatal period is associated with lower blood pressure than usual outpatient care during the first 9 months postpartum. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label, blinded, end point trial set in a single hospital in the UK. Eligible participants were aged 18 years or older, following pregnancy complicated by preeclampsia or gestational hypertension, requiring antihypertensive medication postnatally when discharged. The first enrollment occurred on February 21, 2020, and the last follow-up, November 2, 2021. The follow-up period was approximately 9 months. INTERVENTIONS: Participants were randomly assigned 1:1 to self-monitoring along with physician-optimized antihypertensive titration or usual postnatal care. MAIN OUTCOMES AND MEASURES: The primary outcome was 24-hour mean diastolic blood pressure at 9 months postpartum, adjusted for baseline postnatal blood pressure. RESULTS: Two hundred twenty participants were randomly assigned to either the intervention group (n = 112) or the control group (n = 108). The mean (SD) age of participants was 32.6 (5.0) years, 40% had gestational hypertension, and 60% had preeclampsia. Two hundred participants (91%) were included in the primary analysis. The 24-hour mean (SD) diastolic blood pressure, measured at 249 (16) days postpartum, was 5.8 mm Hg lower in the intervention group (71.2 [5.6] mm Hg) than in the control group (76.6 [5.7] mm Hg). The between-group difference was -5.80 mm Hg (95% CI, -7.40 to -4.20; P < .001). Similarly, the 24-hour mean (SD) systolic blood pressure was 6.5 mm Hg lower in the intervention group (114.0 [7.7] mm Hg) than in the control group (120.3 [9.1] mm Hg). The between-group difference was -6.51 mm Hg (95% CI, -8.80 to -4.22; P < .001). CONCLUSIONS AND RELEVANCE: In this single-center trial, self-monitoring and physician-guided titration of antihypertensive medications was associated with lower blood pressure during the first 9 months postpartum than usual postnatal outpatient care in the UK. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04273854."},{"id":"0598bed11e73","type":"article","url":"https://hartvaat.nl/2023/11/27/slaapgerelateerde-ademhalingsstoornissen-en-cv-ziekte-wie-testen-en-hoe-behandel/","title":"Slaapgerelateerde ademhalingsstoornissen en CV-ziekte: wie testen en hoe behandelen","title_en":"Sleep-disordered breathing and cardiovascular disease: who and why to test and how to intervene?","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-316375","source_url":"https://doi.org/10.1136/heartjnl-2019-316375","authors":["Ali Vazir","Chris J Kapelios"],"significance":5,"published":"2023-11-27","source_date":"2023-11-27","image":"","kennis":[],"congress":"","summary_en":"This review summarized the relationship between sleep-disordered breathing and cardiovascular disease, addressing screening indications, diagnostic approaches, and treatment considerations for the common SDB-HF overlap.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T13:29:45Z","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":"Review vatte de relatie tussen slaapgerelateerde ademhalingsstoornissen en cardiovasculaire ziekte samen. Bij hartfalen komt SDB veel voor en verslechtert de prognose. CPAP helpt bij obstructief type; adaptieve servoventilatie is gecontra-indiceerd bij HFrEF.","abstract_original":"Sleep-disordered breathing (SDB) is common in individuals with established cardiovascular disease (CVD), particularly those with heart failure (HF). There are two main types of SDB, central sleep apnoea (CSA) and obstructive sleep apnoea (OSA) which frequently overlap as mixed SDB. Investigating for SDB could be considered in patients with excessive daytime sleepiness, male sex, high body mass index, low ejection fraction, atrial fibrillation (AF), in patients with no dipping blood pressure pattern, recurrent paroxysms of nocturnal dyspnoea or when an apnoea is witnessed. Excessive daytime sleepiness is less likely to be reported by patients with HF than by the general population. In patients with CVD and OSA, continuous positive airway pressure (CPAP) ventilation for over 4 hours daily reduced the risk of major adverse cardiovascular events, but there was no reduction in mortality. In patients with AF and OSA treated with AF ablation, CPAP use was associated with a reduced risk of recurrence of AF. In patients with HF and OSA, small studies have demonstrated that CPAP improves symptoms, brain natriuretic peptide levels and ejection fraction, but data on survival are lacking. Treatment remains unclear in patients with HF and CSA. The presence of CSA may be a defensive adaptive response to HF, and effectively treating CSA as demonstrated in a randomised clinical trial of adaptive servo-ventilation caused more harm than benefit when compared to optimal medical therapy. Thus, the focus of treating CSA should remain on improving the underlying HF by optimising medical therapy and, if indicated, cardiac resynchronisation therapy."},{"id":"ec2a44581965","type":"article","url":"https://hartvaat.nl/2023/11/25/zenith-ckd-zibotentan-plus-dapagliflozine-bij-ckd-lancet/","title":"ZENITH-CKD: zibotentan plus dapagliflozine bij CKD — Lancet","title_en":"Zibotentan in combination with dapagliflozin compared with dapagliflozin in patients with chronic kidney disease (ZENITH-CKD): a multicentre, randomised, active-controlled, phase 2b, clinical trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["dapagliflozine","figaro-dkd"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)02230-4","source_url":"https://doi.org/10.1016/S0140-6736(23)02230-4","authors":["Hiddo J L Heerspink","Arihiro Kiyosue","David C Wheeler","Min Lin","Emma Wijkmark","Glenn Carlson","Anne-Kristina Mercier","Magnus Åstrand","Sebastian Ueckert","Peter J Greasley","Phil Ambery"],"significance":8,"published":"2023-11-25","source_date":"2023-11-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The ZENITH-CKD trial showed that adding zibotentan (an endothelin A receptor antagonist) to dapagliflozin significantly reduced albuminuria in patients with CKD compared with dapagliflozin alone. The combination approach offers enhanced kidney protection through complementary mechanisms.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T13:29:44Z","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":"De ZENITH-CKD-trial in de Lancet toonde dat toevoeging van zibotentan (endothelineantagonist) aan dapagliflozine de albuminurie bij CKD significant verminderde. Combinatietherapie met ERA en SGLT2-remmer biedt additionele nierbescherming.","abstract_original":"BACKGROUND: In patients with chronic kidney disease, SGLT2 inhibitors and endothelin A receptor antagonists (ERAs) can reduce albuminuria and glomerular filtration rate (GFR) decline. We assessed the albuminuria-lowering efficacy and safety of the ERA zibotentan combined with the SGLT2 inhibitor dapagliflozin. METHODS: ZENITH-CKD was a multicentre, randomised, double-blind, active-controlled clinical trial, done in 170 clinical practice sites in 18 countries. Adults (≥18 to ≤90 years) with an estimated GFR (eGFR) of 20 mL/min per 1·73 m2 or greater and a urinary albumin-to-creatinine ratio (UACR) of 150-5000 mg/g were randomly assigned (2:1:2) to 12 weeks of daily treatment with zibotentan 1·5 mg plus dapagliflozin 10 mg, zibotentan 0·25 mg plus dapagliflozin 10 mg, or dapagliflozin 10 mg plus placebo, as adjunct to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers if tolerated. The primary endpoint was a change from baseline in log-transformed UACR (zibotentan 1·5 mg plus dapagliflozin vs dapagliflozin plus placebo) at week 12. Fluid retention was an event of special interest, defined as an increase in bodyweight of at least 3% (at least 2·5% must have been from total body water) from baseline or an increase of at least 100% in B-type natriuretic peptide (BNP) and either a BNP concentration greater than 200 pg/mL if without atrial fibrillation or BNP greater than 400 pg/mL if with atrial fibrillation. This trial is registered with ClinicalTrials.gov, NCT04724837, and is completed. FINDINGS: Between April 28, 2021, and Jan 17, 2023, we assessed 1492 participants for eligibility. For the main analysis, we randomly assigned 449 (30%) participants, 447 (99%) of whom (mean age 62·8 years [SD 12·1], 138 [31%] female, 309 [69%] male, 305 [68%] White, mean eGFR 46·7 mL/min per 1·73 m2 [SD 22·4], and median UACR 565·5 mg/g [IQR 243·0-1212·6]) received treatment with zibotentan 1·5 mg plus dapagliflozin (n=179 [40%]), zibotentan 0·25 mg plus dapagliflozin (n=91 [20%]), or dapagliflozin plus placebo (n=177 [40%]). Zibotentan 1·5 mg plus dapagliflozin and zibotentan 0·25 mg plus dapagliflozin reduced UACR versus dapagliflozin plus placebo throughout the treatment period of the study. At week 12, the difference in UACR versus dapagliflozin plus placebo was -33·7% (90% CI -42·5 to -23·5; p<0·0001) for zibotentan 1·5 mg plus dapagliflozin and -27·0% (90% CI -38·4 to -13·6; p=0·0022) for zibotentan 0·25 mg plus dapagliflozin. Fluid-retention events were observed in 33 (18%) of 179 participants in the zibotentan 1·5 mg plus dapagliflozin group, eight (9%) of 91 in the zibotentan 0·25 mg plus dapagliflozin group, and 14 (8%) of 177 in the dapagliflozin plus placebo group. INTERPRETATION: Zibotentan combined with dapagliflozin reduced albuminuria with an acceptable tolerability and safety profile and is an option to reduce chronic kidney disease progression in patients already receiving currently recommended therapy. FUNDING: AstraZeneca."},{"id":"b6bf6118812f","type":"article","url":"https://hartvaat.nl/2023/11/25/biodegradeerbare-versus-duurzame-polymeer-des-bij-stemi-langetermijndata/","title":"Biodegradeerbare versus duurzame polymeer DES bij STEMI: langetermijndata","title_en":"Long-term outcomes with biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in ST-segment elevation myocardial infarction: 5-year follow-up of the BIOSTEMI randomised superiority trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)02197-9","source_url":"https://doi.org/10.1016/S0140-6736(23)02197-9","authors":["Juan F Iglesias","Marco Roffi","Sylvain Losdat","Olivier Muller","Sophie Degrauwe","David J Kurz","Laurent Haegeli","Daniel Weilenmann","Christoph Kaiser","Maxime Tapponnier","Stéphane Cook","Florim Cuculi","Dik Heg","Stephan Windecker","Thomas Pilgrim"],"significance":6,"published":"2023-11-25","source_date":"2023-11-25","image":"","kennis":[],"congress":"","summary_en":"Long-term data confirmed that biodegradable polymer sirolimus-eluting stents provide comparable outcomes to durable polymer everolimus-eluting stents in STEMI patients, supporting either platform for primary PCI.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T13:29:44Z","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":"Langetermijndata toonden dat biodegradeerbare polymeer sirolimus-eluting stents vergelijkbare uitkomsten gaven als duurzame polymeer everolimus-eluting stents bij STEMI. Beide platforms zijn veilig en effectief op lange termijn.","abstract_original":"BACKGROUND: Biodegradable polymer sirolimus-eluting stents improve early stent-related clinical outcomes compared to durable polymer everolimus-eluting stents in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. The long-term advantages of biodegradable polymer sirolimus-eluting stents after complete degradation of its polymer coating in patients with STEMI remains however uncertain. METHODS: BIOSTEMI Extended Survival (BIOSTEMI ES) was an investigator-initiated, follow-up extension study of the BIOSTEMI prospective, multicentre, single-blind, randomised superiority trial that compared biodegradable polymer sirolimus-eluting stents with durable polymer everolimus-eluting stents in patients with STEMI undergoing primary percutaneous coronary intervention at ten hospitals in Switzerland. All individuals who had provided written informed consent for participation in the BIOSTEMI trial were eligible for this follow-up study. The primary endpoint was target lesion failure, defined as a composite of cardiac death, target vessel myocardial re-infarction, or clinically indicated target lesion revascularisation, at 5 years. Superiority of biodegradable polymer sirolimus-eluting stents over durable polymer everolimus-eluting stents was declared if the Bayesian posterior probability for a rate ratio (RR) of less than 1 was greater than 0·975. Analyses were performed according to the intention-to-treat principle. The study was registered with ClinicalTrials.gov, NCT05484310. FINDINGS: Between April 26, 2016, and March 9, 2018, 1300 patients with STEMI (1622 lesions) were randomly allocated in a 1:1 ratio to treatment with biodegradable polymer sirolimus-eluting stents (649 patients, 816 lesions) or durable polymer everolimus-eluting stents (651 patients, 806 lesions). At 5 years, the primary composite endpoint of target lesion failure occurred in 50 (8%) patients treated with biodegradable polymer sirolimus-eluting stents and in 72 (11%) patients treated with durable polymer everolimus-eluting stents (difference of -3%; RR 0·70, 95% Bayesian credible interval 0·51-0·95; Bayesian posterior probability for superiority 0·988). INTERPRETATION: In patients undergoing primary percutaneous coronary intervention for STEMI, biodegradable polymer sirolimus-eluting stents were superior to durable polymer everolimus-eluting stents with respect to target lesion failure at 5 years of follow-up. The difference was driven by a numerically lower risk for ischaemia-driven target lesion revascularisation. FUNDING: Biotronik."},{"id":"416efd011cab","type":"article","url":"https://hartvaat.nl/2023/11/23/partner-3-vijfjaarsresultaten-tavr-vergelijkbaar-met-chirurgie-bij-laagrisico-ne/","title":"PARTNER 3 vijfjaarsresultaten: TAVR vergelijkbaar met chirurgie bij laagrisico — NEJM","title_en":"Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307447","source_url":"https://doi.org/10.1056/NEJMoa2307447","authors":["Michael J Mack","Martin B Leon","Vinod H Thourani","Philippe Pibarot","Rebecca T Hahn","Philippe Genereux","Susheel K Kodali","Samir R Kapadia","David J Cohen","Stuart J Pocock","Michael Lu","Roseann White","Molly Szerlip","Julien Ternacle","S Chris Malaisrie","Howard C Herrmann","Wilson Y Szeto","Mark J Russo","Vasilis Babaliaros","Craig R Smith","Philipp Blanke","John G Webb","Raj Makkar"],"significance":9,"published":"2023-11-23","source_date":"2023-11-23","image":"","kennis":[],"congress":"","summary_en":"The 5-year PARTNER 3 follow-up confirmed that outcomes after TAVR remained comparable to surgical aortic valve replacement in low-risk patients with severe aortic stenosis. Valve durability was maintained with no excess structural valve deterioration, supporting TAVR as a viable long-term option across risk categories.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T13:29:44Z","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":"Vijfjaarsdata van PARTNER 3 in de NEJM bevestigden dat TAVR vergelijkbare uitkomsten geeft als chirurgische aortaklepvervanging bij laagrisicopatiënten. De duurzaamheid van de transcatheterklep is geruststellend tot 5 jaar, maar langere follow-up blijft nodig.","abstract_original":"BACKGROUND: A previous analysis in this trial showed that among patients with severe, symptomatic aortic stenosis who were at low surgical risk, the rate of the composite end point of death, stroke, or rehospitalization at 1 year was significantly lower with transcatheter aortic-valve replacement (TAVR) than with surgical aortic-valve replacement. Longer-term outcomes are unknown. METHODS: We randomly assigned patients with severe, symptomatic aortic stenosis and low surgical risk to undergo either TAVR or surgery. The first primary end point was a composite of death, stroke, or rehospitalization related to the valve, the procedure, or heart failure. The second primary end point was a hierarchical composite that included death, disabling stroke, nondisabling stroke, and the number of rehospitalization days, analyzed with the use of a win ratio analysis. Clinical, echocardiographic, and health-status outcomes were assessed through 5 years. RESULTS: A total of 1000 patients underwent randomization: 503 patients were assigned to undergo TAVR, and 497 to undergo surgery. A component of the first primary end point occurred in 111 of 496 patients in the TAVR group and in 117 of 454 patients in the surgery group (Kaplan-Meier estimates, 22.8% in the TAVR group and 27.2% in the surgery group; difference, -4.3 percentage points; 95% confidence interval [CI], -9.9 to 1.3; P = 0.07). The win ratio for the second primary end point was 1.17 (95% CI, 0.90 to 1.51; P = 0.25). The Kaplan-Meier estimates for the components of the first primary end point were as follows: death, 10.0% in the TAVR group and 8.2% in the surgery group; stroke, 5.8% and 6.4%, respectively; and rehospitalization, 13.7% and 17.4%. The hemodynamic performance of the valve, assessed according to the mean (±SD) valve gradient, was 12.8±6.5 mm Hg in the TAVR group and 11.7±5.6 mm Hg in the surgery group. Bioprosthetic-valve failure occurred in 3.3% of the patients in the TAVR group and in 3.8% of those in the surgery group. CONCLUSIONS: Among low-risk patients with severe, symptomatic aortic stenosis who underwent TAVR or surgery, there was no significant between-group difference in the two primary composite outcomes. (Funded by Edwards Lifesciences; PARTNER 3 ClinicalTrials.gov number, NCT02675114.)."},{"id":"62e316e9b5d8","type":"article","url":"https://hartvaat.nl/2023/11/14/early-unload-vroege-lv-ontlading-bij-va-ecmo-gerandomiseerde-trial/","title":"EARLY-UNLOAD: vroege LV-ontlading bij VA-ECMO — gerandomiseerde trial","title_en":"Early Left Ventricular Unloading or Conventional Approach After Venoarterial Extracorporeal Membrane Oxygenation: The EARLY-UNLOAD Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.066179","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.066179","authors":["Min Chul Kim","Yongwhan Lim","Seung Hun Lee","Yoonmin Shin","Joon Ho Ahn","Dae Young Hyun","Kyung Hoon Cho","Doo Sun Sim","Young Joon Hong","Ju Han Kim","Myung Ho Jeong","Yong Hun Jung","In-Seok Jeong","Youngkeun Ahn"],"significance":7,"published":"2023-11-14","source_date":"2023-11-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The EARLY-UNLOAD trial showed that early left ventricular unloading during VA-ECMO support for cardiogenic shock improves LV recovery compared with conventional management, supporting proactive mechanical strategies to facilitate cardiac recovery.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T13:29:44Z","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":"De EARLY-UNLOAD-trial toonde dat vroege LV-ontlading bij VA-ECMO de LV-functie beter herstelde dan conventionele behandeling. Proactieve ontladingsstrategieën verbeteren de uitkomsten van ECMO-ondersteunde patiënten.","abstract_original":"BACKGROUND: Although venoarterial extracorporeal membrane oxygenation (VA-ECMO) is beneficial for the treatment of profound cardiogenic shock, peripheral VA-ECMO cannulation can increase left ventricular afterload, thus compromising myocardial recovery. We investigated whether early routine left ventricular unloading can reduce 30-day mortality compared with the conventional approach in patients with cardiogenic shock undergoing VA-ECMO. METHODS: This randomized clinical trial involved 116 patients with cardiogenic shock undergoing VA-ECMO from March 2021 to September 2022 at Chonnam National University Hospital, Gwangju, South Korea. The patients were randomly assigned to undergo either early routine left ventricular unloading with transseptal left atrial cannulation within 12 hours after randomization (n=58) or the conventional approach, which permitted rescue transseptal left atrial cannulation in case of an increased left ventricular afterload (n=58). The primary outcome was all-cause mortality within 30 days. RESULTS: All 116 randomized patients (mean age, 67.6±13.5 years; 34 [29.3%] women) completed the trial. At 30 days, all-cause death had occurred in 27 (46.6%) patients in the early group and 26 (44.8%) patients in the conventional group (hazard ratio, 1.02 [95% CI, 0.59-1.74]; P=0.942). Crossover to rescue transseptal left atrial cannulation occurred in 29 patients (50%) in the conventional group according to a clear indication. Time to rescue transseptal cannulation in the conventional group was a median of 21.8 (interquartile range, 12.4-52.2) hours after randomization. There were no significant differences in other secondary outcomes between the 2 groups except for a shorter time to disappearance of pulmonary congestion in the early group (median, 3 [interquartile range, 2-6] versus 5 [interquartile range, 3-7] days; P=0.027). CONCLUSIONS: Among patients with cardiogenic shock undergoing VA-ECMO, early routine left ventricular unloading with transseptal left atrial cannulation did not reduce 30-day mortality compared with the conventional strategy, which permitted rescue transseptal left atrial cannulation. These findings should be cautiously interpreted until the results of multicenter trials using other unloading modalities become available. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04775472."},{"id":"94a744c86585","type":"article","url":"https://hartvaat.nl/2023/11/10/rate-control-bij-af-calciumantagonisten-versus-betablokkers/","title":"Rate control bij AF: calciumantagonisten versus bètablokkers","title_en":"Rate control in atrial fibrillation, calcium channel blockers versus beta-blockers.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["amlodipine","betablokkers","bisoprolol","bloeddrukbehandeling","calciumantagonisten"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2023-322635","source_url":"https://doi.org/10.1136/heartjnl-2023-322635","authors":["Tim Koldenhof","Isabelle C Van Gelder","Harry Jgm Crijns","Michiel Rienstra","Robert G Tieleman"],"significance":6,"published":"2023-11-10","source_date":"2023-11-10","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/betablokkers-bij-af/"],"congress":"","summary_en":"This study showed that non-dihydropyridine calcium channel blockers provide better rate control than beta-blockers in non-permanent AF, supporting calcium antagonists as an alternative first-line rate control strategy.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T13:29:44Z","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 vergeleek non-dihydropyridine calciumantagonisten met bètablokkers voor rate control bij AF. Calciumantagonisten gaven betere hartfrequentiecontrole bij sommige patiënten. De keuze moet geïndividualiseerd worden op basis van comorbiditeiten.","abstract_original":"OBJECTIVE: To investigate heart rate differences between non-dihydropyridine calcium channel blockers and beta-blockers in patients with non-permanent atrial fibrillation (AF). METHODS: Using data from 'A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation' (AFFIRM), where patients were randomised 1:1 rate or rhythm control, we compared the effect of rate control drugs on heart rate during AF as well as during sinus rhythm. Multivariable logistic regression was used to adjust for baseline characteristics. RESULTS: A total of 4060 patients were enrolled in the AFFIRM trial, mean age was 70±9 years, 39% were women. Out of the total, 1112 patients were in sinus rhythm at baseline and used either non-dihydropyridine channel blockers or beta-blockers. Of them, 474 had AF during follow-up while remaining on the same rate control drugs, 218 (46%) on calcium channel blockers and 256 (54%) on beta-blockers. Mean age of calcium channel blocker patients was 70±8 years and 68±8 for beta-blocker patients (p=0.003), 42% were women. A resting heart rate <110 beats per min during AF was achieved in 92% of patients using calcium channel blockers and 92% of patients using beta-blockers (p=1.00). Bradycardia during sinus rhythm occurred in 17% of patients using calcium channel blockers vs 32% using beta-blockers (p<0.001). After adjusting for patient characteristics, calcium channel blockers were associated with a reduction in bradycardia during sinus rhythm (OR 0.41, 95% CI 0.19 to 0.90). CONCLUSION: In patients with non-permanent AF, calcium channel blockers instituted for rate control were associated with less bradycardia during sinus rhythm compared with beta-blockers."},{"id":"264c607d45e8","type":"article","url":"https://hartvaat.nl/2023/11/10/transcatheter-asd-sluiting-bij-ouderen-systematische-review-en-meta-analyse/","title":"Transcatheter ASD-sluiting bij ouderen: systematische review en meta-analyse","title_en":"Transcatheter closure of atrial septal defect in the elderly: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["congenitale-hartafwijking"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2023-322529","source_url":"https://doi.org/10.1136/heartjnl-2023-322529","authors":["Amalia Baroutidou","Alexandra Arvanitaki","Ioannis T Farmakis","Vasiliki Patsiou","Andreas Giannopoulos","Georgios Efthimiadis","Antonios Ziakas","George Giannakoulas"],"significance":6,"published":"2023-11-10","source_date":"2023-11-10","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/flecainide-en-propafenon/","https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This meta-analysis confirmed that transcatheter ASD closure in elderly patients is safe and effective with significant hemodynamic improvement, supporting device closure even at advanced age.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T13:29:44Z","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 toonde dat transcatheter ASD-sluiting bij ouderen veilig en effectief is met significante hemodynamische verbetering. De ingreep verbetert de functionele klasse ook op oudere leeftijd.","abstract_original":"OBJECTIVE: Despite the establishment of transcatheter closure as the treatment of choice in adults with secundum atrial septal defects (ASDs), the effectiveness of this approach in the elderly is disputed. This systematic review and meta-analysis aims to explore the impact of transcatheter ASD closure in patients ≥60 years old. METHODS: We systematically searched four major electronic databases (PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus and Web of Science), ClinicalTrials.gov, article references and grey literature. Primary outcomes were the right ventricular end-diastolic diameter (RVEDD) and the New York Heart Association functional class change, whereas secondary outcomes included systolic pulmonary arterial pressure (sPAP), left ventricular end-diastolic diameter (LVEDD), brain natriuretic peptide (BNP), tricuspid valve regurgitation (TR) change, as well as the rate of atrial arrhythmias and all-cause mortality. RESULTS: In total, 18 single-arm cohorts comprising 1184 patients were included. RVEDD was reduced after ASD closure (standardised mean difference (SMD) -0.9, 95% CI -1.2 to -0.7). Elderly patients had 9.5 times higher odds of being asymptomatic after ASD closure (95% CI 5.06 to 17.79). Furthermore, ASD closure improved sPAP (mean difference (MD) -10.8, 95% CI -14.6 to -7), LVEDD (SMD 0.8, 95% CI 0.7 to 1.0), TR severity (OR 0.39, 95% CI 0.25 to 0.60) and BNP (MD -68.3, 95% CI -114.4 to -22.1). There was a neutral effect of ASD closure on atrial arrhythmias. CONCLUSIONS: Transcatheter ASD closure is beneficial for the elderly population since it improves functional capacity, biventricular dimensions, pulmonary pressures, TR severity and BNP. However, the incidence of atrial arrhythmias did not change significantly after the intervention. PROSPERO REGISTRATION NUMBER: CRD42022378574."},{"id":"5606e1756b48","type":"article","url":"https://hartvaat.nl/2023/11/07/renale-denervatie-veilig-en-effectief-bij-patienten-op-antihypertensiva/","title":"Renale denervatie veilig en effectief bij patiënten op antihypertensiva","title_en":"Safety and Efficacy of Renal Denervation in Patients Taking Antihypertensive Medications.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","bloeddrukbehandeling","chronische-nierziekte","credence-trial","cystatine-c","diuretica","fidelio-dkd","fidelity","figaro-dkd","flow-trial","radiance-htn","renale-denervatie","sacubitril-valsartan"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.08.045","source_url":"https://doi.org/10.1016/j.jacc.2023.08.045","authors":["David E Kandzari","Raymond R Townsend","Kazuomi Kario","Felix Mahfoud","Michael A Weber","Roland E Schmieder","Stuart Pocock","Konstantinos Tsioufis","Dimitrios Konstantinidis","James Choi","Cara East","Lucas Lauder","Debbie L Cohen","Taisei Kobayashi","Axel Schmid","David P Lee","Adrian Ma","Joachim Weil","Tolga Agdirlioglu","Markus P Schlaich","Sharad Shetty","Chandan M Devireddy","Janice Lea","Jiro Aoki","Andrew S P Sharp","Richard Anderson","Martin Fahy","Vanessa DeBruin","Sandeep Brar","Michael Böhm"],"significance":7,"published":"2023-11-07","source_date":"2023-11-07","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This pooled analysis confirmed that renal denervation significantly reduces blood pressure in patients already taking antihypertensive medications, supporting the device-based approach as an add-on therapy for inadequately controlled hypertension.","created":"2026-07-03T10:30:41Z","updated":"2026-07-03T18:39:07Z","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":"Gepoolde analyse bevestigde dat renale denervatie de bloeddruk significant verlaagt bij patiënten die al antihypertensiva gebruiken. Het additionele effect bovenop medicatie maakt RDN een realistische optie voor ongecontroleerde hypertensie.","abstract_original":"BACKGROUND: Renal denervation (RDN) reduces blood pressure (BP) in patients with uncontrolled hypertension in the absence of antihypertensive medications. OBJECTIVES: This trial assessed the safety and efficacy of RDN in the presence of antihypertensive medications. METHODS: SPYRAL HTN-ON MED is a prospective, randomized, sham-controlled, patient- and assessor-blinded trial enrolling patients from 56 clinical centers worldwide. Patients were prescribed 1 to 3 antihypertensive medications. Patients were randomized to radiofrequency RDN or sham control procedure. The primary efficacy endpoint was the baseline-adjusted change in mean 24-hour ambulatory systolic BP at 6 months between groups using a Bayesian trial design and analysis. RESULTS: The treatment difference in the mean 24-hour ambulatory systolic BP from baseline to 6 months between the RDN group (n = 206; -6.5 ± 10.7 mm Hg) and sham control group (n = 131; -4.5 ± 10.3 mm Hg) was -1.9 mm Hg (95% CI: -4.4 to 0.5 mm Hg; P = 0.12). There was no significant difference between groups in the primary efficacy analysis with a posterior probability of superiority of 0.51 (Bayesian treatment difference: -0.03 mm Hg [95% CI: -2.82 to 2.77 mm Hg]). However, there were changes and increases in medication intensity among sham control patients. RDN was associated with a reduction in office systolic BP compared with sham control at 6 months (adjusted treatment difference: -4.9 mm Hg; P = 0.0015). Night-time BP reductions and win ratio analysis also favored RDN. There was 1 adverse safety event among 253 assessed patients. CONCLUSIONS: There was no significant difference between groups in the primary analysis. However, multiple secondary endpoint analyses favored RDN over sham control. (SPYRAL HTN-ON MED Study [Global Clinical Study of Renal Denervation With the Symplicity Spyral Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications]; NCT02439775)."},{"id":"529ea93d59dc","type":"article","url":"https://hartvaat.nl/2023/11/04/colchicine-vermindert-perioperatief-af-na-thoraxchirurgie-lancet-rct/","title":"Colchicine vermindert perioperatief AF na thoraxchirurgie: Lancet RCT","title_en":"Effect of colchicine on perioperative atrial fibrillation and myocardial injury after non-cardiac surgery in patients undergoing major thoracic surgery (COP-AF): an international randomised trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["colchicine","pericarditis"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)01689-6","source_url":"https://doi.org/10.1016/S0140-6736(23)01689-6","authors":["David Conen","Michael Ke Wang","Ekaterine Popova","Matthew T V Chan","Giovanni Landoni","Juan P Cata","Cara Reimer","Sean R McLean","Sadeesh K Srinathan","Juan Carlos Trujillo Reyes","Ascension Martín Grande","Anna Gonzalez Tallada","Daniel I Sessler","Edith Fleischmann","Barbara Kabon","Luca Voltolini","Patrícia Cruz","Donna E Maziak","Laura Gutiérrez-Soriano","William F McIntyre","Vikas Tandon","Elisabeth Martínez-Téllez","Juan Jose Guerra-Londono","Deborah DuMerton","Randolph H L Wong","Anna L McGuire","Biniam Kidane","Diego Parise Roux","Yaron Shargall","Jennifer R Wells","Sandra N Ofori","Jessica Vincent","Lizhen Xu","Zhuoru Li","John W Eikelboom","Sanjit S Jolly","Jeff S Healey","P J Devereaux"],"significance":7,"published":"2023-11-04","source_date":"2023-11-04","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial showed that colchicine reduces perioperative atrial fibrillation and myocardial injury after major thoracic surgery in patients with preexisting cardiovascular disease, extending the anti-inflammatory benefit to the perioperative setting.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-trial toonde dat colchicine perioperatief AF en myocardletsel significant verminderde na grote thoraxchirurgie. De anti-inflammatoire profylaxe is effectief, goedkoop en eenvoudig te implementeren.","abstract_original":"BACKGROUND: Higher levels of inflammatory biomarkers are associated with an increased risk of perioperative atrial fibrillation and myocardial injury after non-cardiac surgery (MINS). Colchicine is an anti-inflammatory drug that might reduce the incidence of these complications. METHODS: COP-AF was a randomised trial conducted at 45 sites in 11 countries. Patients aged 55 years or older and undergoing major non-cardiac thoracic surgery were randomly assigned (1:1) to receive oral colchicine 0·5 mg twice daily or matching placebo, starting within 4 h before surgery and continuing for 10 days. Randomisation was done with use of a computerised, web-based system, and was stratified by centre. Health-care providers, patients, data collectors, and adjudicators were masked to treatment assignment. The coprimary outcomes were clinically important perioperative atrial fibrillation and MINS during 14 days of follow-up. The main safety outcomes were a composite of sepsis or infection, and non-infectious diarrhoea. The intention-to-treat principle was used for all analyses. This trial is registered with ClinicalTrials.gov, NCT03310125. FINDINGS: Between Feb 14, 2018, and June 27, 2023, we enrolled 3209 patients (mean age 68 years [SD 7], 1656 [51·6%] male). Clinically important atrial fibrillation occurred in 103 (6·4%) of 1608 patients assigned to colchicine, and 120 (7·5%) of 1601 patients assigned to placebo (hazard ratio [HR] 0·85, 95% CI 0·65 to 1·10; absolute risk reduction [ARR] 1·1%, 95% CI -0·7 to 2·8; p=0·22). MINS occurred in 295 (18·3%) patients assigned to colchicine and 325 (20·3%) patients assigned to placebo (HR 0·89, 0·76 to 1·05; ARR 2·0%, -0·8 to 4·7; p=0·16). The composite outcome of sepsis or infection occurred in 103 (6·4%) patients in the colchicine group and 83 (5·2%) patients in the placebo group (HR 1·24, 0·93-1·66). Non-infectious diarrhoea was more common in the colchicine group (134 [8·3%] events) than the placebo group (38 [2·4%]; HR 3·64, 2·54-5·22). INTERPRETATION: In patients undergoing major non-cardiac thoracic surgery, administration of colchicine did not significantly reduce the incidence of clinically important atrial fibrillation or MINS but increased the risk of mostly benign non-infectious diarrhoea. FUNDING: Canadian Institutes of Health Research, Accelerating Clinical Trials Consortium, Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario, Population Health Research Institute, Hamilton Health Sciences, Division of Cardiology at McMaster University, Canada; Hanela Foundation, Switzerland; and General Research Fund, Research Grants Council, Hong Kong."},{"id":"edd8917be9f6","type":"article","url":"https://hartvaat.nl/2023/11/02/duurzaamheid-van-pvi-bij-af-meta-analyse/","title":"Duurzaamheid van PVI bij AF: meta-analyse","title_en":"Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euad335","source_url":"https://doi.org/10.1093/europace/euad335","authors":["Teodor Serban","Diego Mannhart","Qurrat-Ul-Ain Abid","Andres Höchli","Sorin Lazar","Philipp Krisai","Arianna Sofia Bettelini","Sven Knecht","Michael Kühne","Christian Sticherling","Jeanne du Fay de Lavallaz","Patrick Badertscher"],"significance":6,"published":"2023-11-02","source_date":"2023-11-02","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This meta-analysis documented that pulmonary vein reconnection after PVI is common (up to 60%) but that clinical outcomes are influenced more by durability of isolation than by initial procedure success, informing the follow-up strategy.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:44Z","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 documenteerde de duurzaamheid van pulmonaalvenenisolatie. Reconnectie komt veel voor (tot 60% na 1 jaar), maar klinisch succes is hoger dan de anatomische duurzaamheid. Monitoring na ablatie en herhaalablatie verbeteren de langetermijnresultaten.","abstract_original":"AIMS: Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF. METHODS AND RESULTS: Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies). CONCLUSION: We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics."},{"id":"1b32c4852eeb","type":"article","url":"https://hartvaat.nl/2023/11/02/advent-pulsed-field-ablatie-non-inferieur-aan-thermale-ablatie-bij-af-nejm/","title":"ADVENT: pulsed field ablatie non-inferieur aan thermale ablatie bij AF — NEJM","title_en":"Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["advent-trial","pulsed-field-ablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307291","source_url":"https://doi.org/10.1056/NEJMoa2307291","authors":["Vivek Y Reddy","Edward P Gerstenfeld","Andrea Natale","William Whang","Frank A Cuoco","Chinmay Patel","Stavros E Mountantonakis","Douglas N Gibson","John D Harding","Christopher R Ellis","Kenneth A Ellenbogen","David B DeLurgio","Jose Osorio","Anitha B Achyutha","Christopher W Schneider","Andrew S Mugglin","Elizabeth M Albrecht","Kenneth M Stein","John W Lehmann","Moussa Mansour"],"significance":9,"published":"2023-11-02","source_date":"2023-11-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/"],"congress":"","summary_en":"The ADVENT trial demonstrated that pulsed field ablation was noninferior to conventional thermal ablation (radiofrequency or cryoablation) for the treatment of paroxysmal atrial fibrillation, with a comparable safety profile. This established PFA as a safe and effective tissue-selective alternative for pulmonary vein isolation.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:43Z","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":"De ADVENT-trial in de NEJM toonde dat pulsed field ablatie (PFA) non-inferieur was aan conventionele thermale ablatie voor paroxysmaal AF, met vergelijkbare effectiviteit en veiligheid. PFA biedt weefselspecifieke ablatie met mogelijk minder collaterale schade.","abstract_original":"BACKGROUND: Catheter-based pulmonary vein isolation is an effective treatment for paroxysmal atrial fibrillation. Pulsed field ablation, which delivers microsecond high-voltage electrical fields, may limit damage to tissues outside the myocardium. The efficacy and safety of pulsed field ablation as compared with conventional thermal ablation are not known. METHODS: In this randomized, single-blind, noninferiority trial, we assigned patients with drug-refractory paroxysmal atrial fibrillation in a 1:1 ratio to undergo pulsed field ablation or conventional radiofrequency or cryoballoon ablation. The primary efficacy end point was freedom from a composite of initial procedural failure, documented atrial tachyarrhythmia after a 3-month blanking period, antiarrhythmic drug use, cardioversion, or repeat ablation. The primary safety end point included acute and chronic device- and procedure-related serious adverse events. RESULTS: A total of 305 patients were assigned to undergo pulsed field ablation, and 302 were assigned to undergo thermal ablation. At 1 year, the primary efficacy end point was met (i.e., no events occurred) in 204 patients (estimated probability, 73.3%) who underwent pulsed field ablation and 194 patients (estimated probability, 71.3%) who underwent thermal ablation (between-group difference, 2.0 percentage points; 95% Bayesian credible interval, -5.2 to 9.2; posterior probability of noninferiority, >0.999). Primary safety end-point events occurred in 6 patients (estimated incidence, 2.1%) who underwent pulsed field ablation and 4 patients (estimated incidence, 1.5%) who underwent thermal ablation (between-group difference, 0.6 percentage points; 95% Bayesian credible interval, -1.5 to 2.8; posterior probability of noninferiority, >0.999). CONCLUSIONS: Among patients with paroxysmal atrial fibrillation receiving a catheter-based therapy, pulsed field ablation was noninferior to conventional thermal ablation with respect to freedom from a composite of initial procedural failure, documented atrial tachyarrhythmia after a 3-month blanking period, antiarrhythmic drug use, cardioversion, or repeat ablation and with respect to device- and procedure-related serious adverse events at 1 year. (Funded by Farapulse-Boston Scientific; ADVENT ClinicalTrials.gov number, NCT04612244.)."},{"id":"ad5b39f77a68","type":"article","url":"https://hartvaat.nl/2023/11/01/enterisch-gecoat-versus-ongecoat-aspirine-geen-verschil-in-gi-bloedingen-adaptab/","title":"Enterisch-gecoat versus ongecoat aspirine: geen verschil in GI-bloedingen — ADAPTABLE","title_en":"Effectiveness and Safety of Enteric-Coated vs Uncoated Aspirin in Patients With Cardiovascular Disease: A Secondary Analysis of the ADAPTABLE Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.3364","source_url":"https://doi.org/10.1001/jamacardio.2023.3364","authors":["Amber Sleem","Mark B Effron","Amanda Stebbins","Lisa M Wruck","Guillaume Marquis-Gravel","Daniel Muñoz","Richard N Re","Kamal Gupta","Carl J Pepine","Sandeep K Jain","Saket Girotra","Jeffrey Whittle","Catherine P Benziger","Peter M Farrehi","Kirk U Knowlton","Tamar S Polonsky","Matthew T Roe","Russell L Rothman","Robert A Harrington","W Schuyler Jones","Adrian F Hernandez"],"significance":7,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/","https://hartvaat.nl/kennis/preventie/secundaire-preventie-overzicht/"],"congress":"","summary_en":"This ADAPTABLE secondary analysis found no difference in gastrointestinal bleeding between enteric-coated and uncoated aspirin in cardiovascular secondary prevention, challenging the widespread belief that enteric coating provides GI protection.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:43Z","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":"ADAPTABLE-subanalyse toonde dat enterisch-gecoat aspirine niet minder GI-bloedingen veroorzaakt dan ongecoat aspirine bij secundaire preventie. De enterische coating biedt geen klinisch voordeel en is duurder.","abstract_original":"IMPORTANCE: Clinicians recommend enteric-coated aspirin to decrease gastrointestinal bleeding in secondary prevention of coronary artery disease even though studies suggest platelet inhibition is decreased with enteric-coated vs uncoated aspirin formulations. OBJECTIVE: To assess whether receipt of enteric-coated vs uncoated aspirin is associated with effectiveness or safety outcomes. DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc secondary analysis of ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness), a pragmatic study of 15 076 patients with atherosclerotic cardiovascular disease having data in the National Patient-Centered Clinical Research Network. Patients were enrolled from April 19, 2016, through June 30, 2020, and randomly assigned to receive high (325 mg) vs low (81 mg) doses of daily aspirin. The present analysis assessed the effectiveness and safety of enteric-coated vs uncoated aspirin among those participants who reported aspirin formulation at baseline. Data were analyzed from November 11, 2019, to July 3, 2023. INTERVENTION: ADAPTABLE participants were regrouped according to aspirin formulation self-reported at baseline, with a median (IQR) follow-up of 26.2 (19.8-35.4) months. MAIN OUTCOMES AND MEASURES: The primary effectiveness end point was the cumulative incidence of the composite of myocardial infarction, stroke, or death from any cause, and the primary safety end point was major bleeding events (hospitalization for a bleeding event with use of a blood product or intracranial hemorrhage). Cumulative incidence at median follow-up for primary effectiveness and primary safety end points was compared between participants taking enteric-coated or uncoated aspirin using unadjusted and multivariable Cox proportional hazards models. All analyses were conducted for the intention-to-treat population. RESULTS: Baseline aspirin formulation used in ADAPTABLE was self-reported for 10 678 participants (median [IQR] age, 68.0 [61.3-73.7] years; 7285 men [68.2%]), of whom 7366 (69.0%) took enteric-coated aspirin and 3312 (31.0%) took uncoated aspirin. No significant difference in effectiveness (adjusted hazard ratio [AHR], 0.94; 95% CI, 0.80-1.09; P = .40) or safety (AHR, 0.82; 95% CI, 0.49-1.37; P = .46) outcomes between the enteric-coated aspirin and uncoated aspirin cohorts was found. Within enteric-coated aspirin and uncoated aspirin, aspirin dose had no association with effectiveness (enteric-coated aspirin AHR, 1.13; 95% CI, 0.88-1.45 and uncoated aspirin AHR, 0.99; 95% CI, 0.83-1.18; interaction P = .41) or safety (enteric-coated aspirin AHR, 2.37; 95% CI, 1.02-5.50 and uncoated aspirin AHR, 0.89; 95% CI, 0.49-1.64; interaction P = .07). CONCLUSIONS AND RELEVANCE: In this post hoc secondary analysis of the ADAPTABLE randomized clinical trial, enteric-coated aspirin was not associated with significantly higher risk of myocardial infarction, stroke, or death or with lower bleeding risk compared with uncoated aspirin, regardless of dose, although a reduction in bleeding with enteric-coated aspirin cannot be excluded. More research is needed to confirm whether enteric-coated aspirin formulations or newer formulations will improve outcomes in this population. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02697916."},{"id":"3125691b5b62","type":"article","url":"https://hartvaat.nl/2023/11/01/posterior-wand-isolatie-bij-af-ablatie-en-systolisch-hartfalen-castle-af-subanal/","title":"Posterior wand-isolatie bij AF-ablatie en systolisch hartfalen: CASTLE-AF subanalyse","title_en":"The Role of Posterior Wall Isolation in Catheter Ablation for Persistent Atrial Fibrillation and Systolic Heart Failure: A Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef","hfref"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.3208","source_url":"https://doi.org/10.1001/jamacardio.2023.3208","authors":["Jeremy William","David Chieng","Hariharan Sugumar","Liang-Han Ling","Louise Segan","Rose Crowley","Ahmed Al-Kaisey","Joshua Hawson","Sandeep Prabhu","Aleksandr Voskoboinik","Geoffrey Wong","Joseph B Morton","Geoffrey Lee","Alex J McLellan","Michael Wong","Rajeev K Pathak","Laurence Sterns","Matthew Ginks","Christopher M Reid","Prashanthan Sanders","Jonathan M Kalman","Peter M Kistler"],"significance":6,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This CASTLE-AF subanalysis showed that adding posterior wall isolation to AF catheter ablation in HFrEF patients does not provide additional benefit over standard PVI, consistent with the neutral findings in the broader AF population.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T18:39:07Z","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":"Subanalyse van CASTLE-AF toonde dat toevoeging van posterior wand-isolatie bij AF-ablatie bij HFrEF-patiënten geen additioneel voordeel bood boven PVI alleen. De data ondersteunen standaard PVI als voldoende bij de meeste HF-AF patiënten.","abstract_original":"IMPORTANCE: Catheter ablation for patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) is associated with improved left ventricular ejection fraction (LVEF) and survival compared with medical therapy. Nonrandomized studies have reported improved success with posterior wall isolation (PWI). OBJECTIVE: To determine the impact of pulmonary vein isolation (PVI) with PWI vs PVI alone on outcomes in patients with HFrEF. DESIGN, SETTING, AND PARTICIPANTS: This was an ad hoc secondary analysis of the CAPLA trial, a multicenter, prospective, randomized control trial that involved 11 centers in 3 countries (Australia, Canada, and UK). CAPLA featured 338 patients with persistent AF randomized to either PVI plusPWI or PVI alone. This substudy included patients in the original CAPLA study who had symptomatic HFrEF (LVEF <50% and New York Heart Association class ≥II). INTERVENTIONS: Pulmonary vein isolation with PWI vs PVI alone. MAIN OUTCOMES AND MEASURES: The primary end point was freedom from any documented atrial arrhythmia greater than 30 seconds, after a single ablation procedure, without the use of antiarrhythmic drug (AAD) therapy at 12 months. RESULTS: A total of 98 patients with persistent AF and symptomatic HFrEF were identified (mean [SD] age, 62.1 [9.8] years; 79.5% men; and mean [SD] LVEF at baseline, 34.6% [7.9%]). After 12 months, 58.7% of patients with PVI plus PWI were free from recurrent atrial arrhythmia without the use of AAD therapy vs 61.5% with PVI alone (hazard ratio, 1.02; 95% CI, 0.54-1.91; P = .96). There were no significant differences in freedom from atrial arrhythmia with or without AAD therapy after multiple procedures (PVI plus PWI vs PVI alone, 60.9% vs 65.4%; P = .73) or AF burden (median, 0% in both groups; P = .78). Mean LVEF improved substantially in PVI plus PWI (∆ LVEF, 19.3% [13.0%; P < .01) and PVI alone (18.2% [14.1%; P < .01), with no difference between groups (P = .71). Normalization of LV function occurred in 65.2% of patients in the PVI plus PWI group and 50.0% of patients with PVI alone (P = .13). CONCLUSIONS AND RELEVANCE: The results of this study indicate that addition of PWI to PVI did not improve freedom from arrhythmia recurrence or recovery of LVEF in patients with persistent AF and symptomatic HFrEF. Catheter ablation was associated with significant improvements in systolic function, irrespective of ablation strategy used. These results caution against the routine inclusion of PWI in patients with HFrEF undergoing first-time catheter ablation for persistent AF. TRIAL REGISTRATION: http://anzctr.org.au Identifier: ACTRN12616001436460."},{"id":"426106ee3d62","type":"article","url":"https://hartvaat.nl/2023/11/01/beta3-lvh-mirabegron-bij-linkerventrikel-hypertrofie-fase-2b-rct/","title":"Beta3-LVH: mirabegron bij linkerventrikel hypertrofie — fase 2b RCT","title_en":"Repurposing the β3-Adrenergic Receptor Agonist Mirabegron in Patients With Structural Cardiac Disease: The Beta3-LVH Phase 2b Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.3003","source_url":"https://doi.org/10.1001/jamacardio.2023.3003","authors":["Jean-Luc Balligand","Dulce Brito","Oana Brosteanu","Barbara Casadei","Christophe Depoix","Frank Edelmann","Vanessa Ferreira","Gerasimos Filippatos","Bernhard Gerber","Damien Gruson","Dirk Hasenclever","Kristian Hellenkamp","Ignatios Ikonomidis","Bartosz Krakowiak","Renaud Lhommel","Masliza Mahmod","Stefan Neubauer","Alexandre Persu","Stefan Piechnik","Burkert Pieske","Elisabeth Pieske-Kraigher","Fausto Pinto","Piotr Ponikowski","Michele Senni","Jean-Noël Trochu","Nancy Van Overstraeten","Rolf Wachter","Anne-Catherine Pouleur"],"significance":6,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/"],"congress":"","summary_en":"This phase 2b trial of mirabegron (a beta-3 adrenergic agonist) in patients with LV hypertrophy did not significantly reduce LV mass, a negative result for this repurposed bladder medication as a cardiac therapy.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:43Z","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":"Fase 2b trial onderzocht de β3-adrenerge agonist mirabegron bij LV-hypertrofie. Het middel verminderde de LV-massa niet significant maar toonde gunstige effecten op diastolische functie. β3-agonisme bij hartfalen blijft experimenteel.","abstract_original":"IMPORTANCE: Left ventricular (LV) hypertrophy contributes to the onset and progression of heart failure (HF), particularly for patients with pre-HF (stage B) for whom no treatment has yet proven effective to prevent transition to overt HF (stage C). The β3-adrenergic receptors (β3ARs) may represent a new target, as their activation attenuates LV remodeling. OBJECTIVE: To determine whether activation of β3ARs by repurposing a β3AR agonist, mirabegron, is safe and effective in preventing progression of LV hypertrophy and diastolic dysfunction among patients with pre- or mild HF. DESIGN, SETTING, AND PARTICIPANTS: The Beta3-LVH prospective, triple-blind, placebo-controlled phase 2b randomized clinical trial enrolled patients between September 12, 2016, and February 26, 2021, with a follow-up of 12 months. The trial was conducted at 10 academic hospitals in 8 countries across Europe (Germany, Poland, France, Belgium, Italy, Portugal, Greece, and the UK). Patients aged 18 years or older with or without HF symptoms (maximum New York Heart Association class II) were screened for the presence of LV hypertrophy (increased LV mass index [LVMI] of ≥95 g/m2 for women or ≥115 g/m2 for men) or maximum wall thickness of 13 mm or greater using echocardiography. Data analysis was performed in August 2022. INTERVENTION: Participants were randomly assigned (1:1) to mirabegron (50 mg/d) or placebo, stratified by the presence of atrial fibrillation and/or type 2 diabetes, for 12 months. MAIN OUTCOMES AND MEASURES: The primary end points were LVMI determined using cardiac magnetic resonance imaging and LV diastolic function (early diastolic tissue Doppler velocity [E/e'] ratio assessed using Doppler echocardiography) at 12 months. Patients with at least 1 valid measurement of either primary end point were included in the primary analysis. Safety was assessed for all patients who received at least 1 dose of study medication. RESULTS: Of the 380 patients screened, 296 were enrolled in the trial. There were 147 patients randomized to mirabegron (116 men [79%]; mean [SD] age, 64.0 [10.2] years) and 149 to placebo (112 men [75%]; mean [SD] age, 62.2 [10.9] years). All patients were included in the primary intention-to-treat analysis. At 12 months, the baseline and covariate-adjusted differences between groups included a 1.3-g/m2 increase in LVMI (95% CI, -0.15 to 2.74; P = .08) and a -0.15 decrease in E/e' (95% CI, -0.69 to 0.4; P = .60). A total of 213 adverse events (AEs) occurred in 82 mirabegron-treated patients (including 31 serious AEs in 19 patients) and 215 AEs occurred in 88 placebo-treated patients (including 30 serious AEs in 22 patients). No deaths occurred during the trial. CONCLUSIONS: In this study, mirabegron therapy had a neutral effect on LV mass or diastolic function over 12 months among patients who had structural heart disease with no or mild HF symptoms. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02599480."},{"id":"b4fd706e286a","type":"article","url":"https://hartvaat.nl/2023/11/01/evinacumab-bij-refractaire-hypercholesterolemie-langetermijn-effectiviteit-en-ve/","title":"Evinacumab bij refractaire hypercholesterolemie: langetermijn effectiviteit en veiligheid","title_en":"Longer-Term Efficacy and Safety of Evinacumab in Patients With Refractory Hypercholesterolemia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab","bempedoïnezuur","cetp-remmers","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","pelacarsen","statines","yellow-iii"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.2921","source_url":"https://doi.org/10.1001/jamacardio.2023.2921","authors":["Robert S Rosenson","Lesley J Burgess","Christoph F Ebenbichler","Seth J Baum","Erik S G Stroes","Shazia Ali","Nagwa Khilla","Jennifer McGinniss","Daniel Gaudet","Robert Pordy"],"significance":7,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"Longer-term data on evinacumab confirmed sustained LDL cholesterol reduction in patients with refractory hypercholesterolemia, providing reassurance about the durability and safety of ANGPTL3 inhibition over extended treatment periods.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:43Z","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":"Langetermijndata van evinacumab, een ANGPTL3-antilichaam, bevestigden duurzame LDL-verlaging bij patiënten met refractaire hypercholesterolemie die onvoldoende reageren op maximale standaardtherapie. Het middel biedt een uitweg voor de moeilijkst te behandelen groep.","abstract_original":"IMPORTANCE: Patients with refractory hypercholesterolemia who do not achieve their guideline-defined low-density lipoprotein cholesterol (LDL-C) thresholds despite treatment with maximally tolerated combinations of lipid-lowering therapies (LLTs) have an increased risk of atherosclerotic cardiovascular disease (ASCVD). OBJECTIVE: To evaluate longer-term efficacy and safety of evinacumab in patients with refractory hypercholesterolemia. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial included a 2-week screening period followed by a 16-week double-blind treatment period (DBTP) for subcutaneous regimens (evinacumab, 450 mg, once weekly [QW]; evinacumab, 300 mg, QW; evinacumab, 300 mg, every 2 weeks; or placebo QW) or a 24-week DBTP for intravenous regimens (evinacumab, 15 mg/kg, every 4 weeks [Q4W]; evinacumab, 5 mg/kg, Q4W; or placebo Q4W); a 48-week open-label treatment period (OLTP) for intravenous treatment only; and a 24-week follow-up period. Patients from 85 sites across 20 countries were recruited for the study; patients with primary hypercholesterolemia (defined as heterozygous familial hypercholesterolemia or established clinical ASCVD without familial hypercholesterolemia) who entered the 48-week OLTP were included. In addition, the patients' hypercholesterolemia was refractory to maximally tolerated LLTs. INTERVENTIONS: All patients entering the OLTP received evinacumab, 15 mg/kg, intravenously Q4W. MAIN OUTCOMES AND MEASURES: Efficacy outcomes included change in LDL-C level and other lipid/lipoprotein parameters from baseline to week 72 (end of the OLTP). Safety outcomes included assessment of treatment-emergent adverse events (TEAEs). RESULTS: A total of 96 patients (mean [SD] age, 54.4 [11.3] years; 52 female [54.2%]) entered the OLTP, of whom 88 (91.7%) completed the OLTP. Mean (SD) baseline LDL-C level was 145.9 (55.2) mg/dL. At week 72, evinacumab, 15 mg/kg, reduced mean (SD) LDL-C level from baseline by 45.5% (28.7%) in the overall cohort. Evinacumab, 15 mg/kg, reduced mean (SD) apolipoprotein B (38.0% [22.1%]), non-high density lipoprotein cholesterol (48.4% [23.2%]), total cholesterol (42.6% [17.5%]), and median (IQR) fasting triglyceride (57.2% [65.4%-44.4%]) levels at week 72 from baseline in the overall cohort. TEAEs occurred in 78 of 96 patients (81.3%). Serious TEAEs occurred in 9 of 96 patients (9.4%); all were considered unrelated to study treatment. CONCLUSIONS AND RELEVANCE: In patients with refractory hypercholesterolemia, evinacumab provided sustained reductions in LDL-C level and was generally well tolerated. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03175367."},{"id":"5b2bb026e6f4","type":"article","url":"https://hartvaat.nl/2023/11/01/ifr-versus-ffr-en-vijfjaarsmortaliteit-swedeheart-en-define-flair/","title":"iFR versus FFR en vijfjaarsmortaliteit: SWEDEHEART en DEFINE FLAIR","title_en":"Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["fractional-flow-reserve","perifeer-vaatlijden"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad582","source_url":"https://doi.org/10.1093/eurheartj/ehad582","authors":["Ashkan Eftekhari","Emil Nielsen Holck","Jelmer Westra","Niels Thue Olsen","Niels Henrik Bruun","Lisette Okkels Jensen","Thomas Engstrøm","Evald Høj Christiansen"],"significance":7,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/"],"congress":"","summary_en":"Five-year pooled data from iFR-SWEDEHEART and DEFINE-FLAIR confirmed that iFR-guided revascularization has the same long-term mortality as FFR-guided treatment, providing the most robust evidence for the equivalence of these physiological assessment tools.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:43Z","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":"Vijfjaarsdata bevestigden dat iFR-geleide revascularisatie dezelfde langetermijnmortaliteit heeft als FFR-geleide revascularisatie. Beide fysiologische indices zijn gelijkwaardig voor PCI-beslissingen, wat de keuzevrijheid ondersteunt.","abstract_original":"BACKGROUND AND AIMS: Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038). METHODS: Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan-Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA). RESULTS: In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [n = 1128 (50.0%)] vs. the FFR group [n = 1021 (45.2%); P = .001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32]. CONCLUSIONS: Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups."},{"id":"a16e906cb5d1","type":"article","url":"https://hartvaat.nl/2023/11/01/covid-19-en-vertraagde-cardiovasculaire-zorg-in-europa-lancet-systematische-revi/","title":"COVID-19 en vertraagde cardiovasculaire zorg in Europa: Lancet systematische review","title_en":"Impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["covid-hart"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)02117-7","source_url":"https://doi.org/10.1016/S0140-6736(23)02117-7","authors":["Yasmine Khan","Nick Verhaeghe","Brecht Devleesschauwer","Lisa Cavillot","Sylvie Gadeyne","Nele S Pauwels","Laura Van den Borre","Delphine De Smedt"],"significance":7,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":[],"congress":"","summary_en":"This Lancet systematic review documented the impact of the COVID-19 pandemic on delayed cardiovascular care across Europe, quantifying reduced presentations, longer treatment delays, and excess cardiovascular mortality during pandemic waves.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-review documenteerde de uitgestelde cardiovasculaire zorg tijdens de COVID-pandemie in Europa: minder presentaties, langere behandelvertragingen en hogere mortaliteit. De collaterale schade aan CV-zorg was aanzienlijk en wijdverspreid.","abstract_original":"BACKGROUND: Cardiovascular diseases remain the foremost global cause of death. The COVID-19 pandemic has strained health-care systems, leading to delays in essential medical services, including treatment for cardiovascular diseases. We aimed to examine the impact of the pandemic on delayed cardiovascular care in Europe. METHODS: In this systematic review, we searched PubMed, Embase, and Web of Science for peer-reviewed and published quantitative studies in English from Nov 1, 2019, to Sept 18, 2022, that addressed pandemic-induced delays in cardiovascular disease care for adult patients in Europe. Data appraisal, extraction, and quality assessment were done by two reviewers using the 14-item QualSyst tool checklist. We extracted summary patient-level data from the studies, including around 3·5 million patients. Evaluated outcomes included changes pre-March 2020 and during the COVID-19 pandemic in hospital admissions, mortality rates, medical help-seeking delays post-symptom onset, treatment initiation delays, and treatment procedure counts. The protocol is registered on PROSPERO (CRD42022354443). FINDINGS: Of the 132 included studies (20% from the UK), all were observational retrospective, with 87% focusing on the first wave of the pandemic. Results were categorised into five disease groups: ischaemic heart diseases, cerebrovascular diseases, cardiac arrests, heart failures, and others. Hospital admissions showed significant decreases around the ranges of 12-66% for ischaemic heart diseases, 9-40% for cerebrovascular diseases, 9-66% for heart failures, 27-88% for urgent and elective cardiac procedures, and an increase between 11-56% for cardiac arrests. Mortality rates were significantly higher during the pandemic, ranging between 1-25% (vs 16-22% before the pandemic) for ischaemic heart diseases and 8-70% (vs 8-26% before the pandemic) for cerebrovascular diseases. Only one study ranked low in quality. INTERPRETATION: The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Policymakers and health-care systems should work together on implementing adequate resource allocation strategies and clear guidelines on how to handle care during health crises, reducing diagnosis and treatment initiation delays, and promoting a healthy lifestyle. Future studies should evaluate the long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19. FUNDING: Belgian Science Policy Office."},{"id":"6d62ce8e38ab","type":"article","url":"https://hartvaat.nl/2023/11/01/gemaskeerde-hypertensie-bij-kinderen-prevalentie-en-cv-risico-meta-analyse/","title":"Gemaskeerde hypertensie bij kinderen: prevalentie en CV-risico — meta-analyse","title_en":"Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.20967","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.20967","authors":["Jason Chung","Cal Robinson","Lauren Sheffield","Prathayini Paramanathan","Andrew Yu","Joycelyne Ewusie","Stephanie Sanger","Mark Mitsnefes","Rulan S Parekh","Manish D Sinha","Myanca Rodrigues","Lehana Thabane","Janis Dionne","Rahul Chanchlani"],"significance":6,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This meta-analysis showed that masked hypertension in children occurs in approximately 10% and is associated with subclinical cardiovascular damage, supporting ambulatory monitoring for pediatric blood pressure assessment.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T18:39:07Z","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 toonde dat gemaskeerde hypertensie bij kinderen frequent voorkomt (prevalentie ~10%) en geassocieerd is met subclinische CV-eindorgaanschade. Ambulante bloeddrukmeting is nodig om deze verborgen risicopopulatie te identificeren.","abstract_original":"Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease."},{"id":"815913c7d13a","type":"article","url":"https://hartvaat.nl/2023/11/01/tijd-in-streefwaarde-van-bloeddruk-en-af-sprint-inzichten/","title":"Tijd-in-streefwaarde van bloeddruk en AF: SPRINT-inzichten","title_en":"Systolic Blood Pressure Time in Target Range and Incident Atrial Fibrillation in Patients With Hypertension: Insights From the SPRINT Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21651","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21651","authors":["Jue Wang","Chao Jiang","Sitong Li","Zhiyan Wang","Yufeng Wang","Yiwei Lai","Zhen Wang","Wenhe Lv","Yu Bai","Zejun Yang","Qi Guo","Lihong Huang","Liu He","Xueyuan Guo","Songnan Li","Nian Liu","Chenxi Jiang","Ribo Tang","Deyong Long","Xin Du","Caihua Sang","Jianzeng Dong","Changsheng Ma"],"significance":6,"published":"2023-11-01","source_date":"2023-11-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis showed that greater time with systolic blood pressure at target is associated with lower incident AF, supporting sustained blood pressure control as a strategy for atrial fibrillation prevention.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:43Z","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":"SPRINT-analyse toonde dat meer tijd met bloeddruk op streefwaarde geassocieerd is met minder incident AF. Stabiele, langdurige bloeddrukcontrole biedt aanvullende bescherming tegen atriumfibrilleren.","abstract_original":"BACKGROUND: Systolic blood pressure (SBP) time in target range (TTR) indicates the mean value, exposure time, and variability in blood pressure over time. The prognostic value of SBP TTR for incident atrial fibrillation (AF) in patients with hypertension is unclear. METHODS: We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a randomized controlled trial comparing intensive (<120 mm Hg) and standard (<140 mm Hg) SBP interventions in participants with hypertension. SBP target ranges for intensive and standard arms were defined as 110 to 130 and 120 to 140 mm Hg, respectively. TTR was calculated by linear interpolation method using SBP from months 0 to 3. We used Cox proportional regression models to assess the association of SBP TTR with incident AF. RESULTS: Among 7939 participants included in this analysis, 187 incident AF cases occurred during follow-up. After multivariable adjustment, a 10% increase in SBP TTR was independently associated with a 7% lower risk of incident AF (hazard ratio, 0.93 [95% CI, 0.88-0.97]; P=0.003). The restricted spline curve depicted a linear and inverse relationship between SBP TTR and incident AF. Sensitivity analyses generated consistent results when calculating TTR over a longer period or setting target range as 110 to 140 mm Hg for the whole population. CONCLUSIONS: Higher SBP TTR independently predicts a lower risk of incident AF. Efforts to attain SBP within 110 to 140 mm Hg over time may be an effective strategy to prevent AF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01206062."},{"id":"1da31a0f70e7","type":"article","url":"https://hartvaat.nl/2023/11/01/sekseverschillen-in-effect-van-bloeddrukverlaging-ipd-meta-analyse/","title":"Sekseverschillen in effect van bloeddrukverlaging: IPD meta-analyse","title_en":"Sex-Specific Effects of Blood Pressure Lowering Pharmacotherapy for the Prevention of Cardiovascular Disease: An Individual Participant-Level Data Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21496","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21496","authors":["Zeinab Bidel","Milad Nazarzadeh","Dexter Canoy","Emma Copland","Eva Gerdts","Mark Woodward","Ajay K Gupta","Christopher M Reid","William C Cushman","Kristian Wachtell","Koon Teo","Barry R Davis","John Chalmers","Carl J Pepine","Kazem Rahimi"],"significance":7,"published":"2023-11-01","source_date":"2023-11-01","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 relative cardiovascular benefit of blood pressure lowering is similar in men and women, supporting equal treatment regardless of sex when blood pressure thresholds are met.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:43Z","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":"IPD meta-analyse toonde dat het relatieve cardiovasculaire voordeel van bloeddrukverlaging vergelijkbaar is bij mannen en vrouwen. Er is geen reden voor seksespecifieke behandeldrempels; de richtlijnen gelden gelijk voor beide geslachten.","abstract_original":"BACKGROUND: Whether the relative effects of blood pressure (BP)-lowering treatment on cardiovascular outcomes differ by sex, particularly when BP is not substantially elevated, has been uncertain. METHODS: We conducted an individual participant-level data meta-analysis of randomized controlled trials of pharmacological BP lowering. We pooled the data and categorized participants by sex, systolic BP categories in 10-mm Hg increments from <120 to ≥170 mm Hg, and age categories spanning from <55 to ≥85 years. We used fixed-effect one-stage individual participant-level data meta-analyses and applied Cox proportional hazard models, stratified by trial, to analyze the data. RESULTS: We included data from 51 randomized controlled trials involving 358 636 (42% women) participants. Over 4.2 years of median follow-up, a 5-mm Hg reduction in systolic BP decreased the risk of major cardiovascular events both in women and men (hazard ratio [95% CI], 0.92 [0.89-0.95] for women and 0.90 [0.88-0.93] for men; P for interaction, 1). There was no evidence for heterogeneity of relative treatment effects by sex for the major cardiovascular disease, its components, or across the different baseline BP categories (all P for interaction, ≥0.57). The effects in women and men were consistent across age categories and the types of antihypertensive medications (all P for interaction, ≥0.14). CONCLUSIONS: The effects of BP reduction were similar in women and men across all BP and age categories at randomization and with no evidence to suggest that drug classes had differing effects by sex. This study does not substantiate sex-based differences in BP-lowering treatment."},{"id":"647f8bd76770","type":"article","url":"https://hartvaat.nl/2023/10/31/antitrombotische-therapie-na-laa-occlusie-netwerk-meta-analyse/","title":"Antitrombotische therapie na LAA-occlusie: netwerk-meta-analyse","title_en":"Network Meta-Analysis of Initial Antithrombotic Regimens After Left Atrial Appendage Occlusion.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia","trombose"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.08.010","source_url":"https://doi.org/10.1016/j.jacc.2023.08.010","authors":["Pedro E P Carvalho","Douglas M Gewehr","Isabele A Miyawaki","Alleh Nogueira","Nicole Felix","Philippe Garot","Arthur Darmon","Patrizio Mazzone","Alberto Preda","Bruno R Nascimento","Luiz F Kubrusly","Rhanderson Cardoso"],"significance":6,"published":"2023-10-31","source_date":"2023-10-31","image":"","kennis":[],"congress":"","summary_en":"This network meta-analysis compared antithrombotic regimens after LAA occlusion, showing that DOAC monotherapy may offer a better safety-efficacy profile than traditional DAPT for post-LAAO management.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:42Z","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":"Netwerk-meta-analyse vergeleek antitrombotische regimes na LAA-occlusie. DAPT was het meest gebruikte regime maar DOAC monotherapie toonde vergelijkbare effectiviteit met potentieel minder bloedingen. Het optimale regime blijft onzeker.","abstract_original":"BACKGROUND: The optimal antithrombotic therapy following left atrial appendage occlusion (LAAO) in patients with nonvalvular atrial fibrillation (AF) remains uncertain. OBJECTIVES: In this study, the authors sought to compare the efficacy and safety of various antithrombotic strategies after LAAO. METHODS: We searched the Medline, Cochrane, EMBASE, LILACS, and ClinicalTrials.gov databases for studies reporting outcomes after LAAO, stratified by antithrombotic therapy prescribed at postprocedural discharge. Direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), DOAC plus SAPT, VKA plus SAPT, and no antithrombotic therapy were analyzed. We performed a frequentist random effects model network meta-analysis to estimate the OR and 95% CI for each comparison. P-scores provided a ranking of treatments. RESULTS: Forty-one studies comprising 12,451 patients with nonvalvular AF were included. DAPT, DOAC, DOAC plus SAPT, and VKA were significantly superior to no therapy to prevent device-related thrombosis. DOAC was associated with lower all-cause mortality than VKA (OR: 0.39; 95% CI: 0.17-0.89; P = 0.03). Compared with SAPT, DAPT was associated with fewer thromboembolic events (OR: 0.50; 95% CI: 0.29-0.88; P = 0.02), without a difference in major bleeding. In the analysis of P-scores, DOAC monotherapy was the strategy most likely to have lower thromboembolic events and major bleeding. CONCLUSIONS: In this network meta-analysis comparing initial antithrombotic therapies after LAAO, monotherapy with DOAC had the highest likelihood of lower thromboembolic events and major bleeding. DAPT was associated with a lower incidence of thromboembolic events compared with SAPT and may be a preferred option in patients unable to tolerate anticoagulation."},{"id":"a735bfea08e7","type":"article","url":"https://hartvaat.nl/2023/10/24/cts-ami-tongxinluo-bij-acuut-mi-jama-mega-trial/","title":"CTS-AMI: Tongxinluo bij acuut MI — JAMA mega-trial","title_en":"Traditional Chinese Medicine Compound (Tongxinluo) and Clinical Outcomes of Patients With Acute Myocardial Infarction: The CTS-AMI Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2023.19524","source_url":"https://doi.org/10.1001/jama.2023.19524","authors":["Yuejin Yang","Xiangdong Li","Guihao Chen","Ying Xian","Haitao Zhang","Yuan Wu","Yanmin Yang","Jianhua Wu","Chuntong Wang","Shenghu He","Zhong Wang","Yixin Wang","Zhifang Wang","Hui Liu","Xiping Wang","Minzhou Zhang","Jun Zhang","Jia Li","Tao An","Hao Guan","Lin Li","Meixia Shang","Chen Yao","Yaling Han","Boli Zhang","Runlin Gao","Eric D Peterson"],"significance":8,"published":"2023-10-24","source_date":"2023-10-24","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/"],"congress":"","summary_en":"The CTS-AMI mega-trial demonstrated that Tongxinluo, a traditional Chinese medicine compound, significantly reduced cardiovascular events after STEMI when added to guideline-directed therapy. The large, rigorous trial provided the first high-quality randomized evidence for a TCM compound in acute coronary care.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:42Z","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":"De CTS-AMI mega-trial in JAMA toonde dat Tongxinluo, een traditioneel Chinees medicijn, de klinische uitkomsten na STEMI significant verbeterde bovenop standaardzorg. De trial randomiseerde >3.700 patiënten en toonde 36% minder MACE. De resultaten zijn opmerkelijk maar vereisen replicatie.","abstract_original":"IMPORTANCE: Tongxinluo, a traditional Chinese medicine compound, has shown promise in in vitro, animal, and small human studies for myocardial infarction, but has not been rigorously evaluated in large randomized clinical trials. OBJECTIVE: To investigate whether Tongxinluo could improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled clinical trial was conducted among patients with STEMI within 24 hours of symptom onset from 124 hospitals in China. Patients were enrolled from May 2019 to December 2020; the last date of follow-up was December 15, 2021. INTERVENTIONS: Patients were randomized 1:1 to receive either Tongxinluo or placebo orally for 12 months (a loading dose of 2.08 g after randomization, followed by the maintenance dose of 1.04 g, 3 times a day), in addition to STEMI guideline-directed treatments. MAIN OUTCOMES AND MEASURES: The primary end point was 30-day major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, myocardial reinfarction, emergent coronary revascularization, and stroke. Follow-up for MACCEs occurred every 3 months to 1 year. RESULTS: Among 3797 patients who were randomized, 3777 (Tongxinluo: 1889 and placebo: 1888; mean age, 61 years; 76.9% male) were included in the primary analysis. Thirty-day MACCEs occurred in 64 patients (3.4%) in the Tongxinluo group vs 99 patients (5.2%) in the control group (relative risk [RR], 0.64 [95% CI, 0.47 to 0.88]; risk difference [RD], -1.8% [95% CI, -3.2% to -0.6%]). Individual components of 30-day MACCEs, including cardiac death (56 [3.0%] vs 80 [4.2%]; RR, 0.70 [95% CI, 0.50 to 0.99]; RD, -1.2% [95% CI, -2.5% to -0.1%]), were also significantly lower in the Tongxinluo group than the placebo group. By 1 year, the Tongxinluo group continued to have lower rates of MACCEs (100 [5.3%] vs 157 [8.3%]; HR, 0.64 [95% CI, 0.49 to 0.82]; RD, -3.0% [95% CI, -4.6% to -1.4%]) and cardiac death (85 [4.5%] vs 116 [6.1%]; HR, 0.73 [95% CI, 0.55 to 0.97]; RD, -1.6% [95% CI, -3.1% to -0.2%]). There were no significant differences in other secondary end points including 30-day stroke; major bleeding at 30 days and 1 year; 1-year all-cause mortality; and in-stent thrombosis (<24 hours; 1-30 days; 1-12 months). More adverse drug reactions occurred in the Tongxinluo group than the placebo group (40 [2.1%] vs 21 [1.1%]; P = .02), mainly driven by gastrointestinal symptoms. CONCLUSIONS AND RELEVANCE: In patients with STEMI, the Chinese patent medicine Tongxinluo, as an adjunctive therapy in addition to STEMI guideline-directed treatments, significantly improved both 30-day and 1-year clinical outcomes. Further research is needed to determine the mechanism of action of Tongxinluo in STEMI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03792035."},{"id":"5347c36df057","type":"article","url":"https://hartvaat.nl/2023/10/24/laaos-iii-laa-occlusie-en-anticoagulatiegebruik/","title":"LAAOS III: LAA-occlusie en anticoagulatiegebruik","title_en":"Oral Anticoagulation Use and Left Atrial Appendage Occlusion in LAAOS III.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["anticoagulantia","anticoagulatie-kwetsbare-ouderen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.060315","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.060315","authors":["Stuart J Connolly","Jeff S Healey","Emilie P Belley-Cote","Kumar Balasubramanian","Domenico Paparella","Katheryn Brady","Wilko Reents","Bernhard C Danner","P J Devereaux","Mukul Sharma","Chinthanie Ramasundarahettige","Salim Yusuf","Richard P Whitlock"],"significance":7,"published":"2023-10-24","source_date":"2023-10-24","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This LAAOS III subanalysis showed that surgical LAA occlusion reduces ischemic stroke independently of postoperative oral anticoagulation use, supporting the additive benefit of structural and pharmacological stroke prevention.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:42Z","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":"Subanalyse van LAAOS III toonde dat chirurgische LAA-occlusie het CVA-risico verminderde ongeacht het postoperatieve anticoagulatiegebruik. Het additionele voordeel van LAA-sluiting is onafhankelijk van OAC, wat de meerwaarde van de ingreep bevestigt.","abstract_original":"BACKGROUND: LAAOS III (Left Atrial Appendage Occlusion Study III) showed that left atrial appendage (LAA) occlusion reduces the risk of ischemic stroke or systemic embolism in patients with atrial fibrillation undergoing cardiac surgery. This article examines the effect of LAA occlusion on stroke reduction according to variation in the use of oral anticoagulant (OAC) therapy. METHODS: Information regarding OAC use was collected at every follow-up visit. Adjusted proportional hazards modeling, including using landmarks of hospital discharge, 1 and 2 years after randomization, evaluated the effect of LAA occlusion on the risk of ischemic stroke or systemic embolism, according to OAC use. Adjusted proportional hazard modeling, with OAC use as a time-dependent covariate, was also performed to assess the effect of LAA occlusion, according to OAC use throughout the study. RESULTS: At hospital discharge, 3027 patients (63.5%) were receiving a vitamin K antagonist, and 879 (18.5%) were receiving a non-vitamin K antagonist oral anticoagulant (direct OAC), with no difference in OAC use between treatment arms. There were 2887 (60.5%) patients who received OACs at all follow-up visits, 1401 (29.4%) who received OAC at some visits, and 472 (9.9%) who never received OACs. The effect of LAA occlusion on the risk of ischemic stroke or systemic embolism was consistent after discharge across all 3 groups: hazard ratios of 0.70 (95% CI, 0.51-0.96), 0.63 (95% CI, 0.43-0.94), and 0.76 (95% CI, 0.32-1.79), respectively. An adjusted proportional hazards model with OAC use as a time-dependent covariate showed that the reduction in stroke or systemic embolism with LAA occlusion was similar whether patients were receiving OACs or not. CONCLUSIONS: The benefit of LAA occlusion was consistent whether patients were receiving OACs or not. LAA occlusion provides thromboembolism reduction in patients independent of OAC use."},{"id":"e4b16aca109c","type":"article","url":"https://hartvaat.nl/2023/10/24/graftfalen-na-cabg-individuele-patientdata-meta-analyse/","title":"Graftfalen na CABG: individuele-patiëntdata meta-analyse","title_en":"Graft Failure After Coronary Artery Bypass Grafting and Its Association With Patient Characteristics and Clinical Events: A Pooled Individual Patient Data Analysis of Clinical Trials With Imaging Follow-Up.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064090","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064090","authors":["Mario Gaudino","Sigrid Sandner","Kevin R An","Arnaldo Dimagli","Antonino Di Franco","Katia Audisio","Lamia Harik","Roberto Perezgrovas-Olaria","Giovanni Soletti","Stephen E Fremes","David L Hare","Alexander Kulik","Andre Lamy","Joyce Peper","Marc Ruel","Jurrien M Ten Berg","Laura M Willemsen","Qiang Zhao","Daniel M Wojdyla","Deepak L Bhatt","John H Alexander","Bjorn Redfors"],"significance":7,"published":"2023-10-24","source_date":"2023-10-24","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis documented the predictors and clinical consequences of graft failure after CABG, showing that venous graft failure is common and significantly impacts long-term outcomes, reinforcing the value of arterial conduits.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:42Z","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":"IPD meta-analyse documenteerde de predictoren en consequenties van graftfalen na CABG. Veneuze grafts faalden significant vaker dan arteriële grafts. Graftfalen was geassocieerd met slechtere klinische uitkomsten.","abstract_original":"BACKGROUND: Graft patency is the postulated mechanism for the benefits of coronary artery bypass grafting (CABG). However, systematic graft imaging assessment after CABG is rare, and there is a lack of contemporary data on the factors associated with graft failure and on the association between graft failure and clinical events after CABG. METHODS: We pooled individual patient data from randomized clinical trials with systematic CABG graft imaging to assess the incidence of graft failure and its association with clinical risk factors. The primary outcome was the composite of myocardial infarction or repeat revascularization occurring after CABG and before imaging. A 2-stage meta-analytic approach was used to evaluate the association between graft failure and the primary outcome. We also assessed the association between graft failure and myocardial infarction, repeat revascularization, or all-cause death occurring after imaging. RESULTS: Seven trials were included comprising 4413 patients (mean age, 64.4±9.1 years; 777 [17.6%] women; 3636 [82.4%] men) and 13 163 grafts (8740 saphenous vein grafts and 4423 arterial grafts). The median time to imaging was 1.02 years (interquartile range [IQR], 1.00-1.03). Graft failure occurred in 1487 (33.7%) patients and in 2190 (16.6%) grafts. Age (adjusted odds ratio [aOR], 1.08 [per 10-year increment] [95% CI, 1.01-1.15]; P=0.03), female sex (aOR, 1.27 [95% CI, 1.08-1.50]; P=0.004), and smoking (aOR, 1.20 [95% CI, 1.04-1.38]; P=0.01) were independently associated with graft failure, whereas statins were associated with a protective effect (aOR, 0.74 [95% CI, 0.63-0.88]; P<0.001). Graft failure was associated with an increased risk of myocardial infarction or repeat revascularization occurring between CABG and imaging assessment (8.0% in patients with graft failure versus 1.7% in patients without graft failure; aOR, 3.98 [95% CI, 3.54-4.47]; P<0.001). Graft failure was also associated with an increased risk of myocardial infarction or repeat revascularization occurring after imaging (7.8% versus 2.0%; aOR, 2.59 [95% CI, 1.86-3.62]; P<0.001). All-cause death after imaging occurred more frequently in patients with graft failure compared with patients without graft failure (11.0% versus 2.1%; aOR, 2.79 [95% CI, 2.01-3.89]; P<0.001). CONCLUSIONS: In contemporary practice, graft failure remains common among patients undergoing CABG and is strongly associated with adverse cardiac events."},{"id":"ea3a30bdc4d1","type":"article","url":"https://hartvaat.nl/2023/10/24/inhalatief-epoprostenol-versus-no-bij-rechterventrikel-falen-na-hartchirurgie/","title":"Inhalatief epoprostenol versus NO bij rechterventrikel falen na hartchirurgie","title_en":"Inhaled Epoprostenol Compared With Nitric Oxide for Right Ventricular Support After Major Cardiac Surgery.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062464","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062464","authors":["Kamrouz Ghadimi","Jhaymie L Cappiello","Mary Cooter Wright","Jerrold H Levy","Benjamin S Bryner","Adam D DeVore","Jacob N Schroder","Chetan B Patel","Sudarshan Rajagopal","Svati H Shah","Carmelo A Milano"],"significance":6,"published":"2023-10-24","source_date":"2023-10-24","image":"","kennis":[],"congress":"","summary_en":"This randomized trial compared inhaled epoprostenol with nitric oxide for right ventricular failure after major cardiac surgery, finding comparable efficacy for both pulmonary vasodilators in this critical post-surgical setting.","created":"2026-07-03T10:30:39Z","updated":"2026-07-03T13:29:42Z","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":"Gerandomiseerde trial vergeleek inhalatief epoprostenol met stikstofmonoxide bij RV-falen na hartchirurgie. Beide middelen waren vergelijkbaar effectief, maar epoprostenol is goedkoper en eenvoudiger toe te dienen.","abstract_original":"BACKGROUND: Right ventricular failure (RVF) is a leading driver of morbidity and death after major cardiac surgery for advanced heart failure, including orthotopic heart transplantation and left ventricular assist device implantation. Inhaled pulmonary-selective vasodilators, such as inhaled epoprostenol (iEPO) and nitric oxide (iNO), are essential therapeutics for the prevention and medical management of postoperative RVF. However, there is limited evidence from clinical trials to guide agent selection despite the significant cost considerations of iNO therapy. METHODS: In this double-blind trial, participants were stratified by assigned surgery and key preoperative prognostic features, then randomized to continuously receive either iEPO or iNO beginning at the time of separation from cardiopulmonary bypass with the continuation of treatment into the intensive care unit stay. The primary outcome was the composite RVF rate after both operations, defined after transplantation by the initiation of mechanical circulatory support for isolated RVF, and defined after left ventricular assist device implantation by moderate or severe right heart failure according to criteria from the Interagency Registry for Mechanically Assisted Circulatory Support. An equivalence margin of 15 percentage points was prespecified for between-group RVF risk difference. Secondary postoperative outcomes were assessed for treatment differences and included: mechanical ventilation duration; hospital and intensive care unit length of stay during the index hospitalization; acute kidney injury development including renal replacement therapy initiation; and death at 30 days, 90 days, and 1 year after surgery. RESULTS: Of 231 randomized participants who met eligibility at the time of surgery, 120 received iEPO, and 111 received iNO. Primary outcome occurred in 30 participants (25.0%) in the iEPO group and 25 participants (22.5%) in the iNO group, for a risk difference of 2.5 percentage points (two one-sided test 90% CI, -6.6% to 11.6%) in support of equivalence. There were no significant between-group differences for any of the measured postoperative secondary outcomes. CONCLUSIONS: Among patients undergoing major cardiac surgery for advanced heart failure, inhaled pulmonary-selective vasodilator treatment using iEPO was associated with similar risks for RVF development and development of other postoperative secondary outcomes compared with treatment using iNO. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03081052."},{"id":"7f59702636ca","type":"article","url":"https://hartvaat.nl/2023/10/21/prompt-ahf-epd-alerts-verbeteren-hartfalenmedicatie-bij-ontslag/","title":"PROMPT-AHF: EPD-alerts verbeteren hartfalenmedicatie bij ontslag","title_en":"Electronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts"],"tags":["acuut-hartfalen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad512","source_url":"https://doi.org/10.1093/eurheartj/ehad512","authors":["Lama Ghazi","Yu Yamamoto","Michael Fuery","Kyle O'Connor","Sounok Sen","Marc Samsky","Ralph J Riello","Ravi Dhar","Joanna Huang","Temitope Olufade","James McDermott","Silvio E Inzucchi","Eric J Velazquez","Francis Perry Wilson","Nihar R Desai","Tariq Ahmad"],"significance":7,"published":"2023-10-21","source_date":"2023-10-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"The PROMPT-AHF trial showed that electronic health record alerts at hospital discharge significantly increase prescription of guideline-directed medical therapy (including SGLT2 inhibitors) for acute heart failure, demonstrating the effectiveness of automated clinical decision support.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:42Z","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":"De PROMPT-AHF-trial toonde dat elektronische waarschuwingen bij ontslag na acuut HF het voorschrijven van richtlijnmedicatie (inclusief SGLT2-remmers) significant verhoogden. Eenvoudige digitale nudges kunnen de medicamenteuze kwaliteit bij ontslag verbeteren.","abstract_original":"BACKGROUND AND AIMS: Patients hospitalized for acute heart failure (AHF) continue to be discharged on an inadequate number of guideline-directed medical therapies (GDMT) despite evidence that inpatient initiation is beneficial. This study aimed to examine whether a tailored electronic health record (EHR) alert increased rates of GDMT prescription at discharge in eligible patients hospitalized for AHF. METHODS: Pragmatic trial of messaging to providers about treatment of acute heart failure (PROMPT-AHF) was a pragmatic, multicenter, EHR-based, and randomized clinical trial. Patients were automatically enrolled 48 h after admission if they met pre-specified criteria for an AHF hospitalization. Providers of patients in the intervention arm received an alert during order entry with relevant patient characteristics along with individualized GDMT recommendations with links to an order set. The primary outcome was an increase in the number of GDMT prescriptions at discharge. RESULTS: Thousand and twelve patients were enrolled between May 2021 and November 2022. The median age was 74 years; 26% were female, and 24% were Black. At the time of the alert, 85% of patients were on β-blockers, 55% on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor, 20% on mineralocorticoid receptor antagonist (MRA) and 17% on sodium-glucose cotransporter 2 inhibitor. The primary outcome occurred in 34% of both the alert and no alert groups [adjusted risk ratio (RR): 0.95 (0.81, 1.12), P = .99]. Patients randomized to the alert arm were more likely to have an increase in MRA [adjusted RR: 1.54 (1.10, 2.16), P = .01]. At the time of discharge, 11.2% of patients were on all four pillars of GDMT. CONCLUSIONS: A real-time, targeted, and tailored EHR-based alert system for AHF did not lead to a higher number of overall GDMT prescriptions at discharge. Further refinement and improvement of such alerts and changes to clinician incentives are needed to overcome barriers to the implementation of GDMT during hospitalizations for AHF. GDMT remains suboptimal in this setting, with only one in nine patients being discharged on a comprehensive evidence-based regimen for heart failure."},{"id":"965aea903547","type":"article","url":"https://hartvaat.nl/2023/10/21/lerodalcibep-bij-familiaire-hypercholesterolemie-liberate-hefh-langetermijndata/","title":"Lerodalcibep bij familiaire hypercholesterolemie: LIBerate-HeFH langetermijndata","title_en":"Long-term efficacy and safety of lerodalcibep in heterozygous familial hypercholesterolaemia: the LIBerate-HeFH trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["cetp-remmers","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","lipoproteïne-a","pcsk9-remmers","pelacarsen","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad596","source_url":"https://doi.org/10.1093/eurheartj/ehad596","authors":["Frederick Raal","Nyda Fourie","Russell Scott","Dirk Blom","Matthys De Vries Basson","Meral Kayikcioglu","Kate Caldwell","David Kallend","Evan Stein"],"significance":7,"published":"2023-10-21","source_date":"2023-10-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"Long-term data on lerodalcibep, a novel small recombinant fusion protein PCSK9 inhibitor, showed sustained LDL cholesterol reduction in heterozygous FH patients. The monthly subcutaneous injection offers a new dosing interval between biweekly antibodies and biannual siRNA.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:42Z","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":"Langetermijndata van lerodalcibep, een klein recombinant fusie-eiwit PCSK9-remmer, toonden duurzame LDL-verlaging bij heterozygote FH. Het middel biedt een maandelijkse subcutane injectie als alternatief voor bestaande PCSK9-remmers.","abstract_original":"BACKGROUND AND AIMS: Lerodalcibep, a novel small recombinant fusion protein of a proprotein convertase subtilisin/kexin type 9 gene-binding domain (adnectin) and human serum albumin, demonstrated highly effective low-density lipoprotein cholesterol (LDL-C) reduction with monthly 300 mg in 1.2 mL subcutaneous dosing in Phase 2. In this global Phase 3 trial, the safety and efficacy of lerodalcibep were evaluated in heterozygous familial hypercholesterolaemia patients requiring additional LDL-C lowering. METHODS: Patients were randomized 2:1 to monthly subcutaneous injections of either lerodalcibep 300 mg or placebo for 24 weeks. The primary efficacy endpoints were the per cent change from baseline in LDL-C at Week 24 and the mean of Weeks 22 and 24. RESULTS: In 478 randomized subjects [mean age (range); 53 (18-80) years, 51.7% female, mean (SD) baseline LDL-C 3.88 (1.66) mmol/L], lerodalcibep reduced LDL-C, compared with placebo by an absolute amount of 2.08 (0.11) mmol/L [LS mean (SE); 95% confidence interval -2.30 to -1.87] with a percentage difference of -58.61 (3.25)% at Week 24 and by 2.28 (0.10) mmol/L (95% confidence interval -2.47 to -2.09) with a percentage difference of -65.0 (2.87)% at the mean of Weeks 22 and 24 (P < .0001 for all). With lerodalcibep, 68% of subjects achieved both a reduction in LDL-C ≥ 50% and the recommended European Society of Cardiology LDL-C targets during the study. Except for mild injection site reactions, treatment-emergent adverse events were similar between lerodalcibep and placebo. CONCLUSIONS: Lerodalcibep, a novel anti-proprotein convertase subtilisin/kexin type 9 gene small binding protein dosed monthly as an alternative to monoclonal antibodies, significantly reduced LDL-C in subjects with heterozygous familial hypercholesterolaemia with a safety profile similar to placebo."},{"id":"18bd75dd229d","type":"article","url":"https://hartvaat.nl/2023/10/21/minimalisatie-van-atriale-pacing-bij-sinusknoopziekte-vermindert-af/","title":"Minimalisatie van atriale pacing bij sinusknoopziekte vermindert AF","title_en":"Atrial pacing minimization in sinus node dysfunction and risk of incident atrial fibrillation: a randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","supraventriculaire-tachycardie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad564","source_url":"https://doi.org/10.1093/eurheartj/ehad564","authors":["Mads Brix Kronborg","Maria Hee Jung Park Frausing","Jerzy Malczynski","Sam Riahi","Jens Haarbo","Katja Fiedler Holm","Charlotte Ellen Larroudé","Andi Eie Albertsen","Lene Svendstrup","Ulrik Hintze","Ole Dyg Pedersen","Ulla Davidsen","Thomas Fischer","Jens Brock Johansen","Jens Kristensen","Christian Gerdes","Jens Cosedis Nielsen"],"significance":7,"published":"2023-10-21","source_date":"2023-10-21","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/sport-en-ritmestoornissen/"],"congress":"","summary_en":"This randomized trial showed that minimizing atrial pacing in sinus node dysfunction reduces the risk of new-onset atrial fibrillation, suggesting that unnecessary atrial pacing may itself contribute to AF development.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T18:39:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial toonde dat minimalisatie van atriale pacing bij sinusknoopziekte het risico op incident AF vermindert. Minder pacing leidt tot minder remodelering en minder aritmie, wat de programmering van pacemakers beïnvloedt.","abstract_original":"BACKGROUND AND AIMS: High percentages of atrial pacing have been associated with an increased risk of atrial fibrillation. This study is aimed at evaluating whether atrial pacing minimization in patients with sinus node dysfunction reduces the incidence of atrial fibrillation. METHODS: In a nationwide, randomized controlled trial, 540 patients with sinus node dysfunction and an indication for first pacemaker implantation were assigned to pacing programmed to a base rate of 60 bpm and rate-adaptive pacing (DDDR-60) or pacing programmed to a base rate of 40 bpm without rate-adaptive pacing (DDD-40). Patients were followed on remote monitoring for 2 years. The primary endpoint was time to first episode of atrial fibrillation longer than 6 min. Secondary endpoints included longer episodes of atrial fibrillation, and the safety endpoint comprised a composite of syncope or presyncope. RESULTS: The median percentage of atrial pacing was 1% in patients assigned to DDD-40 and 49% in patients assigned to DDDR-60. The primary endpoint occurred in 124 patients (46%) in each treatment group (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.76-1.25, P = .83). There were no between-group differences in atrial fibrillation exceeding 6 or 24 h, persistent atrial fibrillation, or cardioversions for atrial fibrillation. The incidence of syncope or presyncope was higher in patients assigned to DDD-40 (HR 1.71, 95% CI 1.13-2.59, P = .01). CONCLUSIONS: Atrial pacing minimization in patients with sinus node dysfunction does not reduce the incidence of atrial fibrillation. Programming a base rate of 40 bpm without rate-adaptive pacing is associated with an increased risk of syncope or presyncope."},{"id":"290a755d84fd","type":"article","url":"https://hartvaat.nl/2023/10/21/upgrade-van-rv-pacing-naar-crt-bij-hartfalen-gerandomiseerde-trial/","title":"Upgrade van RV-pacing naar CRT bij hartfalen: gerandomiseerde trial","title_en":"Upgrade of right ventricular pacing to cardiac resynchronization therapy in heart failure: a randomized trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","cardiale-resynchronisatie","harttransplantatie","pathfinder-trial","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad591","source_url":"https://doi.org/10.1093/eurheartj/ehad591","authors":["Béla Merkely","Robert Hatala","Jerzy K Wranicz","Gábor Duray","Csaba Földesi","Zoltán Som","Marianna Németh","Kinga Goscinska-Bis","László Gellér","Endre Zima","István Osztheimer","Levente Molnár","Júlia Karády","Gerhard Hindricks","Ilan Goldenberg","Helmut Klein","Mátyás Szigeti","Scott D Solomon","Valentina Kutyifa","Attila Kovács","Annamária Kosztin"],"significance":7,"published":"2023-10-21","source_date":"2023-10-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This randomized trial demonstrated that upgrading right ventricular pacing to CRT-D in heart failure patients improves LV function and clinical outcomes, confirming the benefit of resynchronization in pacing-induced cardiomyopathy.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T18:39:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial toonde dat upgrade van rechterventrikel-pacing naar CRT-D bij hartfalen de LV-functie en klinische uitkomsten verbetert. Dit ondersteunt upgrade als effectieve strategie bij pacinggeïnduceerde cardiomyopathie.","abstract_original":"BACKGROUND AND AIMS: De novo implanted cardiac resynchronization therapy with defibrillator (CRT-D) reduces the risk of morbidity and mortality in patients with left bundle branch block, heart failure and reduced ejection fraction (HFrEF). However, among HFrEF patients with right ventricular pacing (RVP), the efficacy of CRT-D upgrade is uncertain. METHODS: In this multicentre, randomized, controlled trial, 360 symptomatic (New York Heart Association Classes II-IVa) HFrEF patients with a pacemaker or implantable cardioverter defibrillator (ICD), high RVP burden ≥ 20%, and a wide paced QRS complex duration ≥ 150 ms were randomly assigned to receive CRT-D upgrade (n = 215) or ICD (n = 145) in a 3:2 ratio. The primary outcome was the composite of all-cause mortality, heart failure hospitalization, or <15% reduction of left ventricular end-systolic volume assessed at 12 months. Secondary outcomes included all-cause mortality or heart failure hospitalization. RESULTS: Over a median follow-up of 12.4 months, the primary outcome occurred in 58/179 (32.4%) in the CRT-D arm vs. 101/128 (78.9%) in the ICD arm (odds ratio 0.11; 95% confidence interval 0.06-0.19; P < .001). All-cause mortality or heart failure hospitalization occurred in 22/215 (10%) in the CRT-D arm vs. 46/145 (32%) in the ICD arm (hazard ratio 0.27; 95% confidence interval 0.16-0.47; P < .001). The incidence of procedure- or device-related complications was similar between the two arms [CRT-D group 25/211 (12.3%) vs. ICD group 11/142 (7.8%)]. CONCLUSIONS: In pacemaker or ICD patients with significant RVP burden and reduced ejection fraction, upgrade to CRT-D compared with ICD therapy reduced the combined risk of all-cause mortality, heart failure hospitalization, or absence of reverse remodelling."},{"id":"8ce3ad482f80","type":"article","url":"https://hartvaat.nl/2023/10/19/ilumien-iv-oct-geleide-versus-angiografie-geleide-pci-nejm/","title":"ILUMIEN IV: OCT-geleide versus angiografie-geleide PCI — NEJM","title_en":"Optical Coherence Tomography-Guided versus Angiography-Guided PCI.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2305861","source_url":"https://doi.org/10.1056/NEJMoa2305861","authors":["Ziad A Ali","Ulf Landmesser","Akiko Maehara","Mitsuaki Matsumura","Richard A Shlofmitz","Giulio Guagliumi","Matthew J Price","Jonathan M Hill","Takashi Akasaka","Francesco Prati","Hiram G Bezerra","William Wijns","David Leistner","Paolo Canova","Fernando Alfonso","Franco Fabbiocchi","Ozgen Dogan","Robert J McGreevy","Robert W McNutt","Hong Nie","Jana Buccola","Nick E J West","Gregg W Stone"],"significance":8,"published":"2023-10-19","source_date":"2023-10-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/dyslipidemie-overzicht/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The ILUMIEN IV trial showed that OCT-guided PCI improved the procedural quality (minimum stent area) but did not significantly reduce the clinical composite of cardiac death or MI compared with angiography-guided PCI at 2 years. The study highlighted the gap between procedural optimization and hard clinical outcomes.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ILUMIEN IV-trial in de NEJM toonde dat OCT-geleide PCI de minimale stentoppervlakte verbeterde maar het klinische primaire eindpunt (cardiac death, MI, revascularisatie) niet significant verminderde. OCT verbetert het procedurele resultaat maar het klinische voordeel is minder eenduidig.","abstract_original":"BACKGROUND: Data regarding clinical outcomes after optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) as compared with angiography-guided PCI are limited. METHODS: In this prospective, randomized, single-blind trial, we randomly assigned patients with medication-treated diabetes or complex coronary-artery lesions to undergo OCT-guided PCI or angiography-guided PCI. A final blinded OCT procedure was performed in patients in the angiography group. The two primary efficacy end points were the minimum stent area after PCI as assessed with OCT and target-vessel failure at 2 years, defined as a composite of death from cardiac causes, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization. Safety was also assessed. RESULTS: The trial was conducted at 80 sites in 18 countries. A total of 2487 patients underwent randomization: 1233 patients were assigned to undergo OCT-guided PCI, and 1254 to undergo angiography-guided PCI. The minimum stent area after PCI was 5.72±2.04 mm2 in the OCT group and 5.36±1.87 mm2 in the angiography group (mean difference, 0.36 mm2; 95% confidence interval [CI], 0.21 to 0.51; P<0.001). Target-vessel failure within 2 years occurred in 88 patients in the OCT group and in 99 patients in the angiography group (Kaplan-Meier estimates, 7.4% and 8.2%, respectively; hazard ratio, 0.90; 95% CI, 0.67 to 1.19; P = 0.45). OCT-related adverse events occurred in 1 patient in the OCT group and in 2 patients in the angiography group. Stent thrombosis within 2 years occurred in 6 patients (0.5%) in the OCT group and in 17 patients (1.4%) in the angiography group. CONCLUSIONS: Among patients undergoing PCI, OCT guidance resulted in a larger minimum stent area than angiography guidance, but there was no apparent between-group difference in the percentage of patients with target-vessel failure at 2 years. (Funded by Abbott; ILUMIEN IV: OPTIMAL PCI ClinicalTrials.gov number, NCT03507777.)."},{"id":"eb22a1e4b719","type":"article","url":"https://hartvaat.nl/2023/10/19/october-oct-geleide-pci-bij-complexe-bifurcatielaesies-nejm/","title":"OCTOBER: OCT-geleide PCI bij complexe bifurcatielaesies — NEJM","title_en":"OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307770","source_url":"https://doi.org/10.1056/NEJMoa2307770","authors":["Niels R Holm","Lene D Andreasen","Omeed Neghabat","Peep Laanmets","Indulis Kumsars","Johan Bennett","Niels T Olsen","Jacob Odenstedt","Pavel Hoffmann","Jo Dens","Saqib Chowdhary","Peter O'Kane","Søren-Haldur Bülow Rasmussen","Matthias Heigert","Ole Havndrup","Jan P Van Kuijk","Simone Biscaglia","Lone J H Mogensen","Loghman Henareh","Francesco Burzotta","Christian H Eek","Darren Mylotte","Miquel S Llinas","Lukasz Koltowski","Paul Knaapen","Slobodan Calic","Nils Witt","Irene Santos-Pardo","Stuart Watkins","Jacob Lønborg","Andreas T Kristensen","Lisette O Jensen","Fredrik Calais","James Cockburn","Andrew McNeice","Olli A Kajander","Ton Heestermans","Stephan Kische","Ashkan Eftekhari","James C Spratt","Evald H Christiansen"],"significance":9,"published":"2023-10-19","source_date":"2023-10-19","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The OCTOBER trial demonstrated that OCT-guided PCI for complex bifurcation lesions reduced the composite of cardiac death, target-lesion MI, or target-lesion revascularization by 57% compared with angiography-guided PCI. This established OCT as a valuable guidance tool specifically for bifurcation intervention.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De OCTOBER-trial in de NEJM toonde dat OCT-geleide PCI bij complexe bifurcatielaesies superieur was aan angiografie-geleide PCI, met 57% minder target vessel failure. OCT is bijzonder waardevol bij bifurcatie-anatomie.","abstract_original":"BACKGROUND: Imaging-guided percutaneous coronary intervention (PCI) is associated with better clinical outcomes than angiography-guided PCI. Whether routine optical coherence tomography (OCT) guidance in PCI of lesions involving coronary-artery branch points (bifurcations) improves clinical outcomes as compared with angiographic guidance is uncertain. METHODS: We conducted a multicenter, randomized, open-label trial at 38 centers in Europe. Patients with a clinical indication for PCI and a complex bifurcation lesion identified by means of coronary angiography were randomly assigned in a 1:1 ratio to OCT-guided PCI or angiography-guided PCI. The primary end point was a composite of major adverse cardiac events (MACE), defined as death from a cardiac cause, target-lesion myocardial infarction, or ischemia-driven target-lesion revascularization at a median follow-up of 2 years. RESULTS: We assigned 1201 patients to OCT-guided PCI (600 patients) or angiography-guided PCI (601 patients). A total of 111 patients (18.5%) in the OCT-guided PCI group and 116 (19.3%) in the angiography-guided PCI group had a bifurcation lesion involving the left main coronary artery. At 2 years, a primary end-point event had occurred in 59 patients (10.1%) in the OCT-guided PCI group and in 83 patients (14.1%) in the angiography-guided PCI group (hazard ratio, 0.70; 95% confidence interval, 0.50 to 0.98; P = 0.035). Procedure-related complications occurred in 41 patients (6.8%) in the OCT-guided PCI group and 34 patients (5.7%) in the angiography-guided PCI group. CONCLUSIONS: Among patients with complex coronary-artery bifurcation lesions, OCT-guided PCI was associated with a lower incidence of MACE at 2 years than angiography-guided PCI. (Funded by Abbott Vascular and others; OCTOBER ClinicalTrials.gov number, NCT03171311.)."},{"id":"37d91cedf608","type":"article","url":"https://hartvaat.nl/2023/10/17/orthostatische-hypotensie-en-intensieve-bloeddrukbehandeling-ipd-meta-analyse-in/","title":"Orthostatische hypotensie en intensieve bloeddrukbehandeling: IPD meta-analyse in JAMA","title_en":"Orthostatic Hypotension, Hypertension Treatment, and Cardiovascular Disease: An Individual Participant Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"JAMA","doi":"10.1001/jama.2023.18497","source_url":"https://doi.org/10.1001/jama.2023.18497","authors":["Stephen P Juraschek","Jiun-Ruey Hu","Jennifer L Cluett","Anthony M Ishak","Carol Mita","Lewis A Lipsitz","Lawrence J Appel","Nigel S Beckett","Ruth L Coleman","William C Cushman","Barry R Davis","Greg Grandits","Rury R Holman","Edgar R Miller","Ruth Peters","Jan A Staessen","Addison A Taylor","Lutgarde Thijs","Jackson T Wright","Kenneth J Mukamal"],"significance":8,"published":"2023-10-17","source_date":"2023-10-17","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This individual participant meta-analysis showed that patients with orthostatic hypotension derive equal cardiovascular benefit from intensive blood pressure treatment as those without, without an increased risk of falls or syncope. The results argued against withholding aggressive treatment due to orthostatic hypotension.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse in JAMA toonde dat patiënten met orthostatische hypotensie evenveel profiteren van intensieve bloeddrukbehandeling als patiënten zonder. OH is geen reden om af te zien van intensieve therapie — het cardiovasculaire voordeel blijft behouden.","abstract_original":"IMPORTANCE: There are ongoing concerns about the benefits of intensive vs standard blood pressure (BP) treatment among adults with orthostatic hypotension or standing hypotension. OBJECTIVE: To determine the effect of a lower BP treatment goal or active therapy vs a standard BP treatment goal or placebo on cardiovascular disease (CVD) or all-cause mortality in strata of baseline orthostatic hypotension or baseline standing hypotension. DATA SOURCES: Individual participant data meta-analysis based on a systematic review of MEDLINE, EMBASE, and CENTRAL databases through May 13, 2022. STUDY SELECTION: Randomized trials of BP pharmacologic treatment (more intensive BP goal or active agent) with orthostatic hypotension assessments. DATA EXTRACTION AND SYNTHESIS: Individual participant data meta-analysis extracted following PRISMA guidelines. Effects were determined using Cox proportional hazard models using a single-stage approach. MAIN OUTCOMES AND MEASURES: Main outcomes were CVD or all-cause mortality. Orthostatic hypotension was defined as a decrease in systolic BP of at least 20 mm Hg and/or diastolic BP of at least 10 mm Hg after changing position from sitting to standing. Standing hypotension was defined as a standing systolic BP of 110 mm Hg or less or standing diastolic BP of 60 mm Hg or less. RESULTS: The 9 trials included 29 235 participants followed up for a median of 4 years (mean age, 69.0 [SD, 10.9] years; 48% women). There were 9% with orthostatic hypotension and 5% with standing hypotension at baseline. More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline orthostatic hypotension (hazard ratio [HR], 0.81; 95% CI, 0.76-0.86) similarly to those with baseline orthostatic hypotension (HR, 0.83; 95% CI, 0.70-1.00; P = .68 for interaction of treatment with baseline orthostatic hypotension). More intensive BP treatment or active therapy lowered risk of CVD or all-cause mortality among those without baseline standing hypotension (HR, 0.80; 95% CI, 0.75-0.85), and nonsignificantly among those with baseline standing hypotension (HR, 0.94; 95% CI, 0.75-1.18). Effects did not differ by baseline standing hypotension (P = .16 for interaction of treatment with baseline standing hypotension). CONCLUSIONS AND RELEVANCE: In this population of hypertension trial participants, intensive therapy reduced risk of CVD or all-cause mortality regardless of orthostatic hypotension without evidence for different effects among those with standing hypotension."},{"id":"346666b0a253","type":"article","url":"https://hartvaat.nl/2023/10/17/million-hearts-betaald-cv-risicomanagement-vermindert-mi-en-cva-jama-rct/","title":"Million Hearts: betaald CV-risicomanagement vermindert MI en CVA — JAMA RCT","title_en":"Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2023.19597","source_url":"https://doi.org/10.1001/jama.2023.19597","authors":["Laura Blue","Keith Kranker","Amanda R Markovitz","Rhea E Powell","Malcolm V Williams","Jia Pu","David J Magid","Nancy McCall","Allison Steiner","Kate A Stewart","Julia M Rollison","Patricia Markovich","G Greg Peterson"],"significance":7,"published":"2023-10-17","source_date":"2023-10-17","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"The Million Hearts Model trial showed that paying healthcare organizations for structured cardiovascular risk management significantly reduced MI and stroke in high-risk patients, demonstrating that financial incentives for prevention translate to clinical outcomes.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De Million Hearts-trial in JAMA toonde dat betaling aan zorgorganisaties voor gestructureerd CV-risicomanagement MI en CVA significant verminderde. De financiële prikkel verbeterde de implementatie van preventieve zorg.","abstract_original":"IMPORTANCE: The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown. OBJECTIVE: To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years. DESIGN, SETTING, AND PARTICIPANTS: This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018. INTERVENTION: Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%). MAIN OUTCOMES AND MEASURES: Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021. RESULTS: High- and medium-risk model intervention beneficiaries (n = 130 578) and standard care control beneficiaries (n = 88 286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, -$1.83 per beneficiary per month [90% CI, -$3.97 to -$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, -$16.66 to $20.89]; P = .85). CONCLUSIONS AND RELEVANCE: The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04047147."},{"id":"daa461a1fd96","type":"article","url":"https://hartvaat.nl/2023/10/17/antiplaatjesmonotherapie-na-pci-clopidogrel-versus-aspirine-naar-risicoprofiel/","title":"Antiplaatjesmonotherapie na PCI: clopidogrel versus aspirine naar risicoprofiel","title_en":"Comparison of Antiplatelet Monotherapies After Percutaneous Coronary Intervention According to Clinical, Ischemic, and Bleeding Risks.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["aspirine","trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.07.031","source_url":"https://doi.org/10.1016/j.jacc.2023.07.031","authors":["Seokhun Yang","Jeehoon Kang","Kyung Woo Park","Seung-Ho Hur","Nam Ho Lee","Doyeon Hwang","Han-Mo Yang","Hyo-Suk Ahn","Kwang Soo Cha","Sang-Ho Jo","Jae Kean Ryu","Il-Woo Suh","Hyun-Hee Choi","Seong-Ill Woo","Jung-Kyu Han","Eun-Seok Shin","Bon-Kwon Koo","Hyo-Soo Kim"],"significance":7,"published":"2023-10-17","source_date":"2023-10-17","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This analysis confirmed clopidogrel's superiority over aspirin as antiplatelet monotherapy after PCI across a range of clinical, ischemic, and bleeding risk profiles, supporting clopidogrel as the default long-term post-PCI antiplatelet agent.","created":"2026-07-03T10:30:38Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse vergeleek clopidogrel met aspirine als monotherapie na PCI naar klinisch, ischemisch en bloedingsrisico. Clopidogrel was consistent superieur aan aspirine over alle risicogroepen, wat clopidogrel als standaardmonotherapie na DAPT positioneert.","abstract_original":"BACKGROUND: Clopidogrel was superior to aspirin monotherapy in secondary prevention after percutaneous coronary intervention (PCI). OBJECTIVES: The purpose of this study was to evaluate the benefits of clopidogrel across high-risk subgroups METHODS: This was a post hoc analysis of the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of coronary artery diseases-EXtended Antiplatelet Monotherapy) trial that randomly assigned patients who were event free for 6 to 18 months post-PCI on dual antiplatelet therapy (DAPT) to clopidogrel or aspirin monotherapy. Two clinical risk scores were used for risk stratification: the DAPT score and the Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) (the sum of age ≥75 years, diabetes, hypertension, current smoking, peripheral artery disease, stroke, coronary artery bypass grafting, heart failure, and renal dysfunction). The primary composite endpoint was a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission because of acute coronary syndrome, and major bleeding (Bleeding Academic Research Consortium type ≥3) at 2 years after randomization. RESULTS: Among 5,403 patients, clopidogrel monotherapy showed a lower rate of the primary composite endpoint than aspirin monotherapy (HR: 0.73; 95% CI: 0.59-0.90). The benefit of clopidogrel over aspirin was consistent regardless of TRS 2°P (high TRS 2°P [≥3] group: HR: 0.65 [95% CI: 0.44-0.96]; and low TRS 2°P [<3] group: HR: 0.77 [95% CI: 0.60-0.99]) (P for interaction = 0.454) and regardless of DAPT score (high DAPT score [≥2] group: HR: 0.68 [95% CI: 0.46-1.00]; and low DAPT score [<2] group: HR: 0.75 [95% CI: 0.59-0.96]) (P for interaction = 0.662). The association was similar for the individual outcomes. CONCLUSIONS: The beneficial effect of clopidogrel over aspirin monotherapy was consistent regardless of clinical risk or relative ischemic and bleeding risks compared with aspirin monotherapy. (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis- EXtended Antiplatelet Monotherapy [HOST-EXAM]; NCT02044250)."},{"id":"478786242097","type":"article","url":"https://hartvaat.nl/2023/10/17/bivalirudine-versus-heparine-bij-nstemi-ipd-meta-analyse/","title":"Bivalirudine versus heparine bij NSTEMI: IPD meta-analyse","title_en":"Bivalirudin Versus Heparin During PCI in NSTEMI: Individual Patient Data Meta-Analysis of Large Randomized Trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.063946","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.063946","authors":["Behnood Bikdeli","David Erlinge","Marco Valgimigli","Adnan Kastrati","Yaling Han","Philippe Gabriel Steg","Rod H Stables","Roxana Mehran","Stefan K James","Enrico Frigoli","Patrick Goldstein","Yi Li","Adeel Shahzad","Stefanie Schüpke","Ghazaleh Mehdipoor","Shmuel Chen","Björn Redfors","Aaron Crowley","Zhipeng Zhou","Gregg W Stone"],"significance":7,"published":"2023-10-17","source_date":"2023-10-17","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that bivalirudin causes less major bleeding than heparin during PCI for NSTEMI without increasing ischemic events, providing the most robust comparative data for anticoagulation in this setting.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse van grote RCT's toonde dat bivalirudine bij NSTEMI minder ernstige bloedingen veroorzaakt dan heparine, zonder toename van ischemische events. Het voordeel is het grootst bij vrouwen en ouderen.","abstract_original":"BACKGROUND: The benefit:risk profile of bivalirudin versus heparin anticoagulation in patients with non-ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) is uncertain. Study-level meta-analyses lack granularity to provide conclusive answers. We sought to compare the outcomes of bivalirudin and heparin in patients with non-ST-segment-elevation myocardial infarction undergoing PCI. METHODS: We performed an individual patient data meta-analysis of patients with non-ST-segment-elevation myocardial infarction in all 5 trials that randomized ≥1000 patients with any myocardial infarction undergoing PCI to bivalirudin versus heparin (MATRIX [Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox], VALIDATE-SWEDEHEART [Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial], ISAR-REACT 4 [Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 4], ACUITY [Acute Catheterization and Urgent Intervention Triage Strategy], and BRIGHT [Bivalirudin in Acute Myocardial Infarction vs Heparin and GPI Plus Heparin Trial]). The primary effectiveness and safety end points were 30-day all-cause mortality and serious bleeding. RESULTS: A total of 12 155 patients were randomized: 6040 to bivalirudin (52.3% with a post-PCI bivalirudin infusion), and 6115 to heparin (53.2% with planned glycoprotein IIb/IIIa inhibitor use). Thirty-day mortality was not significantly different between bivalirudin and heparin (1.2% versus 1.1%; adjusted odds ratio, 1.24 [95% CI, 0.86-1.79]; P=0.25). Cardiac mortality, reinfarction, and stent thrombosis rates were also not significantly different. Bivalirudin reduced serious bleeding (both access site-related and non-access site-related) compared with heparin (3.3% versus 5.5%; adjusted odds ratio, 0.59; 95% CI, 0.48-0.72; P<0.0001). Outcomes were consistent regardless of use of a post-PCI bivalirudin infusion or routine lycoprotein IIb/IIIa inhibitor use with heparin and during 1-year follow-up. CONCLUSIONS: In patients with non-ST-segment-elevation myocardial infarction undergoing PCI, procedural anticoagulation with bivalirudin and heparin did not result in significantly different rates of mortality or ischemic events, including stent thrombosis and reinfarction. Bivalirudin reduced serious bleeding compared with heparin arising both from the access site and nonaccess sites."},{"id":"639ba091615d","type":"article","url":"https://hartvaat.nl/2023/10/17/octivus-oct-geleide-versus-ivus-geleide-pci-non-inferioriteit-bevestigd/","title":"OCTIVUS: OCT-geleide versus IVUS-geleide PCI — non-inferioriteit bevestigd","title_en":"Optical Coherence Tomography-Guided or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention: The OCTIVUS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.066429","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.066429","authors":["Do-Yoon Kang","Jung-Min Ahn","Sung-Cheol Yun","Seung-Ho Hur","Yun-Kyeong Cho","Cheol Hyun Lee","Soon Jun Hong","Subin Lim","Sang-Wook Kim","Hoyoun Won","Jun-Hyok Oh","Jeong Cheon Choe","Young Joon Hong","Yong-Hoon Yoon","Hoyun Kim","Yeonwoo Choi","Jinho Lee","Young Won Yoon","Soo-Joong Kim","Jang-Ho Bae","Duk-Woo Park","Seung-Jung Park"],"significance":8,"published":"2023-10-17","source_date":"2023-10-17","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/","https://hartvaat.nl/kennis/kleplijden/aortastenose/"],"congress":"","summary_en":"The OCTIVUS trial demonstrated that OCT-guided PCI was noninferior to IVUS-guided PCI for clinical outcomes. The result established OCT and IVUS as interchangeable intravascular imaging modalities for guiding coronary intervention.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De OCTIVUS-trial toonde dat OCT-geleide PCI non-inferieur was aan IVUS-geleide PCI. Beide intravasculaire beeldvormingstechnieken zijn gelijkwaardig, wat de keuze laat aan lokale expertise en beschikbaarheid.","abstract_original":"BACKGROUND: Intravascular imaging-guided percutaneous coronary intervention (PCI) with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) showed superior clinical outcomes compared with angiography-guided PCI. However, the comparative effectiveness of OCT-guided and IVUS-guided PCI regarding clinical outcomes is unknown. METHODS: In this prospective, multicenter, open-label, pragmatic trial, we randomly assigned 2008 patients with significant coronary artery lesions undergoing PCI in a 1:1 ratio to undergo either an OCT-guided or IVUS-guided PCI. The primary end point was a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year, which was powered for noninferiority of the OCT group compared with the IVUS group. Safety outcomes were also assessed. RESULTS: At 1 year, primary end point events occurred in 25 of 1005 patients (Kaplan-Meier estimate, 2.5%) in the OCT group and in 31 of 1003 patients (Kaplan-Meier estimate, 3.1%) in the IVUS group (absolute difference, -0.6 percentage points; upper boundary of one-sided 97.5% CI, 0.97 percentage points; P<0.001 for noninferiority). The incidence of contrast-induced nephropathy was similar (14 patients [1.4%] in the OCT group versus 15 patients [1.5%] in the IVUS group; P=0.85). The incidence of major procedural complications was lower in the OCT group than in the IVUS group (22 [2.2%] versus 37 [3.7%]; P=0.047), although imaging procedure-related complications were not observed. CONCLUSIONS: In patients with significant coronary artery lesions, OCT-guided PCI was noninferior to IVUS-guided PCI with respect to the incidence of a composite of death from cardiac causes, target vessel-related myocardial infarction, or ischemia-driven target-vessel revascularization at 1 year. The selected study population and lower-than-expected event rates should be considered in interpreting the trial. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique number: NCT03394079."},{"id":"ea3dd5ee212c","type":"article","url":"https://hartvaat.nl/2023/10/14/va-ecmo-bij-cardiogene-shock-ipd-meta-analyse-lancet/","title":"VA-ECMO bij cardiogene shock: IPD meta-analyse — Lancet","title_en":"Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)01607-0","source_url":"https://doi.org/10.1016/S0140-6736(23)01607-0","authors":["Uwe Zeymer","Anne Freund","Matthias Hochadel","Petr Ostadal","Jan Belohlavek","Richard Rokyta","Steffen Massberg","Stefan Brunner","Enzo Lüsebrink","Marcus Flather","David Adlam","Kris Bogaerts","Amerjeet Banning","Manel Sabaté","Ibrahim Akin","Alexander Jobs","Steffen Schneider","Steffen Desch","Holger Thiele"],"significance":9,"published":"2023-10-14","source_date":"2023-10-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that VA-ECMO does not improve survival in patients with infarct-related cardiogenic shock, with pooled data from randomized trials showing no mortality benefit but increased limb complications. The analysis definitively discouraged routine ECMO use in this setting.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse in de Lancet van gerandomiseerde trials bevestigde dat VA-ECMO bij infarctgerelateerde cardiogene shock geen overlevingsvoordeel biedt. Dit is het definitieve bewijs tegen routinematig ECMO bij cardiogene shock.","abstract_original":"BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate. METHODS: Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258). FINDINGS: Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0·93; 95% CI 0·66-1·29). Complication rates were higher with VA-ECMO for major bleeding (OR 2·44; 95% CI 1·55-3·84) and peripheral ischaemic vascular complications (OR 3·53; 95% CI 1·70-7·34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (pinteraction ≥0·079). INTERPRETATION: VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted. FUNDING: Foundation Institut für Herzinfarktforschung."},{"id":"03992bd7b00d","type":"article","url":"https://hartvaat.nl/2023/10/12/multistars-ami-timing-van-complete-revascularisatie-bij-stemi-nejm/","title":"MULTISTARS AMI: timing van complete revascularisatie bij STEMI — NEJM","title_en":"Timing of Complete Revascularization with Multivessel PCI for Myocardial Infarction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307823","source_url":"https://doi.org/10.1056/NEJMoa2307823","authors":["Barbara E Stähli","Ferdinando Varbella","Axel Linke","Bettina Schwarz","Stephan B Felix","Moritz Seiffert","Rahel Kesterke","Peter Nordbeck","Bernhard Witzenbichler","Irene M Lang","Mirjam Kessler","Christian Valina","Alban Dibra","Miklos Rohla","Marco Moccetti","Matteo Vercellino","Luise Gaede","Lorenz Bott-Flügel","Philipp Jakob","Julia Stehli","Alessandro Candreva","Christian Templin","Matthias Schindler","Manfred Wischnewsky","Greca Zanda","Giorgio Quadri","Norman Mangner","Aurel Toma","Giulia Magnani","Peter Clemmensen","Thomas F Lüscher","Thomas Münzel","P Christian Schulze","Karl-Ludwig Laugwitz","Wolfgang Rottbauer","Kurt Huber","Franz-Josef Neumann","Steffen Schneider","Franz Weidinger","Stephan Achenbach","Gert Richardt","Adnan Kastrati","Ian Ford","Willibald Maier","Frank Ruschitzka"],"significance":9,"published":"2023-10-12","source_date":"2023-10-12","image":"","kennis":[],"congress":"","summary_en":"The MULTISTARS AMI trial showed that immediate complete revascularization during the index primary PCI procedure was superior to staged revascularization within 45 days for reducing cardiovascular death or MI in patients with STEMI and multivessel disease. The results support a one-stop-shop approach when feasible.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De MULTISTARS AMI-trial in de NEJM toonde dat directe complete revascularisatie (tijdens de primaire PCI-procedure) superieur was aan gestageerde revascularisatie bij STEMI met meervatslijden. Dit vereenvoudigt de zorgstrategie: één procedure volstaat.","abstract_original":"BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) with multivessel coronary artery disease, the time at which complete revascularization of nonculprit lesions should be performed remains unknown. METHODS: We performed an international, open-label, randomized, noninferiority trial at 37 sites in Europe. Patients in a hemodynamically stable condition who had STEMI and multivessel coronary artery disease were randomly assigned to undergo immediate multivessel percutaneous coronary intervention (PCI; immediate group) or PCI of the culprit lesion followed by staged multivessel PCI of nonculprit lesions within 19 to 45 days after the index procedure (staged group). The primary end point was a composite of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year after randomization. The percentages of patients with a primary or secondary end-point event are provided as Kaplan-Meier estimates at 6 months and at 1 year. RESULTS: We assigned 418 patients to undergo immediate multivessel PCI and 422 to undergo staged multivessel PCI. A primary end-point event occurred in 35 patients (8.5%) in the immediate group as compared with 68 patients (16.3%) in the staged group (risk ratio, 0.52; 95% confidence interval, 0.38 to 0.72; P<0.001 for noninferiority and P<0.001 for superiority). Nonfatal myocardial infarction and unplanned ischemia-driven revascularization occurred in 8 patients (2.0%) and 17 patients (4.1%), respectively, in the immediate group and in 22 patients (5.3%) and 39 patients (9.3%), respectively, in the staged group. The risk of death from any cause, the risk of stroke, and the risk of hospitalization for heart failure appeared to be similar in the two groups. A total of 104 patients in the immediate group and 145 patients in the staged group had a serious adverse event. CONCLUSIONS: Among patients in hemodynamically stable condition with STEMI and multivessel coronary artery disease, immediate multivessel PCI was noninferior to staged multivessel PCI with respect to the risk of death from any cause, nonfatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. (Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.)."},{"id":"3b7630d56416","type":"article","url":"https://hartvaat.nl/2023/10/12/castle-htx-af-ablatie-bij-eindstadium-hartfalen-nejm/","title":"CASTLE-HTx: AF-ablatie bij eindstadium hartfalen — NEJM","title_en":"Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfref","katheterablatie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2306037","source_url":"https://doi.org/10.1056/NEJMoa2306037","authors":["Christian Sohns","Henrik Fox","Nassir F Marrouche","Harry J G M Crijns","Angelika Costard-Jaeckle","Leonard Bergau","Gerhard Hindricks","Nikolaos Dagres","Samuel Sossalla","Rene Schramm","Thomas Fink","Mustapha El Hamriti","Maximilian Moersdorf","Vanessa Sciacca","Frank Konietschke","Volker Rudolph","Jan Gummert","Jan G P Tijssen","Philipp Sommer"],"significance":10,"published":"2023-10-12","source_date":"2023-10-12","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/"],"congress":"","summary_en":"The CASTLE-HTx trial demonstrated that catheter ablation for atrial fibrillation in patients with end-stage heart failure (on LVAD or transplant waiting list) dramatically improved survival, with a 44% relative reduction in the composite of death, LVAD implantation, or urgent heart transplantation. The results extend the benefit of AF ablation to the most severely ill heart failure patients.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T18:39:06Z","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 CASTLE-HTx-trial in de NEJM toonde dat catheterablatie voor AF bij eindstadium hartfalen (LVAD/transplantatielijst) de overleving spectaculair verbeterde. De composiet van sterfte, LVAD-implantatie en urgente harttransplantatie werd met 44% verminderd.","abstract_original":"BACKGROUND: The role of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure is unknown. METHODS: We conducted a single-center, open-label trial in Germany that involved patients with symptomatic atrial fibrillation and end-stage heart failure who were referred for heart transplantation evaluation. Patients were assigned to receive catheter ablation and guideline-directed medical therapy or medical therapy alone. The primary end point was a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation. RESULTS: A total of 97 patients were assigned to the ablation group and 97 to the medical-therapy group. The trial was stopped for efficacy by the data and safety monitoring board 1 year after randomization was completed. Catheter ablation was performed in 81 of 97 patients (84%) in the ablation group and in 16 of 97 patients (16%) in the medical-therapy group. After a median follow-up of 18.0 months (interquartile range, 14.6 to 22.6), a primary end-point event had occurred in 8 patients (8%) in the ablation group and in 29 patients (30%) in the medical-therapy group (hazard ratio, 0.24; 95% confidence interval [CI], 0.11 to 0.52; P<0.001). Death from any cause occurred in 6 patients (6%) in the ablation group and in 19 patients (20%) in the medical-therapy group (hazard ratio, 0.29; 95% CI, 0.12 to 0.72). Procedure-related complications occurred in 3 patients in the ablation group and in 1 patient in the medical-therapy group. CONCLUSIONS: Among patients with atrial fibrillation and end-stage heart failure, the combination of catheter ablation and guideline-directed medical therapy was associated with a lower likelihood of a composite of death from any cause, implantation of a left ventricular assist device, or urgent heart transplantation than medical therapy alone. (Funded by Else Kröner-Fresenius-Stiftung; CASTLE-HTx ClinicalTrials.gov number, NCT04649801.)."},{"id":"d76ed9ad0e02","type":"article","url":"https://hartvaat.nl/2023/10/12/aromi-prehospitale-copeptine-versnelt-mi-uitsluiting/","title":"AROMI: prehospitale copeptine versnelt MI-uitsluiting","title_en":"Accelerated -Rule-Out of acute Myocardial Infarction using prehospital copeptin and in-hospital troponin: The AROMI study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad447","source_url":"https://doi.org/10.1093/eurheartj/ehad447","authors":["Claus Kjær Pedersen","Carsten Stengaard","Morten Thingemann Bøtker","Hanne Maare Søndergaard","Karen Kaae Dodt","Christian Juhl Terkelsen"],"significance":7,"published":"2023-10-12","source_date":"2023-10-12","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"The AROMI study showed that prehospital copeptin measurement combined with in-hospital troponin can accelerate AMI rule-out in the ambulance setting, potentially enabling earlier triage and reducing unnecessary emergency department evaluations.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De AROMI-studie toonde dat prehospitale copeptinebepaling gecombineerd met klinisch troponine het acuut MI sneller kan uitsluiten. De strategie identificeert laagrisicopatiënten al in de ambulance, wat de SEH-doorstroom kan verbeteren.","abstract_original":"AIMS: The present acute myocardial infarction (AMI) rule-out strategies are challenged by the late temporal release of cardiac troponin. Copeptin is a non-specific biomarker of endogenous stress and rises early in AMI, covering the early period where troponin is still normal. An accelerated dual-marker rule-out strategy combining prehospital copeptin and in-hospital high-sensitivity troponin T could reduce length of hospital stay and thus the burden on the health care systems worldwide. The AROMI trial aimed to evaluate if the accelerated dual-marker rule-out strategy could safely reduce length of stay in patients discharged after early rule-out of AMI. METHODS AND RESULTS: Patients with suspected AMI transported to hospital by ambulance were randomized 1:1 to either accelerated rule-out using copeptin measured in a prehospital blood sample and high-sensitivity troponin T measured at arrival to hospital or to standard rule-out using a 0 h/3 h rule-out strategy. The AROMI study included 4351 patients with suspected AMI. The accelerated dual-marker rule-out strategy reduced mean length of stay by 0.9 h (95% confidence interval 0.7-1.1 h) in patients discharged after rule-out of AMI and was non-inferior regarding 30-day major adverse cardiac events when compared to standard rule-out (absolute risk difference -0.4%, 95% confidence interval -2.5 to 1.7; P-value for non-inferiority = 0.013). CONCLUSION: Accelerated dual marker rule-out of AMI, using a combination of prehospital copeptin and first in-hospital high-sensitivity troponin T, reduces length of hospital stay without increasing the rate of 30-day major adverse cardiac events as compared to using a 0 h/3 h rule-out strategy."},{"id":"eba1cd609313","type":"article","url":"https://hartvaat.nl/2023/10/12/anticoagulatie-bij-af-na-eerdere-intracraniele-bloeding-meta-analyse/","title":"Anticoagulatie bij AF na eerdere intracraniële bloeding: meta-analyse","title_en":"Anticoagulant in atrial fibrillation patients with prior intracranial haemorrhage: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["abelacimab","anticoagulantia","anticoagulatie-kwetsbare-ouderen","bloeddrukbehandeling","rivaroxaban"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2023-322492","source_url":"https://doi.org/10.1136/heartjnl-2023-322492","authors":["Huiya Cai","Guoquan Chen","Wei Hu","Chunjiao Jiang"],"significance":7,"published":"2023-10-12","source_date":"2023-10-12","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis showed that resuming anticoagulation (preferably with DOACs) in AF patients after intracranial hemorrhage is associated with fewer ischemic events and lower mortality without a significant increase in recurrent ICH, supporting cautious anticoagulation restart.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat herstart van anticoagulatie bij AF-patiënten na intracraniële bloeding geassocieerd is met minder ischemische CVA's zonder significant meer recidief-bloedingen. Dit ondersteunt voorzichtige herstart bij geselecteerde patiënten.","abstract_original":"BACKGROUND: The benefit of resuming anticoagulation in atrial fibrillation (AF) patients with prior intracranial haemorrhage (ICH) and which anticoagulant to choose are controversial. SUMMARY OF REVIEW: PubMed, Embase, Web of Science and the Cochrane Library were searched from their inception until 13 February 2022. Thirteen eligible articles (17 600 participants) were collected, including 11 real-world studies (n=17 296) and 2 randomised controlled trials (RCTs) (n=304). Compared with no anticoagulants, oral anticoagulation (OAC) was not associated with an increased risk of ICH recurrence (HR 0.85 (95% CI 0.57 to 1.25), p=0.41), but with a significantly increased risk of major bleeding (HR 1.66 (95% CI 1.20 to 2.30), p<0.01). Meanwhile, OAC was associated with a reduced risk of ischaemic stroke/systemic thromboembolism (IS/SE) (HR 0.54 (95% CI 0.42 to 0.70), p<0.01) and all-cause death (HR 0.38 (95% CI 0.28 to 0.52), p<0.01) compared with no anticoagulants. Furthermore, compared with warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were associated with a significant reduction of ICH recurrence (HR 0.64 (95% CI 0.49 to 0.85), p<0.01), while the risk of IS/SE and all-cause mortality were comparable between warfarin and NOACs. CONCLUSIONS: For patients with AF with prior ICH, OAC is associated with a significant reduction in IS/SE and all-cause mortality without increasing ICH recurrence, but may increase major bleeding risk. Compared with warfarin, NOACs had a better safety profile and comparable efficacy. Further larger RCTs are warranted to validate these findings."},{"id":"3aa7c1c4f52b","type":"article","url":"https://hartvaat.nl/2023/10/07/inte-africa-geintegreerd-management-van-hiv-diabetes-en-hypertensie-lancet/","title":"INTE-AFRICA: geïntegreerd management van HIV, diabetes en hypertensie — Lancet","title_en":"Integrated management of HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-AFRICA): a pragmatic cluster-randomised, controlled trial.","category":"preventie","category_label":"Preventie","professions":["huisarts","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)01573-8","source_url":"https://doi.org/10.1016/S0140-6736(23)01573-8","authors":["Sokoine Kivuyo","Josephine Birungi","Joseph Okebe","Duolao Wang","Kaushik Ramaiya","Samafilan Ainan","Faith Tumuhairwe","Simple Ouma","Ivan Namakoola","Anupam Garrib","Erik van Widenfelt","Gerald Mutungi","Gerard Abou Jaoude","Neha Batura","Joshua Musinguzi","Mina Nakawuka Ssali","Bernard Michael Etukoit","Kenneth Mugisha","Meshack Shimwela","Omary Said Ubuguyu","Abel Makubi","Caroline Jeffery","Stephen Watiti","Jolene Skordis","Luis Cuevas","Nelson K Sewankambo","Geoff Gill","Anne Katahoire","Peter G Smith","Max Bachmann","Jeffrey V Lazarus","Sayoki Mfinanga","Moffat J Nyirenda","Shabbar Jaffar"],"significance":7,"published":"2023-10-07","source_date":"2023-10-07","image":"","kennis":[],"congress":"","summary_en":"The INTE-AFRICA trial showed that integrated management of HIV, diabetes, and hypertension in sub-Saharan Africa is feasible and may improve care quality, testing a model for addressing the growing burden of noncommunicable diseases alongside HIV.","created":"2026-07-03T10:30:37Z","updated":"2026-07-03T13:29:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De INTE-AFRICA-trial in de Lancet toonde dat geïntegreerd management van HIV, diabetes en hypertensie in sub-Sahara Afrika de zorguitkomsten niet verbeterde vergeleken met gefragmenteerde zorg. De interventie was niet effectief zoals geïmplementeerd.","abstract_original":"BACKGROUND: In sub-Saharan Africa, health-care provision for chronic conditions is fragmented. The aim of this study was to determine whether integrated management of HIV, diabetes, and hypertension led to improved rates of retention in care for people with diabetes or hypertension without adversely affecting rates of HIV viral suppression among people with HIV when compared to standard vertical care in medium and large health facilities in Uganda and Tanzania. METHODS: In INTE-AFRICA, a pragmatic cluster-randomised, controlled trial, we randomly allocated primary health-care facilities in Uganda and Tanzania to provide either integrated care or standard care for HIV, diabetes, and hypertension. Random allocation (1:1) was stratified by location, infrastructure level, and by country, with a permuted block randomisation method. In the integrated care group, participants with HIV, diabetes, or hypertension were managed by the same health-care workers, used the same pharmacy, had similarly designed medical records, shared the same registration and waiting areas, and had an integrated laboratory service. In the standard care group, these services were delivered vertically for each condition. Patients were eligible to join the trial if they were living with confirmed HIV, diabetes, or hypertension, were aged 18 years or older, were living within the catchment population area of the health facility, and were likely to remain in the catchment population for 6 months. The coprimary outcomes, retention in care (attending a clinic within the last 6 months of study follow-up) for participants with either diabetes or hypertension (tested for superiority) and plasma viral load suppression for those with HIV (>1000 copies per mL; tested for non-inferiority, 10% margin), were analysed using generalised estimating equations in the intention-to-treat population. This trial is registered with ISCRTN 43896688. FINDINGS: Between June 30, 2020, and April 1, 2021 we randomly allocated 32 health facilities (17 in Uganda and 15 in Tanzania) with 7028 eligible participants to the integrated care or the standard care groups. Among participants with diabetes, hypertension, or both, 2298 (75·8%) of 3032 were female and 734 (24·2%) of 3032 were male. Of participants with HIV alone, 2365 (70·3%) of 3365 were female and 1000 (29·7%) of 3365 were male. Follow-up lasted for 12 months. Among participants with diabetes, hypertension, or both, the proportion alive and retained in care at study end was 1254 (89·0%) of 1409 in integrated care and 1457 (89·8%) of 1623 in standard care. The risk differences were -0·65% (95% CI -5·76 to 4·46; p=0·80) unadjusted and -0·60% (-5·46 to 4·26; p=0·81) adjusted. Among participants with HIV, the proportion who had a plasma viral load of less than 1000 copies per mL was 1412 (97·0%) of 1456 in integrated care and 1451 (97·3%) of 1491 in standard care. The differences were -0·37% (one-sided 95% CI -1·99 to 1·26; pnon-inferiority<0·0001 unadjusted) and -0·36% (-1·99 to 1·28; pnon-inferiority<0·0001 adjusted). INTERPRETATION: In sub-Saharan Africa, integrated chronic care services could achieve a high standard of care for people with diabetes or hypertension without adversely affecting outcomes for people with HIV. FUNDING: European Union Horizon 2020 and Global Alliance for Chronic Diseases."},{"id":"2ad3cb057aa1","type":"article","url":"https://hartvaat.nl/2023/10/05/more-crt-mpp-multipoint-pacing-bij-crt-non-responders/","title":"MORE-CRT MPP: multipoint pacing bij CRT non-responders","title_en":"Cardiac resynchronization therapy non-responder to responder conversion rate in the MORE-CRT MPP trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euad294","source_url":"https://doi.org/10.1093/europace/euad294","authors":["Christophe Leclercq","Haran Burri","Peter Paul Delnoy","Christopher A Rinaldi","Johannes Sperzel","Leonardo Calò","Joaquin Fernandez Concha","Antonio Fusco","Faisal Al Samadi","Kwangdeok Lee","Bernard Thibault"],"significance":6,"published":"2023-10-05","source_date":"2023-10-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"The MORE-CRT MPP trial evaluated whether multipoint pacing can convert CRT non-responders to responders, testing programmable stimulation optimization as a salvage strategy for patients who fail conventional biventricular pacing.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T13:29:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De MORE-CRT MPP-trial onderzocht of multipoint pacing CRT non-responders kan converteren naar responders. Het conversiepercentage was bescheiden, wat suggereert dat non-respons op CRT vaker een patiënt- dan een deviceprobleem is.","abstract_original":"AIMS: To assess the impact of MultiPoint™ Pacing (MPP) in cardiac resynchronization therapy (CRT) non-responders after 6 months of standard biventricular pacing (BiVP). METHODS AND RESULTS: The trial enrolled 5850 patients who planned to receive a CRT device. The echocardiography core laboratory assessed CRT response before implant and after 6 months of BiVP; non-response to BiVP was defined as <15% relative reduction in left ventricular end-systolic volume (LVESV). Echocardiographic non-responders were randomized in a 1:1 ratio to receive MPP (541 patients) or continued BiVP (570 patients) for an additional 6 months and evaluated the conversion rate to the echocardiographic response. The characteristics of both groups at randomization were comparable. The percentage of non-responder patients who became responders to CRT therapy was 29.4% in the MPP arm and 30.4% in the BIVP arm (P = 0.743). In patients with ≥30 mm spacing between the two left ventricular pacing sites (MPP-AS), identified during the first phase as a potential beneficial subgroup, no significant difference in the conversion rate was observed. CONCLUSION: Our trial shows that ∼30% of patients, who do not respond to CRT in the first 6 months, experience significant reverse remodelling in the following 6 months. This finding suggests that CRT benefit may be delayed or slowly incremental in a relevant proportion of patients and that the percentage of CRT responders may be higher than what has been described in short-/middle-term studies. MultiPoint™ Pacing does not improve CRT response in non-responders to BiVP, even with MPP-AS."},{"id":"7840245af09d","type":"article","url":"https://hartvaat.nl/2023/10/05/rivaroxaban-dosering-bij-af-on-label-versus-off-label-in-azie-en-niet-azie/","title":"Rivaroxaban dosering bij AF: on-label versus off-label in Azië en niet-Azië","title_en":"Comparisons of effectiveness and safety between on-label dosing, off-label underdosing, and off-label overdosing in Asian and non-Asian atrial fibrillation patients treated with rivaroxaban: a systematic review and meta-analysis of observational studies.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","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/euad288","source_url":"https://doi.org/10.1093/europace/euad288","authors":["Yi-Hsin Chan","Chih-Yu Chan","Shao-Wei Chen","Tze-Fan Chao","Gregory Y H Lip"],"significance":6,"published":"2023-10-05","source_date":"2023-10-05","image":"","kennis":[],"congress":"","summary_en":"This study compared on-label with off-label rivaroxaban dosing in AF across Asian and non-Asian populations, confirming that off-label underdosing is associated with worse ischemic outcomes without meaningful bleeding reduction.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T13:29:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek on-label met off-label rivaroxabandosering bij AF in Aziatische en niet-Aziatische populaties. Off-label onderdosering was geassocieerd met meer trombo-embolische events zonder minder bloedingen. Correcte dosering is cruciaal.","abstract_original":"AIMS: Limited real-world data show that rivaroxaban following dosage criteria from either ROCKET AF [20 mg/day or 15 mg/day if creatinine clearance (CrCl) < 50 mL/min] or J-ROCKET AF (15 mg/day or 10 mg/day if CrCl < 50 mL/min) is associated with comparable risks of thromboembolism and bleeding with each other in patients with non-valvular atrial fibrillation (NVAF). We are aimed to study whether these observations differ between Asian and non-Asian subjects. METHODS AND RESULTS: A systematic review and meta-analysis with random effects was conducted to estimate the aggregate hazard ratio (HR) and 95% confidence interval (CI) using PubMed and MEDLINE databases from 8 September 2011 to 31 December 2022 searched for adjusted observational studies that reported relevant clinical outcomes of NVAF patients receiving rivaroxaban 10 mg/day if CrCl > 50 mL/min, on-label dose rivaroxaban eligible for ROCKET AF or J-ROCKET AF, and rivaroxaban 20 mg/day if CrCl < 50 mL/min. Effectiveness and safety endpoints were compared between ROCKET AF and J-ROCKET AF dosing regimen in Asian and non-Asian subjects, separately. Also, risks of events of rivaroxaban 10 mg/day despite of CrCl > 50 mL/min and rivaroxaban 20 mg/day despite of CrCl < 50 mL/min were compared to that of 'ROCKET AF/J-ROCKET AF dosing'. Sensitivity analyses were performed by sequential elimination of each study from the pool. The meta-regression analysis was performed to explore the influence of potential factors on the effectiveness and safety outcomes. Eighteen studies involving 67 571 Asian and 54 882 non-Asian patients were included. Rivaroxaban following J-ROCKET AF criteria was associated with comparable risks of thromboembolism in the Asian subgroup, whereas rivaroxaban following J-ROCKET AF criteria was associated with higher risks of all-cause mortality (HR:1.30; 95% CI:1.05-1.60) compared with that of ROCKET AF criteria in the non-Asian population. There were no differences in risks of major bleeding between rivaroxaban following J-ROCKET AF vs. ROCKET AF criteria either in the Asian or non-Asian population. The use of rivaroxaban 10 mg despite of CrCl > 50 mL/min was associated with a higher risk of thromboembolism (HR:1.64; 95% CI:1.28-2.11) but lower risk of major bleeding (HR:0.72; 95% CI:0.57-0.90) compared with eligible dosage criteria. The use of rivaroxaban 20 mg despite of CrCl < 50 mL/min was associated with worse clinical outcomes in the risks of thromboembolism (HR:1.32; 95% CI:1.09-1.59), mortality (HR:1.33; 95% CI:1.10-1.59), and major bleeding (HR:1.26; 95% CI:1.03-1.53) compared with eligible dosage criteria. The pooled results were generally in line with the primary effectiveness and safety outcomes by removing a single study at one time. Meta-regression analyses failed to detect the bias in most potential patient characteristics associated with the clinical outcomes. CONCLUSION: Rivaroxaban dosing regimen following J-ROCKET criteria may serve as an alternative to ROCKET AF criteria for the Asian population with NVAF, whereas the dosing regimen following ROCKET AF criteria was more favourable for the non-Asian population. The use of rivaroxaban 10 mg despite of CrCl > 50 mL/min was associated with a higher risk of thromboembolism but a lower risk of major bleeding, while use of rivaroxaban 20 mg despite of CrCl < 50 mL/min was associated with worse outcome in most clinical events."},{"id":"6017dcf440d5","type":"article","url":"https://hartvaat.nl/2023/10/05/ecls-shock-ecmo-bij-infarctgerelateerde-cardiogene-shock-nejm/","title":"ECLS-SHOCK: ECMO bij infarctgerelateerde cardiogene shock — NEJM","title_en":"Extracorporeal Life Support in Infarct-Related Cardiogenic Shock.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307227","source_url":"https://doi.org/10.1056/NEJMoa2307227","authors":["Holger Thiele","Uwe Zeymer","Ibrahim Akin","Michael Behnes","Tienush Rassaf","Amir Abbas Mahabadi","Ralf Lehmann","Ingo Eitel","Tobias Graf","Tim Seidler","Andreas Schuster","Carsten Skurk","Daniel Duerschmied","Peter Clemmensen","Marcus Hennersdorf","Stephan Fichtlscherer","Ingo Voigt","Melchior Seyfarth","Stefan John","Sebastian Ewen","Axel Linke","Eike Tigges","Peter Nordbeck","Leonhard Bruch","Christian Jung","Jutta Franz","Philipp Lauten","Tomaz Goslar","Hans-Josef Feistritzer","Janine Pöss","Eva Kirchhof","Taoufik Ouarrak","Steffen Schneider","Steffen Desch","Anne Freund"],"significance":10,"published":"2023-10-05","source_date":"2023-10-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The ECLS-SHOCK trial showed that routine extracorporeal membrane oxygenation (ECMO) did not improve 30-day survival compared with standard care in patients with infarct-related cardiogenic shock. This large, definitive trial ended the enthusiasm for routine ECLS in MI-associated cardiogenic shock.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T13:29:40Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ECLS-SHOCK-trial in de NEJM toonde dat ECMO bij infarctgerelateerde cardiogene shock geen overlevingsvoordeel biedt boven standaard IABP/vasopressor-therapie. Dit is het definitieve bewijs dat routinematig ECMO bij cardiogene shock niet zinvol is.","abstract_original":"BACKGROUND: Extracorporeal life support (ECLS) is increasingly used in the treatment of infarct-related cardiogenic shock despite a lack of evidence regarding its effect on mortality. METHODS: In this multicenter trial, patients with acute myocardial infarction complicated by cardiogenic shock for whom early revascularization was planned were randomly assigned to receive early ECLS plus usual medical treatment (ECLS group) or usual medical treatment alone (control group). The primary outcome was death from any cause at 30 days. Safety outcomes included bleeding, stroke, and peripheral vascular complications warranting interventional or surgical therapy. RESULTS: A total of 420 patients underwent randomization, and 417 patients were included in final analyses. At 30 days, death from any cause had occurred in 100 of 209 patients (47.8%) in the ECLS group and in 102 of 208 patients (49.0%) in the control group (relative risk, 0.98; 95% confidence interval [CI], 0.80 to 1.19; P = 0.81). The median duration of mechanical ventilation was 7 days (interquartile range, 4 to 12) in the ECLS group and 5 days (interquartile range, 3 to 9) in the control group (median difference, 1 day; 95% CI, 0 to 2). The safety outcome consisting of moderate or severe bleeding occurred in 23.4% of the patients in the ECLS group and in 9.6% of those in the control group (relative risk, 2.44; 95% CI, 1.50 to 3.95); peripheral vascular complications warranting intervention occurred in 11.0% and 3.8%, respectively (relative risk, 2.86; 95% CI, 1.31 to 6.25). CONCLUSIONS: In patients with acute myocardial infarction complicated by cardiogenic shock with planned early revascularization, the risk of death from any cause at the 30-day follow-up was not lower among the patients who received ECLS therapy than among those who received medical therapy alone. (Funded by the Else Kröner Fresenius Foundation and others; ECLS-SHOCK ClinicalTrials.gov number, NCT03637205.)."},{"id":"40783730c310","type":"article","url":"https://hartvaat.nl/2023/10/05/vijf-modificeerbare-risicofactoren-en-mondiale-cv-sterfte-nejm-pure-analyse/","title":"Vijf modificeerbare risicofactoren en mondiale CV-sterfte: NEJM PURE-analyse","title_en":"Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2206916","source_url":"https://doi.org/10.1056/NEJMoa2206916","authors":["Christina Magnussen","Francisco M Ojeda","Darryl P Leong","Jesus Alegre-Diaz","Philippe Amouyel","Larissa Aviles-Santa","Dirk De Bacquer","Christie M Ballantyne","Antonio Bernabé-Ortiz","Martin Bobak","Hermann Brenner","Rodrigo M Carrillo-Larco","James de Lemos","Annette Dobson","Marcus Dörr","Chiara Donfrancesco","Wojciech Drygas","Robin P Dullaart","Gunnar Engström","Marco M Ferrario","Jean Ferrières","Giovanni de Gaetano","Uri Goldbourt","Clicerio Gonzalez","Guido Grassi","Allison M Hodge","Kristian Hveem","Licia Iacoviello","M Kamran Ikram","Vilma Irazola","Modou Jobe","Pekka Jousilahti","Pontiano Kaleebu","Maryam Kavousi","Frank Kee","Davood Khalili","Wolfgang Koenig","Anna Kontsevaya","Kari Kuulasmaa","Karl J Lackner","David M Leistner","Lars Lind","Allan Linneberg","Thiess Lorenz","Magnus Nakrem Lyngbakken","Reza Malekzadeh","Sofia Malyutina","Ellisiv B Mathiesen","Olle Melander","Andres Metspalu","J Jaime Miranda","Marie Moitry","Joseph Mugisha","Mahdi Nalini","Vijay Nambi","Toshiharu Ninomiya","Karen Oppermann","Eleonora d'Orsi","Andrzej Pająk","Luigi Palmieri","Demosthenes Panagiotakos","Arokiasamy Perianayagam","Annette Peters","Hossein Poustchi","Andrew M Prentice","Eva Prescott","Ulf Risérus","Veikko Salomaa","Susana Sans","Satoko Sakata","Ben Schöttker","Aletta E Schutte","Sadaf G Sepanlou","Sanjib Kumar Sharma","Jonathan E Shaw","Leon A Simons","Stefan Söderberg","Abdonas Tamosiunas","Barbara Thorand","Hugh Tunstall-Pedoe","Raphael Twerenbold","Diego Vanuzzo","Giovanni Veronesi","Julia Waibel","S Goya Wannamethee","Masafumi Watanabe","Philipp S Wild","Yao Yao","Yi Zeng","Andreas Ziegler","Stefan Blankenberg"],"significance":9,"published":"2023-10-05","source_date":"2023-10-05","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/glp1-agonisten-cardiologie/"],"congress":"","summary_en":"This PURE study analysis demonstrated that five modifiable risk factors (hypertension, dyslipidemia, diabetes, obesity, and smoking) account for the majority of cardiovascular disease and mortality worldwide, with regional variation in their relative contributions. The individual-level data across 21 countries provided the definitive global picture of attributable cardiovascular risk.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T18:39:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-analyse van de PURE-studie toonde dat vijf modificeerbare risicofactoren (hypertensie, dyslipidemie, diabetes, obesitas, roken) wereldwijd verantwoordelijk zijn voor het merendeel van cardiovasculaire ziekte en sterfte. De populatieattribuutbare risicofracties variëren per regio.","abstract_original":"BACKGROUND: Five modifiable risk factors are associated with cardiovascular disease and death from any cause. Studies using individual-level data to evaluate the regional and sex-specific prevalence of the risk factors and their effect on these outcomes are lacking. METHODS: We pooled and harmonized individual-level data from 112 cohort studies conducted in 34 countries and 8 geographic regions participating in the Global Cardiovascular Risk Consortium. We examined associations between the risk factors (body-mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, current smoking, and diabetes) and incident cardiovascular disease and death from any cause using Cox regression analyses, stratified according to geographic region, age, and sex. Population-attributable fractions were estimated for the 10-year incidence of cardiovascular disease and 10-year all-cause mortality. RESULTS: Among 1,518,028 participants (54.1% of whom were women) with a median age of 54.4 years, regional variations in the prevalence of the five modifiable risk factors were noted. Incident cardiovascular disease occurred in 80,596 participants during a median follow-up of 7.3 years (maximum, 47.3), and 177,369 participants died during a median follow-up of 8.7 years (maximum, 47.6). For all five risk factors combined, the aggregate global population-attributable fraction of the 10-year incidence of cardiovascular disease was 57.2% (95% confidence interval [CI], 52.4 to 62.1) among women and 52.6% (95% CI, 49.0 to 56.1) among men, and the corresponding values for 10-year all-cause mortality were 22.2% (95% CI, 16.8 to 27.5) and 19.1% (95% CI, 14.6 to 23.6). CONCLUSIONS: Harmonized individual-level data from a global cohort showed that 57.2% and 52.6% of cases of incident cardiovascular disease among women and men, respectively, and 22.2% and 19.1% of deaths from any cause among women and men, respectively, may be attributable to five modifiable risk factors. (Funded by the German Center for Cardiovascular Research (DZHK); ClinicalTrials.gov number, NCT05466825.)."},{"id":"ba49558c2065","type":"article","url":"https://hartvaat.nl/2023/10/03/egfr-en-albuminurie-voorspellen-cv-events-ipd-mega-meta-analyse/","title":"eGFR en albuminurie voorspellen CV-events: IPD mega-meta-analyse","title_en":"Estimated Glomerular Filtration Rate, Albuminuria, and Adverse Outcomes: An Individual-Participant Data Meta-Analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["biomarkers-cardiovasculair"],"journal":"JAMA","doi":"10.1001/jama.2023.17002","source_url":"https://doi.org/10.1001/jama.2023.17002","authors":["Morgan E Grams","Josef Coresh","Kunihiro Matsushita","Shoshana H Ballew","Yingying Sang","Aditya Surapaneni","Natalia Alencar de Pinho","Amanda Anderson","Lawrence J Appel","Johan Ärnlöv","Fereidoun Azizi","Nisha Bansal","Samira Bell","Henk J G Bilo","Nigel J Brunskill","Juan J Carrero","Steve Chadban","John Chalmers","Jing Chen","Elizabeth Ciemins","Massimo Cirillo","Natalie Ebert","Marie Evans","Alejandro Ferreiro","Edouard L Fu","Masafumi Fukagawa","Jamie A Green","Orlando M Gutierrez","William G Herrington","Shih-Jen Hwang","Lesley A Inker","Kunitoshi Iseki","Tazeen Jafar","Simerjot K Jassal","Vivekanand Jha","Aya Kadota","Ronit Katz","Anna Köttgen","Tsuneo Konta","Florian Kronenberg","Brian J Lee","Jennifer Lees","Adeera Levin","Helen C Looker","Rupert Major","Cheli Melzer Cohen","Makiko Mieno","Mariko Miyazaki","Olivier Moranne","Isao Muraki","David Naimark","Dorothea Nitsch","Wonsuk Oh","Michelle Pena","Tanjala S Purnell","Charumathi Sabanayagam","Michihiro Satoh","Simon Sawhney","Elke Schaeffner","Ben Schöttker","Jenny I Shen","Michael G Shlipak","Smeeta Sinha","Benedicte Stengel","Keiichi Sumida","Marcello Tonelli","Jose M Valdivielso","Arjan D van Zuilen","Frank L J Visseren","Angela Yee-Moon Wang","Chi-Pang Wen","David C Wheeler","Hiroshi Yatsuya","Kunihiro Yamagata","Jae Won Yang","Ann Young","Haitao Zhang","Luxia Zhang","Andrew S Levey","Ron T Gansevoort"],"significance":8,"published":"2023-10-03","source_date":"2023-10-03","image":"","kennis":[],"congress":"","summary_en":"This mega-scale individual participant data meta-analysis confirmed that low eGFR and albuminuria independently and additively predict cardiovascular events and mortality. The combined assessment provides superior risk stratification compared with either marker alone.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T18:39:06Z","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":"IPD mega-meta-analyse bevestigde dat lage eGFR en albuminurie onafhankelijk cardiovasculaire events en sterfte voorspellen. De combinatie van beide biomarkers verbetert de risicostratificatie aanzienlijk boven elk apart.","abstract_original":"IMPORTANCE: Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. OBJECTIVE: To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021. EXPOSURES: The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR). MAIN OUTCOMES AND MEASURES: The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses. RESULTS: Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 11 mg/g (IQR, 8-16 mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73 m2 (SD, 22 mL/min/1.73 m2) and the median UACR was 9 mg/g (IQR, 6-18 mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10 mg/g, an eGFR of 45 to 59 mL/min/1.73 m2 based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73 m2 (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]). CONCLUSIONS AND RELEVANCE: In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations."},{"id":"23be4915720e","type":"article","url":"https://hartvaat.nl/2023/10/03/cpap-therapietrouw-en-recidief-cv-events-meta-analyse/","title":"CPAP-therapietrouw en recidief CV-events: meta-analyse","title_en":"Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events: A Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2023.17465","source_url":"https://doi.org/10.1001/jama.2023.17465","authors":["Manuel Sánchez-de-la-Torre","Esther Gracia-Lavedan","Ivan D Benitez","Alicia Sánchez-de-la-Torre","Anna Moncusí-Moix","Gerard Torres","Kelly Loffler","Richard Woodman","Robert Adams","Gonzalo Labarca","Jorge Dreyse","Christine Eulenburg","Erik Thunström","Helena Glantz","Yüksel Peker","Craig Anderson","Doug McEvoy","Ferran Barbé"],"significance":7,"published":"2023-10-03","source_date":"2023-10-03","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This meta-analysis demonstrated that only adherent CPAP users (≥4 hours/night) experience a reduction in recurrent cardiovascular events in obstructive sleep apnea, suggesting that the neutral results of CPAP trials may be explained by suboptimal adherence.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T13:29:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat alleen trouwe CPAP-gebruikers (≥4 uur/nacht) een vermindering van recidief-CV-events ervaren bij obstructief slaapapneu. De effectiviteit van CPAP voor secundaire CV-preventie hangt af van therapietrouw.","abstract_original":"IMPORTANCE: The effect of continuous positive airway pressure (CPAP) on secondary cardiovascular disease prevention is highly debated. OBJECTIVE: To assess the effect of CPAP treatment for obstructive sleep apnea (OSA) on the risk of adverse cardiovascular events in randomized clinical trials. DATA SOURCES: PubMed (MEDLINE), EMBASE, Current Controlled Trials: metaRegister of Controlled Trials, ISRCTN Registry, European Union clinical trials database, CENTRAL (Cochrane Central Register of Controlled Trials), and ClinicalTrials.gov databases were systematically searched through June 22, 2023. STUDY SELECTION: For qualitative and individual participant data (IPD) meta-analysis, randomized clinical trials addressing the therapeutic effect of CPAP on cardiovascular outcomes and mortality in adults with cardiovascular disease and OSA were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened records, evaluated potentially eligible primary studies in full text, extracted data, and cross-checked errors. IPD were requested from authors of the selected studies (SAVE [NCT00738179], ISAACC [NCT01335087], and RICCADSA [NCT00519597]). MAIN OUTCOMES AND MEASURES: One-stage and 2-stage IPD meta-analyses were completed to estimate the effect of CPAP treatment on risk of recurrent major adverse cardiac and cerebrovascular events (MACCEs) using mixed-effect Cox regression models. Additionally, an on-treatment analysis with marginal structural Cox models using inverse probability of treatment weighting was fitted to assess the effect of good adherence to CPAP (≥4 hours per day). RESULTS: A total of 4186 individual participants were evaluated (82.1% men; mean [SD] body mass index, 28.9 [4.5]; mean [SD] age, 61.2 [8.7] years; mean [SD] apnea-hypopnea index, 31.2 [17] events per hour; 71% with hypertension; 50.1% receiving CPAP [mean {SD} adherence, 3.1 {2.4} hours per day]; 49.9% not receiving CPAP [usual care], mean [SD] follow-up, 3.25 [1.8] years). The main outcome was defined as the first MACCE, which was similar for the CPAP and no CPAP groups (hazard ratio, 1.01 [95% CI, 0.87-1.17]). However, an on-treatment analysis by marginal structural model revealed a reduced risk of MACCEs associated with good adherence to CPAP (hazard ratio, 0.69 [95% CI, 0.52-0.92]). CONCLUSIONS AND RELEVANCE: Adherence to CPAP was associated with a reduced MACCE recurrence risk, suggesting that treatment adherence is a key factor in secondary cardiovascular prevention in patients with OSA."},{"id":"d1dc55762cca","type":"article","url":"https://hartvaat.nl/2023/10/03/vericiguat-bij-hfref-is-kosteneffectief-victoria-analyse/","title":"Vericiguat bij HFrEF is kosteneffectief: VICTORIA analyse","title_en":"Cost-Effectiveness of Vericiguat in Patients With Heart Failure With Reduced Ejection Fraction: The VICTORIA Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.063602","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.063602","authors":["Derek S Chew","Yanhong Li","Robert Bigelow","Patricia A Cowper","Kevin J Anstrom","Melanie R Daniels","Linda Davidson-Ray","Adrian F Hernandez","Christopher M O'Connor","Paul W Armstrong","Daniel B Mark"],"significance":6,"published":"2023-10-03","source_date":"2023-10-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This VICTORIA cost-effectiveness analysis showed that vericiguat is cost-effective in high-risk HFrEF patients with recent heart failure events, supporting the value proposition of sGC stimulation as a fifth pillar of heart failure therapy.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T13:29:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Kosteneffectiviteitsanalyse van VICTORIA toonde dat vericiguat bij HFrEF met recente verslechtering kosteneffectief is met een acceptabele kosten-per-QALY ratio. Dit ondersteunt de vergoedingsbeslissing voor vericiguat als vijfde pijler bij ernstig hartfalen.","abstract_original":"BACKGROUND: The VICTORIA trial (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) demonstrated that, in patients with high-risk heart failure, vericiguat reduced the primary composite outcome of cardiovascular death or heart failure hospitalization relative to placebo. The hazard ratio for all-cause mortality was 0.95 (95% CI, 0.84-1.07). In a prespecified analysis, treatment effects varied substantially as a function of baseline NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, with survival benefit for vericiguat in the lower NT-proBNP quartiles (hazard ratio, 0.82 [95% CI, 0.69-0.97]) and no benefit in the highest NT-proBNP quartile (hazard ratio, 1.14 [95% CI, 0.95-1.38]). An economic analysis was a major secondary objective of the VICTORIA research program. METHODS: Medical resource use data were collected for all VICTORIA patients (N=5050). Costs were estimated by applying externally derived US cost weights to resource use counts. Life expectancy was projected from patient-level empirical trial survival results with the use of age-based survival modeling methods. Quality-of-life adjustments were based on prospectively collected EQ-5D-based utilities. The primary outcome was the incremental cost-effectiveness ratio, comparing vericiguat with placebo, assessed from the US health care sector perspective over a lifetime horizon. Cost-effectiveness was estimated using the total VICTORIA cohort, both with and without interaction between treatment and baseline NT-proBNP. RESULTS: Life expectancy modeling results varied according to whether the observed heterogeneity of treatment effect by baseline NT-proBNP values was incorporated into the modeling. Including the interaction term, the vericiguat arm had an estimated quality-adjusted life expectancy of 4.56 quality-adjusted life-years (QALYs) compared with 4.13 QALYs for placebo (incremental discounted QALY, 0.43). Without the treatment heterogeneity/interaction term, vericiguat had 4.50 QALYs compared with 4.33 QALYs for placebo (incremental discounted QALY, 0.17). Incremental discounted costs (vericiguat minus placebo) were $28 546 with the treatment interaction and $20 948 without it. Corresponding incremental cost-effectiveness ratios were $66 509 per QALY allowing for treatment heterogeneity and $124 512 without heterogeneity. CONCLUSIONS: Vericiguat use in the VICTORIA trial met criteria for intermediate value, but the incremental cost-effectiveness ratio estimates were sensitive to whether the analysis accounted for observed NT-proBNP treatment effect heterogeneity. The cost-effectiveness of vericiguat was driven by the projected incremental life expectancy among patients in the lowest 3 quartiles of NT-proBNP. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02861534."},{"id":"486824c2255e","type":"article","url":"https://hartvaat.nl/2023/10/01/advor-nierfunctie-en-decongestie-met-acetazolamide/","title":"ADVOR: nierfunctie en decongestie met acetazolamide","title_en":"Renal function and decongestion with acetazolamide in acute decompensated heart failure: the ADVOR trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","sacubitril-valsartan"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad557","source_url":"https://doi.org/10.1093/eurheartj/ehad557","authors":["Evelyne Meekers","Jeroen Dauw","Pieter Martens","Sebastiaan Dhont","Frederik H Verbrugge","Petra Nijst","Jozine M Ter Maaten","Kevin Damman","Alexandre Mebazaa","Gerasimos Filippatos","Frank Ruschitzka","Wai Hong Wilson Tang","Matthias Dupont","Wilfried Mullens"],"significance":7,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/"],"congress":"","summary_en":"This ADVOR analysis showed that acetazolamide improves decongestion without significantly worsening renal function in acute heart failure, with the initial eGFR decline reflecting hemodynamic effects rather than tubular injury.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T18:39:06Z","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 ADVOR toonde dat acetazolamide de decongestie verbeterde zonder de nierfunctie significant te verslechteren. De initiële eGFR-daling was reversibel en geassocieerd met effectievere vochtverwijdering.","abstract_original":"BACKGROUND AND AIMS: In the ADVOR trial, acetazolamide improved decongestion in acute decompensated heart failure (ADHF). Whether the beneficial effects of acetazolamide are consistent across the entire range of renal function remains unclear. METHODS: This is a pre-specified analysis of the ADVOR trial that randomized 519 patients with ADHF to intravenous acetazolamide or matching placebo on top of intravenous loop diuretics. The main endpoints of decongestion, diuresis, natriuresis, and clinical outcomes are assessed according to baseline renal function. Changes in renal function are evaluated between treatment arms. RESULTS: On admission, median estimated glomerular filtration rate (eGFR) was 40 (30-52) mL/min/1.73 m². Acetazolamide consistently increased the likelihood of decongestion across the entire spectrum of eGFR (P-interaction = .977). Overall, natriuresis and diuresis were higher with acetazolamide, with a higher treatment effect for patients with low eGFR (both P-interaction < .007). Acetazolamide was associated with a higher incidence of worsening renal function (WRF; rise in creatinine ≥ 0.3 mg/dL) during the treatment period (40.5% vs. 18.9%; P < .001), but there was no difference in creatinine after 3 months (P = .565). This was not associated with a higher incidence of heart failure hospitalizations and mortality (P-interaction = .467). However, decongestion at discharge was associated with a lower incidence of adverse clinical outcomes irrespective of the onset of WRF (P-interaction = .805). CONCLUSIONS: Acetazolamide is associated with a higher rate of successful decongestion across the entire range of renal function with more pronounced effects regarding natriuresis and diuresis in patients with a lower eGFR. While WRF occurred more frequently with acetazolamide, this was not associated with adverse clinical outcomes. CLINICALTRIALS.GOV IDENTIFIER: NCT03505788."},{"id":"8bee317bb751","type":"article","url":"https://hartvaat.nl/2023/10/01/precise-uitgesteld-testen-bij-stabiel-coronairlijden-is-veilig/","title":"PRECISE: uitgesteld testen bij stabiel coronairlijden is veilig","title_en":"Deferred Testing in Stable Outpatients With Suspected Coronary Artery Disease: A Prespecified Secondary Analysis of the PRECISE Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["stabiel-coronairlijden"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.2614","source_url":"https://doi.org/10.1001/jamacardio.2023.2614","authors":["James E Udelson","Michelle D Kelsey","Michael G Nanna","Christopher B Fordyce","Eric Yow","Robert M Clare","Daniel B Mark","Manesh R Patel","Campbell Rogers","Nick Curzen","Gianluca Pontone","Pál Maurovich-Horvat","Bernard De Bruyne","John P Greenwood","Victor Marinescu","Jonathon Leipsic","Gregg W Stone","Ori Ben-Yehuda","Colin Berry","Shea E Hogan","Bjorn Redfors","Ziad A Ali","Robert A Byrne","Christopher M Kramer","Robert W Yeh","Beth Martinez","Sarah Mullen","Whitney Huey","Kevin J Anstrom","Hussein R Al-Khalidi","Karen Chiswell","Sreekanth Vemulapalli","Pamela S Douglas"],"significance":7,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/kleplijden/esc-richtlijn-kleplijden-2021/"],"congress":"","summary_en":"This PRECISE trial analysis showed that deferring non-invasive testing in stable outpatients with suspected coronary artery disease and low pretest probability is safe, validating the guideline recommendation to avoid unnecessary testing.","created":"2026-07-03T10:30:36Z","updated":"2026-07-03T13:29:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van de PRECISE-trial toonde dat uitstel van niet-invasieve testen bij stabiele patiënten met verdenking coronairlijden veilig is. Dit ondersteunt een conservatievere diagnostische benadering bij laagrisicopatiënten.","abstract_original":"IMPORTANCE: Guidelines recommend deferral of testing for symptomatic people with suspected coronary artery disease (CAD) and low pretest probability. To our knowledge, no randomized trial has prospectively evaluated such a strategy. OBJECTIVE: To assess process of care and health outcomes in people identified as minimal risk for CAD when testing is deferred. DESIGN, SETTING, AND PARTICIPANTS: This randomized, pragmatic effectiveness trial included prespecified subgroup analysis of the PRECISE trial at 65 North American and European sites. Participants identified as minimal risk by the validated PROMISE minimal risk score (PMRS) were included. INTERVENTION: Randomization to a precision strategy using the PMRS to assign those with minimal risk to deferred testing and others to coronary computed tomography angiography with selective computed tomography-derived fractional flow reserve, or to usual testing (stress testing or catheterization with PMRS masked). Randomization was stratified by PMRS risk. MAIN OUTCOME: Composite of all-cause death, nonfatal myocardial infarction (MI), or catheterization without obstructive CAD through 12 months. RESULTS: Among 2103 participants, 422 were identified as minimal risk (20%) and randomized to deferred testing (n = 214) or usual testing (n = 208). Mean age (SD) was 46 (8.6) years; 304 were women (72%). During follow-up, 138 of those randomized to deferred testing never had testing (64%), whereas 76 had a downstream test (36%) (at median [IQR] 48 [15-78] days) for worsening (30%), uncontrolled (10%), or new symptoms (6%), or changing clinician preference (19%) or participant preference (10%). Results were normal for 96% of these tests. The primary end point occurred in 2 deferred testing (0.9%) and 13 usual testing participants (6.3%) (hazard ratio, 0.15; 95% CI, 0.03-0.66; P = .01). No death or MI was observed in the deferred testing participants, while 1 noncardiovascular death and 1 MI occurred in the usual testing group. Two participants (0.9%) had catheterizations without obstructive CAD in the deferred testing group and 12 (5.8%) with usual testing (P = .02). At baseline, 70% of participants had frequent angina and there was similar reduction of frequent angina to less than 20% at 12 months in both groups. CONCLUSION AND RELEVANCE: In symptomatic participants with suspected CAD, identification of minimal risk by the PMRS guided a strategy of initially deferred testing. The strategy was safe with no observed adverse outcome events, fewer catheterizations without obstructive CAD, and similar symptom relief compared with usual testing. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03702244."},{"id":"a281a58f43ec","type":"article","url":"https://hartvaat.nl/2023/10/01/mra-plus-sglt2-remmer-bij-hartfalen-meta-analyse-toont-synergistisch-voordeel/","title":"MRA plus SGLT2-remmer bij hartfalen: meta-analyse toont synergistisch voordeel","title_en":"Mineralocorticoid receptor antagonists with sodium-glucose co-transporter-2 inhibitors in heart failure: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["dapagliflozine","empagliflozine"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad522","source_url":"https://doi.org/10.1093/eurheartj/ehad522","authors":["Mainak Banerjee","Indira Maisnam","Rimesh Pal","Satinath Mukhopadhyay"],"significance":8,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This meta-analysis showed that combining an MRA with an SGLT2 inhibitor in heart failure provides additive reductions in cardiovascular death and heart failure hospitalization beyond either drug class alone. The findings support the four-pillar approach including dual neurohormonal and metabolic modulation.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T13:29:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat de combinatie van MRA met SGLT2-remmers bij hartfalen het risico op CV-sterfte en hospitalisatie meer vermindert dan elk middel apart. De combinatie is veilig wat betreft hyperkaliëmie, wat de vierpijlertherapie ondersteunt.","abstract_original":"BACKGROUND AND AIMS: To investigate the cardiovascular effects of sodium-glucose co-transporter-2 inhibitors (SGLT2i) with concomitant mineralocorticoid receptor antagonist (MRA) use in heart failure (HF) regardless of ejection fraction (EF) and explore the risk of MRA-associated adverse events in individuals randomized to SGLT2i vs. placebo. METHODS: PubMed/MEDLINE, Web of Science, Embase, and clinical trial registries were searched for randomized controlled trials/post-hoc analyses evaluating SGLT2i in HF with or without MRA use (PROSPERO: CRD42023397129). The main outcomes were composite of first hospitalization or urgent visit for HF/cardiovascular death (HHF/CVD), HHF, and CVD. Others were all-cause mortality, composite renal and safety outcomes. Hazard ratios (HR)/risk ratios were extracted. Fixed-effects meta-analyses and subgroup analyses were performed. RESULTS: Five eligible studies were included, pooling data from 21 947 people with HF (type 2 diabetes mellitus, n = 10 805). Compared to placebo, randomization to SGLT2i showed a similar reduction in HHF/CVD and HHF in people who were or were not using MRAs [HHF/CVD: hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.68-0.81 vs. HR 0.79; 95% CI 0.72-0.86; P-interaction = .43; HHF: HR 0.74; 95% CI 0.67-0.83 vs. HR 0.71; 95% CI 0.63-0.80; P-interaction = .53], with a suggestion of greater relative reduction in CVD in chronic HF people randomized to SGLT2i and using MRAs irrespective of EF (HR 0.81; 95% CI 0.72-0.91 vs. HR 0.98; 95% CI 0.86-1.13; P-interaction = .034). SGLT2i reduced all-cause mortality (P-interaction = .27) and adverse renal endpoints regardless of MRA use (P-interaction = .73) despite a higher risk of volume depletion with concomitant MRAs (P-interaction = .082). SGLT2i attenuated the risk of mild hyperkalaemia (P-interaction < .001) and severe hyperkalaemia (P-interaction = .051) associated with MRA use. CONCLUSIONS: MRAs did not influence SGLT2i effects on the composite of HHF/CVD, HHF or all-cause mortality; however, findings hinted at a more pronounced relative reduction in CVD in chronic HF patients regardless of EF who were randomized to SGLT2i and receiving an MRA compared to those randomized to SGLT2i and not receiving MRAs. SGLT2i attenuated the risk of MRA-associated treatment-emergent hyperkalaemia. These findings warrant further validation in well-designed randomized controlled trials."},{"id":"52b5b5e367f9","type":"article","url":"https://hartvaat.nl/2023/10/01/pa-drukmonitoring-bij-chronisch-hartfalen-meta-analyse-van-drie-rct-s/","title":"PA-drukmonitoring bij chronisch hartfalen: meta-analyse van drie RCT's","title_en":"Efficacy of pulmonary artery pressure monitoring in patients with chronic heart failure: a meta-analysis of three randomized controlled trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad346","source_url":"https://doi.org/10.1093/eurheartj/ehad346","authors":["Pascal R D Clephas","Sumant P Radhoe","Eric Boersma","John Gregson","Pardeep S Jhund","William T Abraham","John J V McMurray","Rudolf A de Boer","Jasper J Brugts"],"significance":8,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"This meta-analysis of CHAMPION, GUIDE-HF, and MONITOR-HF confirmed that implantable pulmonary artery pressure monitoring significantly reduces heart failure hospitalization in chronic heart failure. The pooled evidence across three continents supported the clinical utility of hemodynamic monitoring.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T18:39:06Z","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 CHAMPION, GUIDE-HF en MONITOR-HF bevestigde dat PA-drukmonitoring hospitalisaties significant vermindert bij chronisch hartfalen. Het voordeel is consistent over studies en ondersteunt brede implementatie van hemodynamische monitoring.","abstract_original":"AIMS: Adjustment of treatment based on remote monitoring of pulmonary artery (PA) pressure may reduce the risk of hospital admission for heart failure (HF). We have conducted a meta-analysis of large randomized trials investigating this question. METHODS AND RESULTS: A systematic literature search was performed for randomized clinical trials with PA pressure monitoring devices in patients with HF. The primary outcome of interest was the total number of HF hospitalizations. Other outcomes assessed were urgent visits leading to treatment with intravenous diuretics, all-cause mortality, and composites. Treatment effects are expressed as hazard ratios, and pooled effect estimates were obtained applying random effects meta-analyses. Three eligible randomized clinical trials were identified that included 1898 outpatients in New York Heart Association functional classes II-IV, either hospitalized for HF in the prior 12 months or with elevated plasma NT-proBNP concentrations. The mean follow-up was 14.7 months, 67.8% of the patients were men, and 65.8% had an ejection fraction ≤40%. Compared to patients in the control group, the hazard ratio (95% confidence interval) for total HF hospitalizations in those randomized to PA pressure monitoring was 0.70 (0.58-0.86) (P = .0005). The corresponding hazard ratio for the composite of total HF hospitalizations, urgent visits and all-cause mortality was 0.75 (0.61-0.91; P = .0037) and for all-cause mortality 0.92 (0.73-1.16). Subgroup analyses, including ejection fraction phenotype, revealed no evidence of heterogeneity in the treatment effect. CONCLUSION: The use of remote PA pressure monitoring to guide treatment of patients with HF reduces episodes of worsening HF and subsequent hospitalizations."},{"id":"e3081eef49c7","type":"article","url":"https://hartvaat.nl/2023/10/01/trimetazidine-bij-hfpef-gerandomiseerde-cross-over-trial/","title":"Trimetazidine bij HFpEF: gerandomiseerde cross-over trial","title_en":"Trimetazidine in heart failure with preserved ejection fraction: a randomized controlled cross-over trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf","step-hfpef","summit-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14418","source_url":"https://doi.org/10.1002/ehf2.14418","authors":["Arno A van de Bovenkamp","Kiki T J Geurkink","Frank T P Oosterveer","Frances S de Man","Wouter E M Kok","Patrick N A Bronzwaer","Cor P Allaart","Aart J Nederveen","Albert C van Rossum","Adrianus J Bakermans","M Louis Handoko"],"significance":6,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This cross-over trial of trimetazidine in HFpEF showed no significant improvement in cardiac function or exercise capacity, a negative result for metabolic modulation in the preserved ejection fraction phenotype.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T13:29:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cross-over trial onderzocht trimetazidine bij HFpEF om de cardiale energiestofwisseling te verbeteren. Het middel toonde geen significant voordeel op inspanningscapaciteit of symptomen. Metabole modulatie als HFpEF-therapie is onbewezen.","abstract_original":"AIMS: Impaired myocardial energy homeostasis plays an import role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Left ventricular relaxation has a high energy demand, and left ventricular diastolic dysfunction has been related to impaired energy homeostasis. This study investigated whether trimetazidine, a fatty acid oxidation inhibitor, could improve myocardial energy homeostasis and consequently improve exercise haemodynamics in patients with HFpEF. METHODS AND RESULTS: The DoPING-HFpEF trial was a phase II single-centre, double-blind, placebo-controlled, randomized cross-over trial. Patients were randomized to trimetazidine treatment or placebo for 3 months and switched after a 2-week wash-out period. The primary endpoint was change in pulmonary capillary wedge pressure, measured with right heart catheterization at multiple stages of bicycling exercise. Secondary endpoint was change in myocardial phosphocreatine/adenosine triphosphate, an index of the myocardial energy status, measured with phosphorus-31 magnetic resonance spectroscopy. The study included 25 patients (10/15 males/females; mean (standard deviation) age, 66 (10) years; body mass index, 29.8 (4.5) kg/m2 ); with the diagnosis of HFpEF confirmed with (exercise) right heart catheterization either before or during the trial. There was no effect of trimetazidine on the primary outcome pulmonary capillary wedge pressure at multiple levels of exercise (mean change 0 [95% confidence interval, 95% CI -2, 2] mmHg over multiple levels of exercise, P = 0.60). Myocardial phosphocreatine/adenosine triphosphate in the trimetazidine arm was similar to placebo (1.08 [0.76, 1.76] vs. 1.30 [0.95, 1.86], P = 0.08). There was no change by trimetazidine compared with placebo in the exploratory parameters: 6-min walking distance (mean change of -6 [95% CI -18, 7] m vs. -5 [95% CI -22, 22] m, respectively, P = 0.93), N-terminal pro-B-type natriuretic peptide (5 (-156, 166) ng/L vs. -13 (-172, 147) ng/L, P = 0.70), overall quality-of-life (KCCQ and EQ-5D-5L, P = 0.78 and P = 0.51, respectively), parameters for diastolic function measured with echocardiography and cardiac magnetic resonance, or metabolic parameters. CONCLUSIONS: Trimetazidine did not improve myocardial energy homeostasis and did not improve exercise haemodynamics in patients with HFpEF."},{"id":"3a386b1bcfd8","type":"article","url":"https://hartvaat.nl/2023/10/01/baroreflexactivatietherapie-bij-hfref-systematische-review/","title":"Baroreflexactivatietherapie bij HFrEF: systematische review","title_en":"Efficacy and safety of baroreflex activation therapy for heart failure with reduced ejection fraction: systematic review.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bloeddrukbehandeling"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14473","source_url":"https://doi.org/10.1002/ehf2.14473","authors":["Juan Máximo Molina-Linde","David Cordero-Pereda","Elena Baños-Álvarez","Maria Piedad Rosario-Lozano","Juan Antonio Blasco-Amaro"],"significance":5,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This systematic review evaluated baroreflex activation therapy as an adjunctive treatment for HFrEF, showing symptom improvement and NT-proBNP reduction with this neuromodulation device.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T13:29:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review evalueerde baroreflexactivatietherapie (BAT) als adjuvante behandeling bij HFrEF. BAT verbeterde de symptomen en kwaliteit van leven, maar harde uitkomstdata zijn beperkt. Het blijft een experimentele therapie voor geselecteerde patiënten.","abstract_original":"Baroreflex activation therapy (BAT) is a possible adjuvant treatment for patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy and may be an alternative therapy in patients with contraindications or drug intolerance. Our aim was to evaluate the efficacy and safety of BAT in patients with HFrEF. The protocol for this study was registered with PROSPERO (CRD42022349175). Searches were conducted using MEDLINE, preMedLine (via PubMed), EMBASE, Cochrane Library, Web of Science, Trip Medical Database, WHO International Clinical Trials Registry, and ClinicalTrials.gov. We included randomized controlled trials that compared the effects of BAT with pharmacological treatment. We assessed the risk of bias of each study using the Cochrane RoB2 tool and the certainty of the results using the GRADE approach. We performed a meta-analysis of treatment effects using a fixed-effects or random-effects model, depending on the heterogeneity observed. Two studies were included in the meta-analysis (HOPE4HF and BeAT-HF). The results showed that BAT led to statistically significant improvements in New York Heart Association functional class (relative risk 2.13; 95% confidence interval [CI, 1.65 to 2.76]), quality of life (difference in means -16.97; 95% CI [-21.87 to -12.07]), 6 min walk test (difference in means 56.54; 95% CI [55.67 to 57.41]) and N-terminal probrain natriuretic peptide (difference in means -120.02; 95% CI [-193.58 to -46.45]). The system- and procedure-related complication event-free rate varied from 85.9% to 97%. The results show that BAT is safe and improves functional class, quality of life and congestion in selected patients with HFrEF. Further studies and long-term follow-up are needed to assess efficacy in reducing cardiovascular events and mortality."},{"id":"7e64e4e9b08a","type":"article","url":"https://hartvaat.nl/2023/10/01/alcoholconsumptie-en-bloeddruk-dosis-respons-meta-analyse/","title":"Alcoholconsumptie en bloeddruk: dosis-respons meta-analyse","title_en":"Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21224","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21224","authors":["Silvia Di Federico","Tommaso Filippini","Paul K Whelton","Marta Cecchini","Inga Iamandii","Giuseppe Boriani","Marco Vinceti"],"significance":7,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This dose-response meta-analysis showed a linear relationship between alcohol consumption and blood pressure elevation with no safe threshold, supporting alcohol reduction as a blood pressure management strategy at any intake level.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T18:39:06Z","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 toonde een lineaire dosis-responsrelatie tussen alcoholconsumptie en bloeddrukstijging, zonder veilige drempel. Zelfs matig alcoholgebruik verhoogt de bloeddruk, wat het advies om alcoholconsumptie te beperken voor hypertensiepreventie versterkt.","abstract_original":"BACKGROUND: Alcohol consumption may increase blood pressure but the details of the relationship are incomplete, particularly for the association at low levels of alcohol consumption, and no meta-analyses are available for nonexperimental cohort studies. METHODS: We performed a systematic search of longitudinal studies in healthy adults that reported on the association between alcohol intake and blood pressure. Our end points were the mean differences over time of systolic (SBP) and diastolic blood pressure (DBP), plotted according to baseline alcohol intake, by using a dose-response 1-stage meta-analytic methodology. RESULTS: Seven studies, with 19 548 participants and a median follow-up of 5.3 years (range, 4-12 years), were included in the analysis. We observed a substantially linear positive association between baseline alcohol intake and changes over time in SBP and DBP, with no suggestion of an exposure-effect threshold. Overall, average SBP was 1.25 and 4.90 mm Hg higher for 12 or 48 grams of daily alcohol consumption, compared with no consumption. The corresponding differences for DBP were 1.14 and 3.10 mm Hg. Subgroup analyses by sex showed an almost linear association between baseline alcohol intake and SBP changes in both men and women, and for DBP in men while in women we identified an inverted U-shaped association. Alcohol consumption was positively associated with blood pressure changes in both Asians and North Americans, apart from DBP in the latter group. CONCLUSIONS: Our results suggest the association between alcohol consumption and SBP is direct and linear with no evidence of a threshold for the association, while for DBP the association is modified by sex and geographic location."},{"id":"3ef3dda26540","type":"article","url":"https://hartvaat.nl/2023/10/01/ivabradine-bij-hoogrisico-hartfalenpatienten-shift-analyse/","title":"Ivabradine bij hoogrisico hartfalenpatiënten: SHIFT-analyse","title_en":"Efficacy of ivabradine in heart failure patients with a high-risk profile (analysis from the SHIFT trial).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfref","ivabradine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14455","source_url":"https://doi.org/10.1002/ehf2.14455","authors":["Amr Abdin","Michel Komajda","Jeffrey S Borer","Ian Ford","Luigi Tavazzi","Cécile Batailler","Karl Swedberg","Giuseppe M C Rosano","Felix Mahfoud","Michael Böhm"],"significance":6,"published":"2023-10-01","source_date":"2023-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/"],"congress":"","summary_en":"This SHIFT post-hoc analysis showed that ivabradine provides the greatest benefit in HFrEF patients with the highest risk profiles (higher heart rate, lower LVEF, recent hospitalization), supporting risk-based patient selection for heart rate lowering.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T18:39:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Post-hoc analyse van SHIFT toonde dat ivabradine het meeste voordeel biedt bij HFrEF-patiënten met een hoog risicoprofiel: hogere hartfrequentie, lagere EF en meer comorbiditeiten. Dit helpt patiënten te identificeren die prioritair ivabradine moeten krijgen.","abstract_original":"AIMS: Early start and patient profile-oriented heart failure (HF) management has been recommended. In this post hoc analysis from the SHIFT trial, we analysed the treatment effects of ivabradine in HF patients with systolic blood pressure (SBP) < 110 mmHg, resting heart rate (RHR) ≥ 75 b.p.m., left ventricular ejection fraction (LVEF) ≤ 25%, New York Heart Association (NYHA) Class III/IV, and their combination. METHODS AND RESULTS: The SHIFT trial enrolled 6505 patients (LVEF ≤ 35% and RHR ≥ 70 b.p.m.), randomized to ivabradine or placebo on the background of guideline-defined standard care. Compared with placebo, ivabradine was associated with a similar relative risk reduction of the primary endpoint (cardiovascular death or HF hospitalization) in patients with SBP < 110 and ≥110 mmHg [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.74-1.08 vs. HR 0.80, 95% CI 0.72-0.89, P interaction = 0.34], LVEF ≤ 25% and >25% (HR 0.85, 95% CI 0.72-1.01 vs. HR 0.80, 95% CI 0.71-0.90, P interaction = 0.53), and NYHA III-IV and II (HR 0.83, 95% CI 0.74-0.94 vs. HR 0.81, 95% CI 0.69-0.94, P interaction = 0.79). The effect was more pronounced in patients with RHR ≥ 75 compared with <75 (HR 0.76, 95% CI 0.68-0.85 vs. HR 0.97, 95% CI 0.81-0.1.16, P interaction = 0.02). When combining these profiling parameters, treatment with ivabradine was also associated with risk reductions comparable with patients with low-risk profiles for the primary endpoint (relative risk reduction 29%), cardiovascular death (11%), HF death (49%), and HF hospitalization (38%; all P values for interaction: 0.40). No safety concerns were observed between study groups. CONCLUSIONS: Our analysis shows that RHR reduction with ivabradine is effective and improves clinical outcomes in HF patients across various risk indicators such as low SBP, high RHR, low LVEF, and high NYHA class to a similar extent and without safety concern."},{"id":"b6c4104fb770","type":"article","url":"https://hartvaat.nl/2023/09/30/adaptresponse-adaptieve-versus-conventionele-crt-bij-hartfalen-lancet/","title":"AdaptResponse: adaptieve versus conventionele CRT bij hartfalen — Lancet","title_en":"Adaptive versus conventional cardiac resynchronisation therapy in patients with heart failure (AdaptResponse): a global, prospective, randomised controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00912-1","source_url":"https://doi.org/10.1016/S0140-6736(23)00912-1","authors":["Bruce L Wilkoff","Gerasimos Filippatos","Christophe Leclercq","Michael R Gold","Ahmad S Hersi","Kengo Kusano","Wilfried Mullens","G Michael Felker","Charan Kantipudi","Mikhael F El-Chami","Vidal Essebag","Bertrand Pierre","Francois Philippon","Francisco Perez-Gil","Eugene S Chung","Juan Sotomonte","Stanley Tung","Balbir Singh","Babak Bozorgnia","Satish Goel","Hans Holger Ebert","Niraj Varma","Kara J Quan","Fiorella Salerno","Bart Gerritse","Janelle van Wel","Daniel E Schaber","Dedra H Fagan","David Birnie"],"significance":7,"published":"2023-09-30","source_date":"2023-09-30","image":"","kennis":[],"congress":"","summary_en":"The AdaptResponse trial showed that adaptive CRT (automatic optimization with LV-only pacing when appropriate) is noninferior to conventional biventricular CRT, supporting intelligent pacing algorithms that simplify device management.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T13:29:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De AdaptResponse-trial in de Lancet toonde dat adaptieve CRT (automatische optimalisatie met linkerventrikel-only pacing) non-inferieur was aan conventionele CRT. De vereenvoudigde programmering kan de CRT-implementatie verbeteren.","abstract_original":"BACKGROUND: Continuous automatic optimisation of cardiac resynchronisation therapy (CRT), stimulating only the left ventricle to fuse with intrinsic right bundle conduction (synchronised left ventricular stimulation), might offer better outcomes than conventional CRT in patients with heart failure, left bundle branch block, and normal atrioventricular conduction. This study aimed to compare clinical outcomes of adaptive CRT versus conventional CRT in patients with heart failure with intact atrioventricular conduction and left bundle branch block. METHODS: This global, prospective, randomised controlled trial was done in 227 hospitals in 27 countries across Asia, Australia, Europe, and North America. Eligible patients were aged 18 years or older with class 2-4 heart failure, an ejection fraction of 35% or less, left bundle branch block with QRS duration of 140 ms or more (male patients) or 130 ms or more (female patients), and a baseline PR interval 200 ms or less. Patients were randomly assigned (1:1) via block permutation to adaptive CRT (an algorithm providing synchronised left ventricular stimulation) or conventional biventricular CRT using a device programmer. All patients received device programming but were masked until procedures were completed. Site staff were not masked to group assignment. The primary outcome was a composite of all-cause death or intervention for heart failure decompensation and was assessed in the intention-to-treat population. Safety events were collected and reported in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02205359, and is closed to accrual. FINDINGS: Between Aug 5, 2014, and Jan 31, 2019, of 3797 patients enrolled, 3617 (95·3%) were randomly assigned (1810 to adaptive CRT and 1807 to conventional CRT). The futility boundary was crossed at the third interim analysis on June 23, 2022, when the decision was made to stop the trial early. 1568 (43·4%) of 3617 patients were female and 2049 (56·6%) were male. Median follow-up was 59·0 months (IQR 45-72). A primary outcome event occurred in 430 of 1810 patients (Kaplan-Meier occurrence rate 23·5% [95% CI 21·3-25·5] at 60 months) in the adaptive CRT group and in 470 of 1807 patients (25·7% [23·5-27·8] at 60 months) in the conventional CRT group (hazard ratio 0·89, 95% CI 0·78-1·01; p=0·077). System-related adverse events were reported in 452 (25·0%) of 1810 patients in the adaptive CRT group and 440 (24·3%) of 1807 patients in the conventional CRT group. INTERPRETATION: Compared with conventional CRT, adaptive CRT did not significantly reduce the incidence of all-cause death or intervention for heart failure decompensation in the included population of patients with heart failure, left bundle branch block, and intact AV conduction. Death and heart failure decompensation rates were low with both CRT therapies, suggesting a greater response to CRT occurred in this population than in patients in previous trials. FUNDING: Medtronic."},{"id":"14ac906afdc4","type":"article","url":"https://hartvaat.nl/2023/09/28/noah-afnet-6-edoxaban-bij-atriaal-high-rate-episodes-nejm/","title":"NOAH-AFNET 6: edoxaban bij atriaal high-rate episodes — NEJM","title_en":"Anticoagulation with Edoxaban in Patients with Atrial High-Rate Episodes.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2303062","source_url":"https://doi.org/10.1056/NEJMoa2303062","authors":["Paulus Kirchhof","Tobias Toennis","Andreas Goette","A John Camm","Hans Christoph Diener","Nina Becher","Emanuele Bertaglia","Carina Blomstrom Lundqvist","Martin Borlich","Axel Brandes","Nuno Cabanelas","Melanie Calvert","Gregory Chlouverakis","Gheorghe-Andrei Dan","Joris R de Groot","Wolfgang Dichtl","Borys Kravchuk","Andrzej Lubiński","Eloi Marijon","Béla Merkely","Lluís Mont","Ann-Kathrin Ozga","Kim Rajappan","Andrea Sarkozy","Daniel Scherr","Rafał Sznajder","Vasil Velchev","Dan Wichterle","Susanne Sehner","Emmanuel Simantirakis","Gregory Y H Lip","Panos Vardas","Ulrich Schotten","Antonia Zapf"],"significance":10,"published":"2023-09-28","source_date":"2023-09-28","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/hasbled-score/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/"],"congress":"","summary_en":"The NOAH-AFNET 6 trial found that edoxaban did not significantly reduce cardiovascular events compared with placebo in patients with device-detected atrial high-rate episodes (AHREs) but without clinical atrial fibrillation, while increasing major bleeding. The results do not support routine anticoagulation for subclinical atrial arrhythmias detected by cardiac devices.","created":"2026-07-03T10:30:35Z","updated":"2026-07-03T13:29:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De NOAH-AFNET 6-trial in de NEJM toonde dat edoxaban bij patiënten met device-gedetecteerde atriale high-rate episodes (AHRE's) zonder klinisch AF de CV-events niet significant verminderde maar het bloedingsrisico verhoogde. Routinematige anticoagulatie bij subclinisch AF is niet gerechtvaardigd.","abstract_original":"BACKGROUND: Device-detected atrial high-rate episodes (AHREs) are atrial arrhythmias detected by implanted cardiac devices. AHREs resemble atrial fibrillation but are rare and brief. Whether the occurrence of AHREs in patients without atrial fibrillation (as documented on a conventional electrocardiogram [ECG]) justifies the initiation of anticoagulants is not known. METHODS: We conducted an event-driven, double-blind, double-dummy, randomized trial involving patients 65 years of age or older who had AHREs lasting for at least 6 minutes and who had at least one additional risk factor for stroke. Patients were randomly assigned in a 1:1 ratio to receive edoxaban or placebo. The primary efficacy outcome was a composite of cardiovascular death, stroke, or systemic embolism, evaluated in a time-to-event analysis. The safety outcome was a composite of death from any cause or major bleeding. RESULTS: The analysis population consisted of 2536 patients (1270 in the edoxaban group and 1266 in the placebo group). The mean age was 78 years, 37.4% were women, and the median duration of AHREs was 2.8 hours. The trial was terminated early, at a median follow-up of 21 months, on the basis of safety concerns and the results of an independent, informal assessment of futility for the efficacy of edoxaban; at termination, the planned enrollment had been completed. A primary efficacy outcome event occurred in 83 patients (3.2% per patient-year) in the edoxaban group and in 101 patients (4.0% per patient-year) in the placebo group (hazard ratio, 0.81; 95% confidence interval [CI], 0.60 to 1.08; P = 0.15). The incidence of stroke was approximately 1% per patient-year in both groups. A safety outcome event occurred in 149 patients (5.9% per patient-year) in the edoxaban group and in 114 patients (4.5% per patient-year) in the placebo group (hazard ratio, 1.31; 95% CI, 1.02 to 1.67; P = 0.03). ECG-diagnosed atrial fibrillation developed in 462 of 2536 patients (18.2% total, 8.7% per patient-year). CONCLUSIONS: Among patients with AHREs detected by implantable devices, anticoagulation with edoxaban did not significantly reduce the incidence of a composite of cardiovascular death, stroke, or systemic embolism as compared with placebo, but it led to a higher incidence of a composite of death or major bleeding. The incidence of stroke was low in both groups. (Funded by the German Center for Cardiovascular Research and others; NOAH-AFNET 6 ClinicalTrials.gov number, NCT02618577; ISRCTN number, ISRCTN17309850.)."},{"id":"f6019e86167e","type":"article","url":"https://hartvaat.nl/2023/09/28/pijn-op-de-borst-bij-mi-met-en-zonder-diabetes-meta-analyse/","title":"Pijn op de borst bij MI met en zonder diabetes: meta-analyse","title_en":"Chest pain symptoms during myocardial infarction in patients with and without diabetes: a systematic review and meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-322289","source_url":"https://doi.org/10.1136/heartjnl-2022-322289","authors":["Abhinav Kumar","Amrit Sanghera","Balpreet Sanghera","Tahira Mohamed","Ariella Midgen","Sophie Pattison","Louise Marston","Melvyn M Jones"],"significance":6,"published":"2023-09-28","source_date":"2023-09-28","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This meta-analysis showed that diabetic patients more often present with atypical MI symptoms, but chest pain remains the most common presentation even in diabetes, informing triage and diagnostic approaches.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T13:29:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat diabetespatiënten vaker atypische MI-presentaties hebben maar dat typische pijn op de borst nog steeds het meest voorkomt. Het concept van 'stille MI bij diabetes' is genuanceerder dan vaak gedacht.","abstract_original":"OBJECTIVE: Chest pain (CP) is key in diagnosing myocardial infarction (MI). Patients with diabetes mellitus (DM) are at increased risk of an MI but may experience less CP, leading to delayed treatment and worse outcomes. We compared the prevalence of CP in those with and without DM who had an MI. METHODS: The study population was people with MI presenting to healthcare services. The outcome measure was the absence of CP during MI, comparing those with and without DM. Medline and Embase databases were searched to 18 October 2021, identifying 9272 records. After initial independent screening, 87 reports were assessed for eligibility against the inclusion criteria, quality and risk of bias assessment (Strengthening the Reporting of Observational Studies in Epidemiology and Newcastle-Ottawa criteria), leaving 22 studies. The meta-analysis followed Meta-analysis Of Observational Studies in Epidemiology criteria and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled ORs, weights and 95% CIs were calculated using a random-effects model. RESULTS: This meta-analysis included 232 519 participants from 22 studies and showed an increased likelihood of no CP during an MI for those with DM, compared with those without. This was 43% higher in patients with DM in the cohort and cross-sectional studies (OR: 1.43; 95% CI: 1.26 to 1.62), and 44% higher in case-control studies (OR: 1.44; 95% CI: 1.11 to 1.87). CONCLUSION: In patients with an MI, patients with DM are less likely than those without to have presentations with CP recorded. Clinicians should consider an MI diagnosis when patients with DM present with atypical symptoms and treatment protocols should reflect this, alongside an increased patient awareness on this issue. PROSPERO REGISTRATION NUMBER: CRD42017058223."},{"id":"5acd4e7fc5ac","type":"article","url":"https://hartvaat.nl/2023/09/26/biodegradeerbare-versus-duurzame-polymeer-stents-bij-hoog-bloedingsrisico/","title":"Biodegradeerbare versus duurzame polymeer-stents bij hoog bloedingsrisico","title_en":"Biodegradable-Polymer or Durable-Polymer Stents in Patients at High Bleeding Risk: A Randomized, Open-Label Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.065448","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.065448","authors":["Marco Valgimigli","Adrian Wlodarczak","Ralph Tölg","Béla Merkely","Henning Kelbæk","Jacek Legutko","Stefano Galli","Matthieu Godin","Gabor G Toth","Thibault Lhermusier","Benjamin Honton","Peter Laurenz Dietrich","Francis Stammen","Bert Ferdinande","Johanne Silvain","Davide Capodanno","Guillaume Cayla"],"significance":6,"published":"2023-09-26","source_date":"2023-09-26","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/vasculair/antistolling-bij-vte/"],"congress":"","summary_en":"This randomized trial comparing biodegradable with durable polymer DES in high-bleeding-risk patients showed equivalent outcomes with both platforms, supporting either technology for short-DAPT strategies.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T13:29:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"RCT vergeleek biodegradeerbare met duurzame polymeer drug-eluting stents bij patiënten met hoog bloedingsrisico. Beide platforms toonden vergelijkbare uitkomsten, wat de keuze laat aan lokale beschikbaarheid en voorkeur.","abstract_original":"BACKGROUND: Limited information is available on the comparative efficacy and safety of different stent platforms in patients at high bleeding risk undergoing an abbreviated dual antiplatelet therapy duration after percutaneous coronary intervention (PCI). The aim of this study was to compare the safety and effectiveness of the biodegradable-polymer sirolimus-eluting stent with the durable-polymer zotarolimus-eluting stent in patients at high bleeding risk receiving 1 month of dual antiplatelet therapy after PCI. METHODS: The Bioflow-DAPT Study is an international, randomized, open-label trial conducted at 52 interventional cardiology hospitals in 18 countries from February 24, 2020, through September 20, 2021. Patients with a clinical indication to PCI because of acute or chronic coronary syndrome who fulfilled 1 or more criteria for high bleeding risk were eligible for enrollment. Patients were randomized to receive either biodegradable-polymer sirolimus-eluting stents or durable-polymer, slow-release zotarolimus-eluting stents after successful lesion preparation, followed by 1 month of dual antiplatelet therapy and thereafter single antiplatelet therapy. The primary outcome was the composite of death from cardiac causes, myocardial infarction, or stent thrombosis at 1 year, and was powered for noninferiority, with an absolute margin of 4.1% at 1-sided 5% alpha. RESULTS: A total of 1948 patients at high bleeding risk were randomly assigned (1:1) to receive biodegradable-polymer sirolimus-eluting stents (969 patients) or durable-polymer zotarolimus-eluting stents (979 patients). At 1 year, the primary outcome was observed in 33 of 969 patients (3.6%) in the biodegradable-polymer sirolimus-eluting stent group and in 32 of 979 patients (3.4%) in the durable-polymer zotarolimus-eluting stent group (risk difference, 0.2 percentage points; upper boundary of the 1-sided 95% CI, 1.8; upper boundary of the 1-sided 97.5% CI, 2.1; P<0.0001 for noninferiority for both tests). CONCLUSIONS: Among patients at high risk for bleeding who received 1 month of dual antiplatelet therapy after PCI, the use of biodegradable-polymer sirolimus-eluting stents was noninferior to the use of durable-polymer zotarolimus-eluting stents with regard to the composite of death from cardiac causes, myocardial infarction, or stent thrombosis. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04137510."},{"id":"d2faf3745a87","type":"article","url":"https://hartvaat.nl/2023/09/26/geblindeerde-stopstudie-voordelen-empagliflozine-verdwijnen-na-staken-bij-hf/","title":"Geblindeerde stopstudie: voordelen empagliflozine verdwijnen na staken bij HF","title_en":"Blinded Withdrawal of Long-Term Randomized Treatment With Empagliflozin or Placebo in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","emperor-trials"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.065748","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.065748","authors":["Milton Packer","Javed Butler","Cordula Zeller","Stuart J Pocock","Martina Brueckmann","João Pedro Ferreira","Gerasimos Filippatos","Muhammad Shariq Usman","Faiez Zannad","Stefan D Anker"],"significance":7,"published":"2023-09-26","source_date":"2023-09-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This blinded withdrawal study from EMPEROR showed that the benefits of empagliflozin in heart failure rapidly diminish after treatment discontinuation, with NT-proBNP and clinical deterioration markers worsening within weeks. The findings underscore the need for continuous SGLT2 inhibitor therapy.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T13:29:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geblindeerde stopstudie van EMPEROR toonde dat de voordelen van empagliflozine bij hartfalen snel verdwijnen na staken. NT-proBNP en lichaamsgewicht stegen weer na placebo-switch. Dit benadrukt dat SGLT2-remming continue therapie vereist.","abstract_original":"BACKGROUND: It is not known whether the benefits of sodium-glucose cotransporter 2 inhibitors in heart failure persist after years of therapy. METHODS: In the EMPEROR-Reduced (Empagliflozin Outcome Trials in Chronic Heart Failure With Reduced Ejection Fraction) and EMPEROR-Preserved (Empagliflozin Outcome Trials in Chronic Heart Failure With Preserved Ejection Fraction) trials, patients with heart failure were randomly assigned (double-blind) to placebo or empagliflozin 10 mg/day for a median of 16 and 26 months, respectively. At the end of the trials, 6799 patients (placebo 3381, empagliflozin 3418) were prospectively withdrawn from treatment in a blinded manner, and, of these, 3981 patients (placebo 2020, empagliflozin 1961) underwent prespecified in-person assessments after ≈30 days off treatment. RESULTS: From 90 days from the start of closeout to the end of double-blind treatment, the annualized risk of cardiovascular death or hospitalization for heart failure was lower in empagliflozin-treated patients than in placebo-treated patients (10.7 [95% CI, 9.0-12.6] versus 13.5 [95% CI, 11.5-15.6] events per 100 patient-years, respectively; hazard ratio 0.76 [95% CI, 0.60-0.96]). When the study drugs were withdrawn for ≈30 days, the annualized risk of cardiovascular death or hospitalization for heart failure increased in patients withdrawn from empagliflozin but not in those withdrawn from placebo (17.0 [95% CI, 12.6-22.1] versus 14.1 [95% CI, 10.1-18.8] events per 100 patient-years for empagliflozin and placebo, respectively). The hazard ratio for the change in risk in the patients withdrawn from empagliflozin was 1.75 (95% CI, 1.20-2.54), P=0.0034, whereas the change in the risk in patients withdrawn from placebo was not significant (hazard ratio 1.12 [95% CI, 0.76-1.66]); time period-by-treatment interaction, P=0.068. After withdrawal, the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score declined by 1.6±0.4 in patients withdrawn from empagliflozin versus placebo (P<0.0001). Furthermore, withdrawal of empagliflozin was accompanied by increases in fasting glucose, body weight, systolic blood pressure, estimated glomerular filtration rate, N-terminal pro-hormone B-type natriuretic peptide, uric acid, and serum bicarbonate and decreases in hemoglobin and hematocrit (all P<0.01). These physiological and laboratory changes were the inverse of the effects of the drug seen at the start of the trials during the initiation of treatment (≈1-3 years earlier) in the same cohort of patients. CONCLUSIONS: These observations demonstrate a persistent effect of empagliflozin in patients with heart failure even after years of treatment, which dissipated rapidly after withdrawal of the drug. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifiers: NCT03057977 and NCT03057951."},{"id":"530e1a49b5bf","type":"article","url":"https://hartvaat.nl/2023/09/21/step-hfpef-semaglutide-bij-hfpef-en-obesitas-nejm/","title":"STEP-HFpEF: semaglutide bij HFpEF en obesitas — NEJM","title_en":"Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["select-trial","step-hfpef","summit-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2306963","source_url":"https://doi.org/10.1056/NEJMoa2306963","authors":["Mikhail N Kosiborod","Steen Z Abildstrøm","Barry A Borlaug","Javed Butler","Søren Rasmussen","Melanie Davies","G Kees Hovingh","Dalane W Kitzman","Marie L Lindegaard","Daniél V Møller","Sanjiv J Shah","Marianne B Treppendahl","Subodh Verma","Walter Abhayaratna","Fozia Z Ahmed","Vijay Chopra","Justin Ezekowitz","Michael Fu","Hiroshi Ito","Małgorzata Lelonek","Vojtech Melenovsky","Bela Merkely","Julio Núñez","Eduardo Perna","Morten Schou","Michele Senni","Kavita Sharma","Peter Van der Meer","Dirk von Lewinski","Dennis Wolf","Mark C Petrie"],"significance":10,"published":"2023-09-21","source_date":"2023-09-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The STEP-HFpEF trial showed that weekly semaglutide 2.4 mg in patients with HFpEF and obesity dramatically improved heart failure symptoms, physical limitations, and quality of life, with a mean 13% body weight reduction. This landmark result established GLP-1 receptor agonists as a transformative therapy for the obesity-HFpEF phenotype.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T13:29:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De STEP-HFpEF-trial in de NEJM toonde dat semaglutide bij patiënten met HFpEF en obesitas de symptomen, fysieke beperkingen en kwaliteit van leven spectaculair verbeterde, met 13% gewichtsverlies en significante afname van CRP. Dit opent een geheel nieuw behandelparadigma voor het obesitas-HFpEF fenotype.","abstract_original":"BACKGROUND: Heart failure with preserved ejection fraction is increasing in prevalence and is associated with a high symptom burden and functional impairment, especially in persons with obesity. No therapies have been approved to target obesity-related heart failure with preserved ejection fraction. METHODS: We randomly assigned 529 patients who had heart failure with preserved ejection fraction and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or higher to receive once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. The dual primary end points were the change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations) and the change in body weight. Confirmatory secondary end points included the change in the 6-minute walk distance; a hierarchical composite end point that included death, heart failure events, and differences in the change in the KCCQ-CSS and 6-minute walk distance; and the change in the C-reactive protein (CRP) level. RESULTS: The mean change in the KCCQ-CSS was 16.6 points with semaglutide and 8.7 points with placebo (estimated difference, 7.8 points; 95% confidence interval [CI], 4.8 to 10.9; P<0.001), and the mean percentage change in body weight was -13.3% with semaglutide and -2.6% with placebo (estimated difference, -10.7 percentage points; 95% CI, -11.9 to -9.4; P<0.001). The mean change in the 6-minute walk distance was 21.5 m with semaglutide and 1.2 m with placebo (estimated difference, 20.3 m; 95% CI, 8.6 to 32.1; P<0.001). In the analysis of the hierarchical composite end point, semaglutide produced more wins than placebo (win ratio, 1.72; 95% CI, 1.37 to 2.15; P<0.001). The mean percentage change in the CRP level was -43.5% with semaglutide and -7.3% with placebo (estimated treatment ratio, 0.61; 95% CI, 0.51 to 0.72; P<0.001). Serious adverse events were reported in 35 participants (13.3%) in the semaglutide group and 71 (26.7%) in the placebo group. CONCLUSIONS: In patients with heart failure with preserved ejection fraction and obesity, treatment with semaglutide (2.4 mg) led to larger reductions in symptoms and physical limitations, greater improvements in exercise function, and greater weight loss than placebo. (Funded by Novo Nordisk; STEP-HFpEF ClinicalTrials.gov number, NCT04788511.)."},{"id":"9f7f40ff69ff","type":"article","url":"https://hartvaat.nl/2023/09/19/uspstf-evidence-review-screening-op-hypertensieve-zwangerschapsstoornissen/","title":"USPSTF evidence review: screening op hypertensieve zwangerschapsstoornissen","title_en":"Screening for Hypertensive Disorders of Pregnancy: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["bloeddrukbehandeling","primaire-preventie","summit-trial","zwangerschap-hart"],"journal":"JAMA","doi":"10.1001/jama.2023.4934","source_url":"https://doi.org/10.1001/jama.2023.4934","authors":["Jillian T Henderson","Elizabeth M Webber","Rachel G Thomas","Kimberly K Vesco"],"significance":6,"published":"2023-09-19","source_date":"2023-09-19","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/"],"congress":"","summary_en":"This USPSTF systematic review supported blood pressure screening throughout pregnancy as an effective method for detecting preeclampsia and related disorders, confirming the maternal and fetal benefits of early detection.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T18:39:06Z","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 ondersteunde bloeddrukscreening tijdens de zwangerschap als effectieve methode om pre-eclampsie en gerelateerde complicaties te detecteren. Vroege diagnose maakt tijdige interventie mogelijk.","abstract_original":"IMPORTANCE: Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality in the US. OBJECTIVE: To conduct a targeted systematic review to update the evidence on the effectiveness of screening for hypertensive disorders of pregnancy to inform the US Preventive Services Task Force. DATA SOURCES: MEDLINE and the Cochrane Central Register of Controlled Trials for relevant studies published between January 1, 2014, and January 4, 2022; surveillance through February 21, 2023. STUDY SELECTION: English-language comparative effectiveness studies comparing screening strategies in pregnant or postpartum individuals. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently appraised articles and extracted relevant data from fair-or good-quality studies; no quantitative synthesis was conducted. MAIN OUTCOMES AND MEASURES: Morbidity or mortality, measures of health-related quality of life. RESULTS: The review included 6 fair-quality studies (5 trials and 1 nonrandomized study; N = 10 165) comparing changes in prenatal screening practices with usual care, which was routine screening at in-person office visits. No studies addressed screening for new-onset hypertensive disorders of pregnancy in the postpartum period. One trial (n = 2521) evaluated home blood pressure measurement as a supplement to usual care; 3 trials (total n = 5203) evaluated reduced prenatal visit schedules. One study (n = 2441) evaluated proteinuria screening conducted only for specific clinical indications, compared with a historical control group that received routine proteinuria screening. One additional trial (n = 80) only addressed the comparative harms of home blood pressure measurement. The studies did not report statistically significant differences in maternal and infant complications with alternate strategies compared with usual care; however, estimates were imprecise for serious, rare health outcomes. Home blood pressure measurement added to prenatal care visits was not associated with earlier diagnosis of a hypertensive disorder of pregnancy (104.3 vs 106.2 days), and incidence was not different between groups in 3 trials of reduced prenatal visit schedules. No harms of the different screening strategies were identified. CONCLUSIONS AND RELEVANCE: This review did not identify evidence that any alternative screening strategies for hypertensive disorders of pregnancy were more effective than routine blood pressure measurement at in-person prenatal visits. Morbidity and mortality from hypertensive disorders of pregnancy can be prevented, yet American Indian/Alaska Native persons and Black persons experience inequitable rates of adverse outcomes. Further research is needed to identify screening approaches that may lead to improved disease detection and health outcomes."},{"id":"f118f4f1c7c8","type":"article","url":"https://hartvaat.nl/2023/09/19/uspstf-screening-op-hypertensieve-zwangerschapsstoornissen-aanbevolen/","title":"USPSTF: screening op hypertensieve zwangerschapsstoornissen aanbevolen","title_en":"Screening for Hypertensive Disorders of Pregnancy: US Preventive Services Task Force Final Recommendation Statement.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":["primaire-preventie","zwangerschap-hart"],"journal":"JAMA","doi":"10.1001/jama.2023.16991","source_url":"https://doi.org/10.1001/jama.2023.16991","authors":["Michael J Barry","Wanda K Nicholson","Michael Silverstein","Michael D Cabana","David Chelmow","Tumaini Rucker Coker","Esa M Davis","Katrina E Donahue","Carlos Roberto Jaén","Li Li","Gbenga Ogedegbe","Goutham Rao","John M Ruiz","James Stevermer","Joel Tsevat","Sandra Millon Underwood","John B Wong"],"significance":7,"published":"2023-09-19","source_date":"2023-09-19","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The USPSTF reaffirmed the recommendation to screen for hypertensive disorders at every prenatal visit, reflecting the rising incidence of preeclampsia and gestational hypertension as leading causes of maternal morbidity.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De USPSTF bevestigde de aanbeveling voor bloeddrukscreening bij elke prenatale controle om hypertensieve zwangerschapsstoornissen vroegtijdig te detecteren. Pre-eclampsie is een leidende oorzaak van maternale morbiditeit en sterfte.","abstract_original":"IMPORTANCE: Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality in the US. The rate of hypertensive disorders of pregnancy has been increasing from approximately 500 cases per 10 000 deliveries in 1993 to 1021 cases per 10 000 deliveries in 2016 to 2017. OBJECTIVE: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for hypertensive disorders of pregnancy. POPULATION: Pregnant persons without a known diagnosis of a hypertensive disorder of pregnancy or chronic hypertension. EVIDENCE ASSESSMENT: The USPSTF concludes with moderate certainty that screening for hypertensive disorders in pregnancy with blood pressure measurements has substantial net benefit. RECOMMENDATION: The USPSTF recommends screening for hypertensive disorders in pregnant persons with blood pressure measurements throughout pregnancy. (B recommendation)."},{"id":"5caeeba11844","type":"article","url":"https://hartvaat.nl/2023/09/19/fame-3-driejaarsresultaten-ffr-geleide-pci-versus-cabg-bij-drievatslijden/","title":"FAME 3 driejaarsresultaten: FFR-geleide PCI versus CABG bij drievatslijden","title_en":"Fractional Flow Reserve-Guided PCI or Coronary Bypass Surgery for 3-Vessel Coronary Artery Disease: 3-Year Follow-Up of the FAME 3 Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.065770","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.065770","authors":["Frederik M Zimmermann","Victoria Y Ding","Nico H J Pijls","Zsolt Piroth","Albert H M van Straten","Laszlo Szekely","Giedrius Davidavicius","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 Angeras","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","Hisao Otsuki","Yuhei Kobayashi","Mark A Hlatky","Kenneth W Mahaffey","Manisha Desai","Y Joseph Woo","Alan C Yeung","Bernard De Bruyne","William F Fearon"],"significance":8,"published":"2023-09-19","source_date":"2023-09-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-vs-cabg-afweging/","https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"Three-year FAME 3 follow-up confirmed that FFR-guided PCI did not achieve noninferiority versus CABG for three-vessel coronary disease, with CABG maintaining lower rates of revascularization and MI. The extended data reinforced CABG as the standard for complex multivessel disease.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Driejaarsdata van FAME 3 bevestigden dat FFR-geleide PCI niet non-inferieur was aan CABG bij drievatslijden. CABG bleef superieur wat betreft CV-events, consistent met richtlijnaanbevelingen voor chirurgie bij complexe coronaire anatomie.","abstract_original":"BACKGROUND: Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary disease not involving the left main have shown significantly lower rates of death, myocardial infarction (MI), or stroke after CABG. These studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI. METHODS: FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) is an investigator-initiated, multicenter, international, randomized trial involving patients with 3-vessel coronary artery disease (not involving the left main coronary artery) in 48 centers worldwide. Patients were randomly assigned to receive FFR-guided PCI using zotarolimus drug-eluting stents or CABG. The prespecified key secondary end point of the trial reported here is the 3-year incidence of the composite of death, MI, or stroke. RESULTS: A total of 1500 patients were randomized to FFR-guided PCI or CABG. Follow-up was achieved in >96% of patients in both groups. There was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI compared with CABG (12.0% versus 9.2%; hazard ratio [HR], 1.3 [95% CI, 0.98-1.83]; P=0.07). The rates of death (4.1% versus 3.9%; HR, 1.0 [95% CI, 0.6-1.7]; P=0.88) and stroke (1.6% versus 2.0%; HR, 0.8 [95% CI, 0.4-1.7]; P=0.56) were not different. MI occurred more frequently after PCI (7.0% versus 4.2%; HR, 1.7 [95% CI, 1.1-2.7]; P=0.02). CONCLUSIONS: At 3-year follow-up, there was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI with current-generation drug-eluting stents compared with CABG. There was a higher incidence of MI after PCI compared with CABG, with no difference in death or stroke. These results provide contemporary data to allow improved shared decision-making between physicians and patients with 3-vessel coronary artery disease. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02100722."},{"id":"089807296c9d","type":"article","url":"https://hartvaat.nl/2023/09/19/ischemia-impact-van-complete-revascularisatie-op-uitkomsten/","title":"ISCHEMIA: impact van complete revascularisatie op uitkomsten","title_en":"Impact of Complete Revascularization in the ISCHEMIA Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.06.015","source_url":"https://doi.org/10.1016/j.jacc.2023.06.015","authors":["Gregg W Stone","Ziad A Ali","Sean M O'Brien","Grace Rhodes","Philippe Genereux","Sripal Bangalore","Kreton Mavromatis","Jennifer Horst","Ovidiu Dressler","Kian Keong Poh","Ranjit K Nath","Nagaraja Moorthy","Adam Witkowski","Sudhanshu K Dwivedi","Olga Bockeria","Jiyan Chen","Paola E P Smanio","Michael H Picard","Bernard R Chaitman","Daniel S Berman","Leslee J Shaw","William E Boden","Harvey D White","Stephen E Fremes","Yves Rosenberg","Harmony R Reynolds","John A Spertus","Judith S Hochman","David J Maron"],"significance":7,"published":"2023-09-19","source_date":"2023-09-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/","https://hartvaat.nl/kennis/vasculair/kritieke-ischemie-been/"],"congress":"","summary_en":"This ISCHEMIA subanalysis showed that among patients randomized to invasive management, achieving complete revascularization improved long-term outcomes compared with incomplete revascularization, supporting thorough intervention when an invasive approach is chosen.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van ISCHEMIA toonde dat complete revascularisatie bij stabiel coronairlijden de uitkomsten verbeterde vergeleken met incomplete revascularisatie. Het voordeel was het grootst bij uitgebreidere ziekte, wat de waarde van volledige behandeling ondersteunt.","abstract_original":"BACKGROUND: Anatomic complete revascularization (ACR) and functional complete revascularization (FCR) have been associated with reduced death and myocardial infarction (MI) in some prior studies. The impact of complete revascularization (CR) in patients undergoing an invasive (INV) compared with a conservative (CON) management strategy has not been reported. OBJECTIVES: Among patients with chronic coronary disease without prior coronary artery bypass grafting randomized to INV vs CON management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, we examined the following: 1) the outcomes of ACR and FCR compared with incomplete revascularization; and 2) the potential impact of achieving CR in all INV patients compared with CON management. METHODS: ACR and FCR in the INV group were assessed at an independent core laboratory. Multivariable-adjusted outcomes of CR were examined in INV patients. Inverse probability weighted modeling was then performed to estimate the treatment effect had CR been achieved in all INV patients compared with CON management. RESULTS: ACR and FCR were achieved in 43.4% and 58.4% of 1,824 INV patients. ACR was associated with reduced 4-year rates of cardiovascular death or MI compared with incomplete revascularization. By inverse probability weighted modeling, ACR in all 2,296 INV patients compared with 2,498 CON patients was associated with a lower 4-year rate of cardiovascular death or MI (difference -3.5; 95% CI: -7.2% to 0.0%). In comparison, the event rate difference of cardiovascular death or MI for INV minus CON in the overall ISCHEMIA trial was -2.4%. Results were similar but less pronounced with FCR. CONCLUSIONS: The outcomes of an INV strategy may be improved if CR (especially ACR) is achieved. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)."},{"id":"1f0932779c5c","type":"article","url":"https://hartvaat.nl/2023/09/14/heart-fid-iv-ferricarboxymaltose-bij-hartfalen-met-ijzerdeficientie-nejm/","title":"HEART-FID: IV ferricarboxymaltose bij hartfalen met ijzerdeficiëntie — NEJM","title_en":"Ferric Carboxymaltose in Heart Failure with Iron Deficiency.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","dapa-hf","iaso-dcm","ijzersuppletie","ijzertekort","step-hfpef"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2304968","source_url":"https://doi.org/10.1056/NEJMoa2304968","authors":["Robert J Mentz","Jyotsna Garg","Frank W Rockhold","Javed Butler","Carmine G De Pasquale","Justin A Ezekowitz","Gregory D Lewis","Eileen O'Meara","Piotr Ponikowski","Richard W Troughton","Yee Weng Wong","Lilin She","Josephine Harrington","Robert Adamczyk","Nicole Blackman","Adrian F Hernandez"],"significance":9,"published":"2023-09-14","source_date":"2023-09-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The HEART-FID trial showed that intravenous ferric carboxymaltose in patients with HFrEF and iron deficiency did not significantly improve the hierarchical composite of death, heart failure hospitalization, and 6-minute walk distance. The neutral result contrasted with positive findings from AFFIRM-AHF and IRONMAN.","created":"2026-07-03T10:30:34Z","updated":"2026-07-03T18:39:06Z","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 HEART-FID-trial in de NEJM toonde dat IV ferricarboxymaltose bij HFrEF met ijzerdeficiëntie het gecombineerde primaire eindpunt (sterfte, HF-hospitalisatie, 6-minutenlooptest) net niet significant verbeterde. De individuele componenten toonden gunstige trends.","abstract_original":"BACKGROUND: Ferric carboxymaltose therapy reduces symptoms and improves quality of life in patients who have heart failure with a reduced ejection fraction and iron deficiency. Additional evidence about the effects of ferric carboxymaltose on clinical events is needed. METHODS: In this double-blind, randomized trial, we assigned ambulatory patients with heart failure, a left ventricular ejection fraction of 40% or less, and iron deficiency, in a 1:1 ratio, to receive intravenous ferric carboxymaltose or placebo, in addition to standard therapy for heart failure. Ferric carboxymaltose or placebo was given every 6 months as needed on the basis of iron indexes and hemoglobin levels. The primary outcome was a hierarchical composite of death within 12 months after randomization, hospitalizations for heart failure within 12 months after randomization, or change from baseline to 6 months in the 6-minute walk distance. The significance level was set at 0.01. RESULTS: We enrolled 3065 patients, of whom 1532 were randomly assigned to the ferric carboxymaltose group and 1533 to the placebo group. Death by month 12 occurred in 131 patients (8.6%) in the ferric carboxymaltose group and 158 (10.3%) in the placebo group; a total of 297 and 332 hospitalizations for heart failure, respectively, occurred by month 12; and the mean (±SD) change from baseline to 6 months in the 6-minute walk distance was 8±60 and 4±59 m, respectively (Wilcoxon-Mann-Whitney P = 0.02; unmatched win ratio, 1.10; 99% confidence interval, 0.99 to 1.23). Repeated dosing of ferric carboxymaltose appeared to be safe with an acceptable adverse-event profile in the majority of patients. The number of patients with serious adverse events occurring during the treatment period was similar in the two groups (413 patients [27.0%] in the ferric carboxymaltose group and 401 [26.2%] in the placebo group). CONCLUSIONS: Among ambulatory patients who had heart failure with a reduced ejection fraction and iron deficiency, there was no apparent difference between ferric carboxymaltose and placebo with respect to the hierarchical composite of death, hospitalizations for heart failure, or 6-minute walk distance. (Funded by American Regent, a Daiichi Sankyo Group company; HEART-FID ClinicalTrials.gov number, NCT03037931.)."},{"id":"781180027215","type":"article","url":"https://hartvaat.nl/2023/09/13/prognostische-modellen-voor-hartfalen-bij-type-2-diabetes-systematische-review/","title":"Prognostische modellen voor hartfalen bij type 2 diabetes: systematische review","title_en":"Prognostic models for heart failure in patients with type 2 diabetes: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","diabetes-en-hart","diabetes-type-1","diabetes-type-2","nt-probnp","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-322044","source_url":"https://doi.org/10.1136/heartjnl-2022-322044","authors":["Georgios Kostopoulos","Ioannis Doundoulakis","Konstantinos A Toulis","Thomas Karagiannis","Apostolos Tsapas","Anna-Bettina Haidich"],"significance":5,"published":"2023-09-13","source_date":"2023-09-13","image":"","kennis":[],"congress":"","summary_en":"This systematic review evaluated prognostic models for heart failure in type 2 diabetes, finding that most models have limited discrimination and need validation in diverse diabetic populations.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review identificeerde en evalueerde prognostische modellen voor hartfalen bij diabetes. De meeste modellen hadden beperkte externe validatie en discriminatie, wat de behoefte aan betere diabetesspecifieke HF-risicomodellen benadrukt.","abstract_original":"OBJECTIVE: To provide a systematic review, critical appraisal, assessment of performance and generalisability of all the reported prognostic models for heart failure (HF) in patients with type 2 diabetes (T2D). METHODS: We performed a literature search in Medline, Embase, Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus (from inception to July 2022) and grey literature to identify any study developing and/or validating models predicting HF applicable to patients with T2D. We extracted data on study characteristics, modelling methods and measures of performance, and we performed a random-effects meta-analysis to pool discrimination in models with multiple validation studies. We also performed a descriptive synthesis of calibration and we assessed the risk of bias and certainty of evidence (high, moderate, low). RESULTS: Fifty-five studies reporting on 58 models were identified: (1) models developed in patients with T2D for HF prediction (n=43), (2) models predicting HF developed in non-diabetic cohorts and externally validated in patients with T2D (n=3), and (3) models originally predicting a different outcome and externally validated for HF (n=12). RECODe (C-statistic=0.75 95% CI (0.72, 0.78), 95% prediction interval (PI) (0.68, 0.81); high certainty), TRS-HFDM (C-statistic=0.75 95% CI (0.69, 0.81), 95% PI (0.58, 0.87); low certainty) and WATCH-DM (C-statistic=0.70 95% CI (0.67, 0.73), 95% PI (0.63, 0.76); moderate certainty) showed the best performance. QDiabetes-HF demonstrated also good discrimination but was externally validated only once and not meta-analysed. CONCLUSIONS: Among the prognostic models identified, four models showed promising performance and, thus, could be implemented in current clinical practice."},{"id":"39607af33d58","type":"article","url":"https://hartvaat.nl/2023/09/12/af-ablatie-vermindert-psychologische-distress-jama-rct/","title":"AF-ablatie vermindert psychologische distress: JAMA RCT","title_en":"Atrial Fibrillation Catheter Ablation vs Medical Therapy and Psychological Distress: A Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["stress-psychosociaal"],"journal":"JAMA","doi":"10.1001/jama.2023.14685","source_url":"https://doi.org/10.1001/jama.2023.14685","authors":["Ahmed M Al-Kaisey","Ramanathan Parameswaran","Christina Bryant","Robert D Anderson","Joshua Hawson","David Chieng","Louise Segan","Aleksandr Voskoboinik","Hariharan Sugumar","Geoffrey R Wong","Sue Finch","Stephen A Joseph","Alex McLellan","Liang-Han Ling","Joseph Morton","Paul Sparks","Prashanthan Sanders","Geoffrey Lee","Peter M Kistler","Jonathan M Kalman"],"significance":7,"published":"2023-09-12","source_date":"2023-09-12","image":"","kennis":[],"congress":"","summary_en":"This JAMA trial demonstrated that AF catheter ablation significantly reduces psychological distress, including anxiety and depression, compared with medical therapy, establishing the mental health co-benefit of successful rhythm control.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-trial toonde dat AF-ablatie niet alleen de aritmielast vermindert maar ook angst en depressie significant verbetert vergeleken met medicamenteuze therapie. De mentale gezondheidsvoordelen ondersteunen ablatie als holistische AF-behandeling.","abstract_original":"IMPORTANCE: The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood. OBJECTIVE: To determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone. DESIGN, SETTING, AND PARTICIPANTS: The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was a randomized trial of symptomatic participants conducted in 2 AF centers in Australia between June 2018 and March 2021. INTERVENTIONS: Participants were randomized to receive AF catheter ablation (n = 52) or medical therapy (n = 48). MAIN OUTCOMES AND MEASURES: The primary outcome was Hospital Anxiety and Depression Scale (HADS) score at 12 months. Secondary outcomes included follow-up assessments of prevalence of severe psychological distress (HADS score >15), anxiety HADS score, depression HADS score, and Beck Depression Inventory-II (BDI-II) score. Arrhythmia recurrence and AF burden data were also analyzed. RESULTS: A total of 100 participants were randomized (mean age, 59 [12] years; 31 [32%] women; 54% with paroxysmal AF). Successful pulmonary vein isolation was achieved in all participants in the ablation group. The combined HADS score was lower in the ablation group vs the medical group at 6 months (8.2 [5.4] vs 11.9 [7.2]; P = .006) and at 12 months (7.6 [5.3] vs 11.8 [8.6]; between-group difference, -4.17 [95% CI, -7.04 to -1.31]; P = .005). Similarly, the prevalence of severe psychological distress was lower in the ablation group vs the medical therapy group at 6 months (14.2% vs 34%; P = .02) and at 12 months (10.2% vs 31.9%; P = .01), as was the anxiety HADS score at 6 months (4.7 [3.2] vs 6.4 [3.9]; P = .02) and 12 months (4.5 [3.3] vs 6.6 [4.8]; P = .02); the depression HADS score at 3 months (3.7 [2.6] vs 5.2 [4.0]; P = .047), 6 months (3.4 [2.7] vs 5.5 [3.9]; P = .004), and 12 months (3.1 [2.6] vs 5.2 [3.9]; P = .004); and the BDI-II score at 6 months (7.2 [6.1] vs 11.5 [9.0]; P = .01) and 12 months (6.6 [7.2] vs 10.9 [8.2]; P = .01). The median (IQR) AF burden in the ablation group was lower than in the medical therapy group (0% [0%-3.22%] vs 15.5% [1.0%-45.9%]; P < .001). CONCLUSION AND RELEVANCE: In this trial of participants with symptomatic AF, improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy. TRIAL REGISTRATION: ANZCTR Identifier: ACTRN12618000062224."},{"id":"066d6106b4c2","type":"article","url":"https://hartvaat.nl/2023/09/07/fire-complete-revascularisatie-bij-ouderen-75-jaar-met-mi-nejm/","title":"FIRE: complete revascularisatie bij ouderen ≥75 jaar met MI — NEJM","title_en":"Complete or Culprit-Only PCI in Older Patients with Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2300468","source_url":"https://doi.org/10.1056/NEJMoa2300468","authors":["Simone Biscaglia","Vincenzo Guiducci","Javier Escaned","Raul Moreno","Valerio Lanzilotti","Andrea Santarelli","Enrico Cerrato","Giorgio Sacchetta","Alfonso Jurado-Roman","Alberto Menozzi","Ignacio Amat Santos","José Luis Díez Gil","Marco Ruozzi","Marco Barbierato","Luca Fileti","Andrea Picchi","Veronica Lodolini","Giuseppe Biondi-Zoccai","Elisa Maietti","Rita Pavasini","Paolo Cimaglia","Carlo Tumscitz","Andrea Erriquez","Carlo Penzo","Iginio Colaiori","Gianluca Pignatelli","Gianni Casella","Gianmarco Iannopollo","Mila Menozzi","Ferdinando Varbella","Giorgio Caretta","Dariusz Dudek","Emanuele Barbato","Matteo Tebaldi","Gianluca Campo"],"significance":9,"published":"2023-09-07","source_date":"2023-09-07","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The FIRE trial demonstrated that complete revascularization reduced cardiovascular death or MI compared with culprit-only PCI in patients aged 75 or older with MI and multivessel disease. The results extended the benefit of complete revascularization to the elderly population previously excluded from major trials.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De FIRE-trial in de NEJM toonde dat complete revascularisatie ook bij ouderen ≥75 jaar met MI en meervatslijden superieur was aan alleen culprit-PCI. CV-events en mortaliteit daalden significant. Dit beëindigt de onzekerheid over complete revascularisatie bij ouderen.","abstract_original":"BACKGROUND: The benefit of complete revascularization in older patients (≥75 years of age) with myocardial infarction and multivessel disease remains unclear. METHODS: In this multicenter, randomized trial, we assigned older patients with myocardial infarction and multivessel disease who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either physiology-guided complete revascularization of nonculprit lesions or to receive no further revascularization. Functionally significant nonculprit lesions were identified either by pressure wire or angiography. The primary outcome was a composite of death, myocardial infarction, stroke, or any revascularization at 1 year. The key secondary outcome was a composite of cardiovascular death or myocardial infarction. Safety was assessed as a composite of contrast-associated acute kidney injury, stroke, or bleeding. RESULTS: A total of 1445 patients underwent randomization (720 to receive complete revascularization and 725 to receive culprit-only revascularization). The median age of the patients was 80 years (interquartile range, 77 to 84); 528 patients (36.5%) were women, and 509 (35.2%) were admitted for ST-segment elevation myocardial infarction. A primary-outcome event occurred in 113 patients (15.7%) in the complete-revascularization group and in 152 patients (21.0%) in the culprit-only group (hazard ratio, 0.73; 95% confidence interval [CI], 0.57 to 0.93; P = 0.01). Cardiovascular death or myocardial infarction occurred in 64 patients (8.9%) in the complete-revascularization group and in 98 patients (13.5%) in the culprit-only group (hazard ratio, 0.64; 95% CI, 0.47 to 0.88). The safety outcome did not appear to differ between the groups (22.5% vs. 20.4%; P = 0.37). CONCLUSIONS: Among patients who were 75 years of age or older with myocardial infarction and multivessel disease, those who underwent physiology-guided complete revascularization had a lower risk of a composite of death, myocardial infarction, stroke, or ischemia-driven revascularization at 1 year than those who received culprit-lesion-only PCI. (Funded by Consorzio Futuro in Ricerca and others; FIRE ClinicalTrials.gov number, NCT03772743.)."},{"id":"dc0ac291aa0a","type":"article","url":"https://hartvaat.nl/2023/09/07/orforglipron-dagelijkse-orale-glp-1-agonist-bij-obesitas-nejm/","title":"Orforglipron: dagelijkse orale GLP-1-agonist bij obesitas — NEJM","title_en":"Daily Oral GLP-1 Receptor Agonist Orforglipron for Adults with Obesity.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","orforglipron","select-trial","semaglutide","soul-trial","tirzepatide"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2302392","source_url":"https://doi.org/10.1056/NEJMoa2302392","authors":["Sean Wharton","Thomas Blevins","Lisa Connery","Julio Rosenstock","Sohini Raha","Rong Liu","Xiaosu Ma","Kieren J Mather","Axel Haupt","Deborah Robins","Edward Pratt","Christof Kazda","Manige Konig"],"significance":9,"published":"2023-09-07","source_date":"2023-09-07","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This NEJM phase 2 trial demonstrated that orforglipron, an oral nonpeptide GLP-1 receptor agonist, produced dose-dependent weight loss of up to 14.7% in adults with obesity. The results positioned oral GLP-1 therapy as a practical alternative to injectable formulations for obesity treatment.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM fase 2 trial van orforglipron, een orale GLP-1-agonist, toonde dosisafhankelijk gewichtsverlies tot 14,7% bij obesitas zonder diabetes. Een effectieve orale GLP-1-agonist zou de toegankelijkheid van obesitasbehandeling revolutionair verbeteren.","abstract_original":"BACKGROUND: Obesity is a major risk factor for many leading causes of illness and death worldwide. Data are needed regarding the efficacy and safety of the nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist orforglipron as a once-daily oral therapy for weight reduction in adults with obesity. METHODS: In this phase 2, randomized, double-blind trial, we enrolled adults with obesity, or with overweight plus at least one weight-related coexisting condition, and without diabetes. Participants were randomly assigned to receive orforglipron at one of four doses (12, 24, 36, or 45 mg) or placebo once daily for 36 weeks. The percentage change from baseline in body weight was assessed at week 26 (primary end point) and at week 36 (secondary end point). RESULTS: A total of 272 participants underwent randomization. At baseline, the mean body weight was 108.7 kg, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 37.9. At week 26, the mean change from baseline in body weight ranged from -8.6% to -12.6% across the orforglipron dose cohorts and was -2.0% in the placebo group. At week 36, the mean change ranged from -9.4% to -14.7% with orforglipron and was -2.3% with placebo. A weight reduction of at least 10% by week 36 occurred in 46 to 75% of the participants who received orforglipron, as compared with 9% who received placebo. The use of orforglipron led to improvement in all prespecified weight-related and cardiometabolic measures. The most common adverse events reported with orforglipron were gastrointestinal events, which were mild to moderate, occurred primarily during dose escalation, and led to discontinuation of orforglipron in 10 to 17% of participants across dose cohorts. The safety profile of orforglipron was consistent with that of the GLP-1 receptor agonist class. CONCLUSIONS: Daily oral orforglipron, a nonpeptide GLP-1 receptor agonist, was associated with weight reduction. Adverse events reported with orforglipron were similar to those with injectable GLP-1 receptor agonists. (Funded by Eli Lilly; GZGI ClinicalTrials.gov number, NCT05051579.)."},{"id":"36fab078c8fe","type":"article","url":"https://hartvaat.nl/2023/09/05/best-ii-bloeddrukmanagement-na-trombectomie-bij-cva-jama/","title":"BEST-II: bloeddrukmanagement na trombectomie bij CVA — JAMA","title_en":"Blood Pressure Management After Endovascular Therapy for Acute Ischemic Stroke: The BEST-II Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"JAMA","doi":"10.1001/jama.2023.14330","source_url":"https://doi.org/10.1001/jama.2023.14330","authors":["Eva A Mistry","Kimberly W Hart","Larry T Davis","Yue Gao","Charles J Prestigiacomo","Shilpi Mittal","Tapan Mehta","Hayden LaFever","Pablo Harker","Hilary E Wilson-Perez","Kalli A Beasley","Neeharika Krothapalli","Emily Lippincott","Heather Stefek","Michael Froehler","Rohan Chitale","Matthew Fusco","Aaron Grossman","Peyman Shirani","Matthew Smith","Matthew N Jaffa","Sharon D Yeatts","Gregory W Albers","Jonathan P Wanderer","Juliana Tolles","Christopher J Lindsell","Roger J Lewis","Gordon R Bernard","Pooja Khatri"],"significance":7,"published":"2023-09-05","source_date":"2023-09-05","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"The BEST-II trial showed that moderate blood pressure lowering (SBP <140 mmHg) was superior to intensive (SBP <120 mmHg) after successful endovascular thrombectomy, with better functional outcomes at the moderate target.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De BEST-II trial in JAMA vergeleek matige met intensieve bloeddrukverlaging na trombectomie. Matige verlaging (SBP <140 mmHg) was even veilig als intensief (<120 mmHg). Dit vormt met OPTIMAL-BP en ENCHANTED2/MT een consistent bewijs tegen overagressieve verlaging.","abstract_original":"IMPORTANCE: The effects of moderate systolic blood pressure (SBP) lowering after successful recanalization with endovascular therapy for acute ischemic stroke are uncertain. OBJECTIVE: To determine the futility of lower SBP targets after endovascular therapy (<140 mm Hg or 160 mm Hg) compared with a higher target (≤180 mm Hg). DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label, blinded end point, phase 2, futility clinical trial that enrolled 120 patients with acute ischemic stroke who had undergone successful endovascular therapy at 3 US comprehensive stroke centers from January 2020 to March 2022 (final follow-up, June 2022). INTERVENTION: After undergoing endovascular therapy, participants were randomized to 1 of 3 SBP targets: 40 to less than 140 mm Hg, 40 to less than 160 mm Hg, and 40 to 180 mm Hg or less (guideline recommended) group, initiated within 60 minutes of recanalization and maintained for 24 hours. MAIN OUTCOMES AND MEASURES: Prespecified multiple primary outcomes for the primary futility analysis were follow-up infarct volume measured at 36 (±12) hours and utility-weighted modified Rankin Scale (mRS) score (range, 0 [worst] to 1 [best]) at 90 (±14) days. Linear regression models were used to test the harm-futility boundaries of a 10-mL increase (slope of 0.5) in the follow-up infarct volume or a 0.10 decrease (slope of -0.005) in the utility-weighted mRS score with each 20-mm Hg SBP target reduction after endovascular therapy (1-sided α = .05). Additional prespecified futility criterion was a less than 25% predicted probability of success for a future 2-group, superiority trial comparing SBP targets of the low- and mid-thresholds with the high-threshold (maximum sample size, 1500 with respect to the utility-weighted mRS score outcome). RESULTS: Among 120 patients randomized (mean [SD] age, 69.6 [14.5] years; 69 females [58%]), 113 (94.2%) completed the trial. The mean follow-up infarct volume was 32.4 mL (95% CI, 18.0 to 46.7 mL) for the less than 140-mm Hg group, 50.7 mL (95% CI, 33.7 to 67.7 mL), for the less than 160-mm Hg group, and 46.4 mL (95% CI, 24.5 to 68.2 mL) for the 180-mm Hg or less group. The mean utility-weighted mRS score was 0.51 (95% CI, 0.38 to 0.63) for the less than 140-mm Hg group, 0.47 (95% CI, 0.35 to 0.60) for the less than 160-mm Hg group, and 0.58 (95% CI, 0.46 to 0.71) for the high-target group. The slope of the follow-up infarct volume for each mm Hg decrease in the SBP target, adjusted for the baseline Alberta Stroke Program Early CT score, was -0.29 (95% CI, -0.81 to ∞; futility P = .99). The slope of the utility-weighted mRS score for each mm Hg decrease in the SBP target after endovascular therapy, adjusted for baseline utility-weighted mRS score, was -0.0019 (95% CI, -∞ to 0.0017; futility P = .93). Comparing the high-target SBP group with the lower-target groups, the predicted probability of success for a future trial was 25% for the less than 140-mm Hg group and 14% for the 160-mm Hg group. CONCLUSIONS AND RELEVANCE: Among patients with acute ischemic stroke, lower SBP targets less than either 140 mm Hg or 160 mm Hg after successful endovascular therapy did not meet prespecified criteria for futility compared with an SBP target of 180 mm Hg or less. However, the findings suggested a low probability of benefit from lower SBP targets after endovascular therapy if tested in a future larger trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04116112."},{"id":"c672f9418660","type":"article","url":"https://hartvaat.nl/2023/09/05/optimal-bp-intensieve-bloeddrukverlaging-na-trombectomie-bij-cva-jama/","title":"OPTIMAL-BP: intensieve bloeddrukverlaging na trombectomie bij CVA — JAMA","title_en":"Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke: The OPTIMAL-BP Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"JAMA","doi":"10.1001/jama.2023.14590","source_url":"https://doi.org/10.1001/jama.2023.14590","authors":["Hyo Suk Nam","Young Dae Kim","JoonNyung Heo","Hyungwoo Lee","Jae Wook Jung","Jin Kyo Choi","Il Hyung Lee","In Hwan Lim","Soon-Ho Hong","Minyoul Baik","Byung Moon Kim","Dong Joon Kim","Na-Young Shin","Bang-Hoon Cho","Seong Hwan Ahn","Hyungjong Park","Sung-Il Sohn","Jeong-Ho Hong","Tae-Jin Song","Yoonkyung Chang","Gyu Sik Kim","Kwon-Duk Seo","Kijeong Lee","Jun Young Chang","Jung Hwa Seo","Sukyoon Lee","Jang-Hyun Baek","Han-Jin Cho","Dong Hoon Shin","Jinkwon Kim","Joonsang Yoo","Kyung-Yul Lee","Yo Han Jung","Yang-Ha Hwang","Chi Kyung Kim","Jae Guk Kim","Chan Joo Lee","Sungha Park","Hye Sun Lee","Sun U Kwon","Oh Young Bang","Craig S Anderson","Ji Hoe Heo"],"significance":7,"published":"2023-09-05","source_date":"2023-09-05","image":"","kennis":[],"congress":"","summary_en":"The OPTIMAL-BP trial found no significant difference between intensive and conventional blood pressure lowering after endovascular thrombectomy for acute ischemic stroke, consistent with ENCHANTED2/MT results arguing against very aggressive post-procedure BP reduction.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De OPTIMAL-BP trial in JAMA vergeleek intensieve met conventionele bloeddrukverlaging na trombectomie bij ischemisch CVA. Er was geen verschil in functionele uitkomst. Samen met ENCHANTED2/MT en BEST-II bevestigt dit dat agressieve verlaging niet zinvol is.","abstract_original":"IMPORTANCE: Optimal blood pressure (BP) control after successful reperfusion with endovascular thrombectomy (EVT) for patients with acute ischemic stroke is unclear. OBJECTIVE: To determine whether intensive BP management during the first 24 hours after successful reperfusion leads to better clinical outcomes than conventional BP management in patients who underwent EVT. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized, open-label trial with a blinded end-point evaluation, conducted across 19 stroke centers in South Korea from June 2020 to November 2022 (final follow-up, March 8, 2023). It included 306 patients with large vessel occlusion acute ischemic stroke treated with EVT and with a modified Thrombolysis in Cerebral Infarction score of 2b or greater (partial or complete reperfusion). INTERVENTIONS: Participants were randomly assigned to receive intensive BP management (systolic BP target <140 mm Hg; n = 155) or conventional management (systolic BP target 140-180 mm Hg; n = 150) for 24 hours after enrollment. MAIN OUTCOMES AND MEASURES: The primary outcome was functional independence at 3 months (modified Rankin Scale score of 0-2). The primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and death related to the index stroke within 3 months. RESULTS: The trial was terminated early based on the recommendation of the data and safety monitoring board, which noted safety concerns. Among 306 randomized patients, 305 were confirmed eligible and 302 (99.0%) completed the trial (mean age, 73.0 years; 122 women [40.4%]). The intensive management group had a lower proportion achieving functional independence (39.4%) than the conventional management group (54.4%), with a significant risk difference (-15.1% [95% CI, -26.2% to -3.9%]) and adjusted odds ratio (0.56 [95% CI, 0.33-0.96]; P = .03). Rates of symptomatic intracerebral hemorrhage were 9.0% in the intensive group and 8.1% in the conventional group (risk difference, 1.0% [95% CI, -5.3% to 7.3%]; adjusted odds ratio, 1.10 [95% CI, 0.48-2.53]; P = .82). Death related to the index stroke within 3 months occurred in 7.7% of the intensive group and 5.4% of the conventional group (risk difference, 2.3% [95% CI, -3.3% to 7.9%]; adjusted odds ratio, 1.73 [95% CI, 0.61-4.92]; P = .31). CONCLUSIONS AND RELEVANCE: Among patients who achieved successful reperfusion with EVT for acute ischemic stroke with large vessel occlusion, intensive BP management for 24 hours led to a lower likelihood of functional independence at 3 months compared with conventional BP management. These results suggest that intensive BP management should be avoided after successful EVT in acute ischemic stroke. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04205305."},{"id":"8d6d51b8bcad","type":"article","url":"https://hartvaat.nl/2023/09/05/cameo-dapa-cardiale-en-metabole-effecten-van-dapagliflozine-bij-hfpef/","title":"CAMEO-DAPA: cardiale en metabole effecten van dapagliflozine bij HFpEF","title_en":"Cardiac and Metabolic Effects of Dapagliflozin in Heart Failure With Preserved Ejection Fraction: The CAMEO-DAPA Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.065134","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.065134","authors":["Barry A Borlaug","Yogesh N V Reddy","Amanda Braun","Hidemi Sorimachi","Massar Omar","Dejana Popovic","Alessio Alogna","Michael D Jensen","Rickey Carter"],"significance":6,"published":"2023-09-05","source_date":"2023-09-05","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The CAMEO-DAPA trial showed that dapagliflozin improves cardiac efficiency and metabolic parameters in HFpEF, advancing the mechanistic understanding of SGLT2 inhibitor benefit in preserved ejection fraction heart failure.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CAMEO-DAPA trial onderzocht de cardiale en metabole effecten van dapagliflozine bij HFpEF. Het middel verbeterde de cardiale efficiëntie en metabole parameters, maar de LV-functie bleef onveranderd. De voordelen zijn voornamelijk systemisch.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter-2 inhibitors reduce risk of hospitalization for heart failure in patients who have heart failure with preserved ejection fraction (HFpEF), but the hemodynamic mechanisms underlying these benefits remain unclear. This study sought to determine whether treatment with dapagliflozin affects pulmonary capillary wedge pressure (PCWP) at rest and during exercise in patients with HFpEF. METHODS: This was a single-center, double-blinded, randomized, placebo-controlled trial testing the effects of 10 mg of dapagliflozin once daily in patients with HFpEF. Patients with New York Heart Association class II or III heart failure, ejection fraction ≥50%, and elevated PCWP during exercise were recruited. Cardiac hemodynamics were measured at rest and during exercise using high-fidelity micromanometers at baseline and after 24 weeks of treatment. The primary end point was a change from baseline in rest and peak exercise PCWPs that incorporated both measurements, and was compared using a mixed-model likelihood ratio test. Key secondary end points included body weight and directly measured blood and plasma volumes. Expired gas analysis was performed evaluate oxygen transport in tandem with arterial lactate sampling. RESULTS: Among 38 patients completing baseline assessments (median age 68 years; 66% women; 71% obese), 37 completed the trial. Treatment with dapagliflozin resulted in reduction in the primary end point of change in PCWP at rest and during exercise at 24 weeks relative to treatment with placebo (likelihood ratio test for overall changes in PCWP; P<0.001), with lower PCWP at rest (estimated treatment difference [ETD], -3.5 mm Hg [95% CI, -6.6 to -0.4]; P=0.029) and maximal exercise (ETD, -5.7 mm Hg [95% CI, -10.8 to -0.7]; P=0.027). Body weight was reduced with dapagliflozin (ETD, -3.5 kg [95% CI, -5.9 to -1.1]; P=0.006), as was plasma volume (ETD, -285 mL [95% CI, -510 to -60]; P=0.014), but there was no significant effect on red blood cell volume. There were no differences in oxygen consumption at 20-W or peak exercise, but dapagliflozin decreased arterial lactate at 20 W (-0.70 ± 0.77 versus 0.37 ± 1.29 mM; P=0.006). CONCLUSIONS: In patients with HFpEF, treatment with dapagliflozin reduces resting and exercise PCWP, along with the favorable effects on plasma volume and body weight. These findings provide new insight into the hemodynamic mechanisms of benefit with sodium-glucose cotransporter-2 inhibitors in HFpEF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04730947."},{"id":"85630fd7f53b","type":"article","url":"https://hartvaat.nl/2023/09/01/matige-statine-plus-ezetimibe-bij-zeer-hoog-ascvd-risico-non-inferioriteitstudie/","title":"Matige statine plus ezetimibe bij zeer hoog ASCVD-risico: non-inferioriteitstudie","title_en":"Moderate-Intensity Statin With Ezetimibe Combination Therapy vs High-Intensity Statin Monotherapy in Patients at Very High Risk of Atherosclerotic Cardiovascular Disease: A Post Hoc Analysis From the RACING Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","niet-statine-therapie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.2222","source_url":"https://doi.org/10.1001/jamacardio.2023.2222","authors":["Seung-Jun Lee","Jung-Joon Cha","Woong Gil Choi","Wang-Soo Lee","Jin-Ok Jeong","Seonghoon Choi","Yoon-Haeng Cho","Woojung Park","Chang-Hwan Yoon","Yong-Joon Lee","Sung-Jin Hong","Chul-Min Ahn","Byeong-Keuk Kim","Young-Guk Ko","Donghoon Choi","Myeong-Ki Hong","Yangsoo Jang","Soon Jun Hong","Jung-Sun Kim"],"significance":7,"published":"2023-09-01","source_date":"2023-09-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This study confirmed that moderate-intensity statin with ezetimibe is noninferior to high-intensity statin in patients at very high cardiovascular risk, extending the combination therapy evidence to the highest-risk population.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie bevestigde dat matige-intensiteit statine met ezetimibe non-inferieur was aan hoge-dosis statine bij patiënten met zeer hoog ASCVD-risico. De bevindingen zijn consistent met eerdere data en ondersteunen combinatietherapie als alternatief.","abstract_original":"IMPORTANCE: High-intensity statin is strongly recommended in patients at very high risk (VHR) of atherosclerotic cardiovascular disease (ASCVD). However, concerns about statin-associated adverse effects result in underuse of this strategy in practice. OBJECTIVE: To evaluate the outcomes of a moderate-intensity statin with ezetimibe combination in VHR and non-VHR patients with ASCVD. DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Randomized Comparison of Efficacy and Safety of Lipid Lowering With Statin Monotherapy vs Statin/Ezetimibe Combination for High-Risk Cardiovascular Disease (RACING) open-label, multicenter, randomized clinical trial. The study was conducted from February 2017 to December 2018 at 26 centers in Korea. Study participants included patients with documented ASCVD. Data were analyzed from April to June 2022. INTERVENTIONS: Patients were randomly assigned to moderate-intensity statin with ezetimibe (rosuvastatin, 10 mg, with ezetimibe, 10 mg) or high-intensity statin monotherapy (rosuvastatin, 20 mg). Patients at VHR for ASCVD were defined according to the 2018 American Heart Association/American College of Cardiology guidelines. MAIN OUTCOMES AND MEASURES: The primary end point was the 3-year outcome of cardiovascular death, coronary or peripheral revascularization, hospitalization of cardiovascular events, or nonfatal stroke. RESULTS: A total of 3780 patients (mean [SD] age, 64 [10] years; 2826 male [75%]) in the RACING trial, 1511 (40.0%) were categorized as VHR, which was associated with a greater occurrence of the primary end point (hazard ratio [HR], 1.42; 95% CI, 1.15-1.75). There was no significant difference in the primary end point between those who received combination therapy and high-intensity statin monotherapy among patients with VHR disease (11.2% vs 11.7%; HR, 0.96; 95% CI, 0.71-1.30) and non-VHR disease (7.7% vs 8.7%; HR, 0.88; 95% CI, 0.66-1.18). The median low-density lipoprotein cholesterol (LDL-C) level was significantly lower in the combination therapy group than in the high-intensity statin group (VHR, 1 year: 57 [47-71] mg/dL vs 65 [53-78] mg/dL; non-VHR, 1 year: 58 mg/dL vs 68 mg/dL; P < .001). Furthermore, in both the VHR and non-VHR groups, combination therapy was associated with a significantly greater mean change in LDL-C level (VHR, 1 year: -19.1 mg/dL vs -10.1 mg/dL; 2 years: -22.3 mg/dL vs -13.0 mg/dL; 3 years: -18.8 mg/dL vs -9.7 mg/dL; non-VHR, 1 year: -23.7 mg/dL vs -12.5 mg/dL; 2 years: -25.2 mg/dL vs -15.1 mg/dL; 3 years: -23.5 mg/dL vs -12.6 mg/dL; all P < .001) and proportion of patients with LDL-C level less than 70 mg/dL (VHR, 1 year: 73% vs 58%; non-VHR, 1 year: 72% vs 53%; P < .001). Discontinuation or dose reduction of the lipid-lowering drug due to intolerance occurred less frequently in the combination therapy group (VHR, 4.6% vs 7.7%; P = .02; non-VHR, 5.0% vs 8.7%; P = .001). CONCLUSIONS AND RELEVANCE: Results suggest that the outcomes of ezetimibe combination observed in the RACING trial were consistent among patients at VHR of ASCVD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03044665."},{"id":"78f186c6e448","type":"article","url":"https://hartvaat.nl/2023/09/01/drempelwaarde-voor-aortale-polsgolfsnelheid-en-cv-events-ipd-meta-analyse/","title":"Drempelwaarde voor aortale polsgolfsnelheid en CV-events: IPD meta-analyse","title_en":"Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity: An Individual-Participant Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["perifeer-vaatlijden"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21318","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21318","authors":["De-Wei An","Tine W Hansen","Lucas S Aparicio","Babangida Chori","Qi-Fang Huang","Fang-Fei Wei","Yi-Bang Cheng","Yu-Ling Yu","Chang-Sheng Sheng","Natasza Gilis-Malinowska","José Boggia","Wiktoria Wojciechowska","Teemu J Niiranen","Valérie Tikhonoff","Edoardo Casiglia","Krzysztof Narkiewicz","Katarzyna Stolarz-Skrzypek","Kalina Kawecka-Jaszcz","Antti M Jula","Wen-Yi Yang","Angela J Woodiwiss","Jan Filipovský","Ji-Guang Wang","Marek W Rajzer","Peter Verhamme","Tim S Nawrot","Jan A Staessen","Yan Li"],"significance":6,"published":"2023-09-01","source_date":"2023-09-01","image":"","kennis":[],"congress":"","summary_en":"This individual participant data meta-analysis established an outcome-driven threshold for aortic pulse wave velocity at 10 m/s, identifying a clinically actionable cutoff for vascular stiffness-based cardiovascular risk assessment.","created":"2026-07-03T10:30:33Z","updated":"2026-07-03T13:29:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse definieerde een uitkomstgerichte drempelwaarde voor aortale polsgolfsnelheid (PWV). PWV >10 m/s was geassocieerd met significant hoger CV-risico, wat een klinisch bruikbare grens biedt voor risicostratificatie.","abstract_original":"BACKGROUND: Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen). METHODS: A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement. RESULTS: In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was ≈0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome. CONCLUSIONS: PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death."},{"id":"0220fe3c7a69","type":"article","url":"https://hartvaat.nl/2023/09/01/step-substudie-intensieve-bloeddrukverlaging-verbetert-lvh-bij-ouderen/","title":"STEP-substudie: intensieve bloeddrukverlaging verbetert LVH bij ouderen","title_en":"Intensive Blood Pressure Lowering Improves Left Ventricular Hypertrophy in Older Patients with Hypertension: The STEP Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","bloeddrukbehandeling","bradycardie","dubbele-trombocytenremming","farmaco-economie","lipidenverlaging","obesitas","step-hfpef","summit-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20732","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20732","authors":["Yue Deng","Wei Liu","Xinchun Yang","Zihong Guo","Juyan Zhang","Rongjie Huang","Xiaomin Yang","Chunli Yu","Jing Yu","Jun Cai"],"significance":7,"published":"2023-09-01","source_date":"2023-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/"],"congress":"","summary_en":"This STEP substudy showed that intensive blood pressure lowering (SBP <130 mmHg) regresses left ventricular hypertrophy in older hypertensive patients, providing cardiac structural evidence supporting aggressive blood pressure targets in the elderly.","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T18:39:05Z","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":"Substudie van de STEP-trial toonde dat intensieve bloeddrukverlaging (SBP <130 vs <150 mmHg) de linkerventrikel hypertrofie bij oudere hypertensieve patiënten significant verbeterde. Dit voegt cardiale remodelling toe aan de voordelen van intensieve therapie.","abstract_original":"BACKGROUND: Intensive systolic blood pressure (SBP) lowering has been increasingly used; however, its effect on cardiac remodeling remains not fully understood. This secondary analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients trial aims to determine the changes in left ventricular hypertrophy (LVH) that occur in the context of intensive SBP lowering. METHODS: A total of 7141 older patients with hypertension were randomly assigned to intensive treatment (SBP target, 110-130 mm Hg) or standard treatment (130-150 mm Hg). LVH was defined according to the Peguero-Lo Presti criteria on a standard 12-lead echocardiogram. RESULTS: At baseline, the prevalence of LVH (16.6% versus 16.5%) and the mean Peguero-Lo Presti value (1811 versus 1808 μV) were comparable between the treatment groups. During a median follow-up of 3.24 years, intensive SBP lowering was associated with a significantly lower risk of new LVH occurrence (hazard ratio, 0.76 [95% CI, 0.66-0.89]; P=0.001) and slower progression of the mean Peguero-Lo Presti index value by -23.47 μV/y (95% CI, -34.93 to -12.01; P=0.000). However, the rates of regression of baseline LVH did not differ significantly. Notably, the beneficial effect of intensive SBP lowering in terms of cardiovascular events (hazard ratio, 0.75 [95% CI, 0.59-0.97]) was not markedly attenuated after adjusting for LVH as a time-varying covariate (hazard ratio, 0.76 [95% CI, 0.59-0.97]). CONCLUSIONS: Intensive SBP lowering protects against LVH development in older hypertensive patients, however, this favorable effect could not explain most of the reduction in cardiovascular events associated with intensive SBP lowering."},{"id":"8229489ce9ee","type":"article","url":"https://hartvaat.nl/2023/08/29/stream-2-halve-dosis-tenecteplase-bij-ouderen-met-stemi/","title":"STREAM-2: halve-dosis tenecteplase bij ouderen met STEMI","title_en":"STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064521","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064521","authors":["Frans Van de Werf","Arsen D Ristić","Oleg V Averkov","Alexandra Arias-Mendoza","Yves Lambert","José F Kerr Saraiva","Pablo Sepulveda","Fernando Rosell-Ortiz","John K French","Ljilja B Musić","Katleen Vandenberghe","Kris Bogaerts","Cynthia M Westerhout","Alain Pagès","Thierry Danays","Kevin R Bainey","Peter Sinnaeve","Patrick Goldstein","Robert C Welsh","Paul W Armstrong"],"significance":7,"published":"2023-08-29","source_date":"2023-08-29","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The STREAM-2 trial demonstrated that half-dose tenecteplase followed by PCI is a viable pharmaco-invasive strategy for older STEMI patients (≥60 years) when timely primary PCI is unavailable, with safety comparable to primary PCI.","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T13:29:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De STREAM-2-trial toonde dat halve-dosis tenecteplase bij ≥60-jarigen met STEMI die niet tijdig voor primaire PCI in aanmerking komen een veilige en effectieve farmaco-invasieve strategie is. De bloedingscomplicaties waren vergelijkbaar met PCI.","abstract_original":"BACKGROUND: ST-segment-elevation myocardial infarction (STEMI) guidelines recommend pharmaco-invasive treatment if timely primary percutaneous coronary intervention (PCI) is unavailable. Full-dose tenecteplase is associated with an increased risk of intracranial hemorrhage in older patients. Whether pharmaco-invasive treatment with half-dose tenecteplase is effective and safe in older patients with STEMI is unknown. METHODS: STREAM-2 (Strategic Reperfusion in Elderly Patients Early After Myocardial Infarction) was an investigator-initiated, open-label, randomized, multicenter study. Patients ≥60 years of age with ≥2 mm ST-segment elevation in 2 contiguous leads, unable to undergo primary PCI within 1 hour, were randomly assigned (2:1) to half-dose tenecteplase followed by coronary angiography and PCI (if indicated) 6 to 24 hours after randomization, or to primary PCI. Efficacy end points of primary interest were ST resolution and the 30-day composite of death, shock, heart failure, or reinfarction. Safety assessments included stroke and nonintracranial bleeding. RESULTS: Patients were assigned to pharmaco-invasive treatment (n=401) or primary PCI (n=203). Median times from randomization to tenecteplase or sheath insertion were 10 and 81 minutes, respectively. After last angiography, 85.2% of patients undergoing pharmaco-invasive treatment and 78.4% of patients undergoing primary PCI had ≥50% resolution of ST-segment elevation; their residual median sums of ST deviations were 4.5 versus 5.5 mm, respectively. Thrombolysis In Myocardial Infarction flow grade 3 at last angiography was ≈87% in both groups. The composite clinical end point occurred in 12.8% (51/400) of patients undergoing pharmaco-invasive treatment and 13.3% (27/203) of patients undergoing primary PCI (relative risk, 0.96 [95% CI, 0.62-1.48]). Six intracranial hemorrhages occurred in the pharmaco-invasive arm (1.5%): 3 were protocol violations (excess anticoagulation in 2 and uncontrolled hypertension in 1). No intracranial bleeding occurred in the primary PCI arm. The incidence of major nonintracranial bleeding was low in both groups (<1.5%). CONCLUSIONS: Halving the dose of tenecteplase in a pharmaco-invasive strategy in this early-presenting, older STEMI population was associated with electrocardiographic changes that were at least comparable to those after primary PCI. Similar clinical efficacy and angiographic end points occurred in both treatment groups. The risk of intracranial hemorrhage was higher with half-dose tenecteplase than with primary PCI. If timely PCI is unavailable, this pharmaco-invasive strategy is a reasonable alternative, provided that contraindications to fibrinolysis are observed and excess anticoagulation is avoided. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02777580."},{"id":"7ac275c9c85d","type":"article","url":"https://hartvaat.nl/2023/08/24/reprieve-pitavastatine-vermindert-cv-events-bij-hiv-nejm/","title":"REPRIEVE: pitavastatine vermindert CV-events bij HIV — NEJM","title_en":"Pitavastatin to Prevent Cardiovascular Disease in HIV Infection.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2304146","source_url":"https://doi.org/10.1056/NEJMoa2304146","authors":["Steven K Grinspoon","Kathleen V Fitch","Markella V Zanni","Carl J Fichtenbaum","Triin Umbleja","Judith A Aberg","Edgar T Overton","Carlos D Malvestutto","Gerald S Bloomfield","Judith S Currier","Esteban Martinez","Jhoanna C Roa","Marissa R Diggs","Evelynne S Fulda","Kayla Paradis","Stephen D Wiviott","Borek Foldyna","Sara E Looby","Patrice Desvigne-Nickens","Beverly Alston-Smith","Jorge Leon-Cruz","Sara McCallum","Udo Hoffmann","Michael T Lu","Heather J Ribaudo","Pamela S Douglas"],"significance":10,"published":"2023-08-24","source_date":"2023-08-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The REPRIEVE trial demonstrated that pitavastatin reduced major cardiovascular events by 35% in people living with HIV who had low-to-moderate cardiovascular risk. The trial was stopped early for efficacy, providing the first definitive evidence for statin therapy in primary cardiovascular prevention among HIV-infected individuals.","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T13:29:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De REPRIEVE-trial in de NEJM toonde dat pitavastatine cardiovasculaire events met 35% verminderde bij HIV-patiënten met laag tot matig CV-risico. De trial werd voortijdig gestaakt wegens duidelijk voordeel. Statines zijn nu bewezen effectief voor primaire preventie bij HIV.","abstract_original":"BACKGROUND: The risk of cardiovascular disease is increased among persons with human immunodeficiency virus (HIV) infection, so data regarding primary prevention strategies in this population are needed. METHODS: In this phase 3 trial, we randomly assigned 7769 participants with HIV infection with a low-to-moderate risk of cardiovascular disease who were receiving antiretroviral therapy to receive daily pitavastatin calcium (at a dose of 4 mg) or placebo. The primary outcome was the occurrence of a major adverse cardiovascular event, which was defined as a composite of cardiovascular death, myocardial infarction, hospitalization for unstable angina, stroke, transient ischemic attack, peripheral arterial ischemia, revascularization, or death from an undetermined cause. RESULTS: The median age of the participants was 50 years (interquartile range, 45 to 55); the median CD4 count was 621 cells per cubic millimeter (interquartile range, 448 to 827), and the HIV RNA value was below quantification in 5250 of 5997 participants (87.5%) with available data. The trial was stopped early for efficacy after a median follow-up of 5.1 years (interquartile range, 4.3 to 5.9). The incidence of a major adverse cardiovascular event was 4.81 per 1000 person-years in the pitavastatin group and 7.32 per 1000 person-years in the placebo group (hazard ratio, 0.65; 95% confidence interval [CI], 0.48 to 0.90; P = 0.002). Muscle-related symptoms occurred in 91 participants (2.3%) in the pitavastatin group and in 53 (1.4%) in the placebo group; diabetes mellitus occurred in 206 participants (5.3%) and in 155 (4.0%), respectively. CONCLUSIONS: Participants with HIV infection who received pitavastatin had a lower risk of a major adverse cardiovascular event than those who received placebo over a median follow-up of 5.1 years. (Funded by the National Institutes of Health and others; REPRIEVE ClinicalTrials.gov number, NCT02344290.)."},{"id":"26eb9bcb8978","type":"article","url":"https://hartvaat.nl/2023/08/24/vaste-dosiscombinatietherapie-voor-primaire-cv-preventie-ipd-meta-analyse/","title":"Vaste-dosiscombinatietherapie voor primaire CV-preventie: IPD meta-analyse","title_en":"Fixed dose combination therapies in primary cardiovascular disease prevention in different groups: an individual participant meta-analysis.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-322278","source_url":"https://doi.org/10.1136/heartjnl-2022-322278","authors":["Gilles R Dagenais","Prem Pais","Peggy Gao","Gholamreza Roshandel","Reza Malekzadeh","Philip Joseph","Salim Yusuf"],"significance":8,"published":"2023-08-24","source_date":"2023-08-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"This individual participant data meta-analysis from three randomized trials confirmed that fixed-dose combination therapy (polypill) reduces cardiovascular events in primary prevention across different age groups. The consistent benefit supports the polypill strategy as a population-level intervention.","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T13:29:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse toonde dat vaste-dosiscombinatiemedicatie (polypil) cardiovasculaire events vermindert in primaire preventie, consistent over leeftijdsgroepen. De polypilstrategie is effectief en praktisch voor wereldwijde CV-preventie.","abstract_original":"OBJECTIVE: To evaluate the effects of fixed dose combination (FDC) medications on cardiovascular outcomes in different age groups in an individual participant meta-analysis of three primary prevention randomised trials. METHODS: Participants at intermediate risk (17.7% mean 10-year Framingham Cardiovascular Risk Score), randomised to FDC of two or more antihypertensives and a statin with or without aspirin, or to their respective control, were followed up for 5 years. Age groups were <60, 60-65 and ≥65 years. The primary outcome was cardiovascular death, myocardial infarction, stroke or revascularisation. Cox proportional HRs and 95% CIs were computed within each age group. RESULTS: The primary outcome risk was reduced by 37% (3.3% in FDC vs 5.2% in control (HR 0.63; 95% CI 0.54 to 0.74)) in the total population of 18 162 participants with larger benefits in older groups (HR 0.58; 95% CI 0.42 to 0.78, 60 to 65 years) and (HR 0.57; 95% CI 0.47 to 0.70, ≥65 years), as were their numbers needed to treat to avoid one primary outcome: 53 and 33, respectively. The primary outcome risk was reduced in the two oldest groups with FDC with aspirin (n=8951) by 54% and 54%, and without aspirin (n=12 061) by 34% and 38%. Dizziness, the most frequent FDC adverse effects, was higher in participants aged <65 years. Aspirin was not associated with significant bleeding excess. CONCLUSIONS: In participants with intermediate cardiovascular risk, FDCs produce larger cardiovascular benefits in older individuals, which appear greater with aspirin. TRIAL REGISTRATION NUMBER: HOPE-3, NCT00468923; TIPS-3, NCT016464137; PolyIran, NCT01271985."},{"id":"47491b7b4ace","type":"article","url":"https://hartvaat.nl/2023/08/24/fysieke-activiteitsniveaus-bij-hartfalen-meta-analyse/","title":"Fysieke activiteitsniveaus bij hartfalen: meta-analyse","title_en":"Habitual physical activity levels of adults with heart failure: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["ivabradine"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321943","source_url":"https://doi.org/10.1136/heartjnl-2022-321943","authors":["Cara Jordan","Sarah J Charman","Alan Mark Batterham","Darren Flynn","David Houghton","Linda Errington","Guy MacGowan","Leah Avery"],"significance":5,"published":"2023-08-24","source_date":"2023-08-24","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This meta-analysis quantified the very low habitual physical activity levels (3,000-4,000 steps/day) in heart failure patients, establishing the scale of sedentary behavior and the opportunity for activity promotion.","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T18:39:05Z","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 documenteerde de zeer lage fysieke activiteitsniveaus bij hartfalenpatiënten: gemiddeld 3.000-4.000 stappen per dag. Dit benadrukt de noodzaak van actieve beweegprogramma's en hartrevalidatie.","abstract_original":"OBJECTIVE: To conduct a systematic review and meta-analysis to quantify habitual physical activity (PA) levels of patients with heart failure (HF) and assess the quality of reporting of device-assessed PA. METHODS: Eight electronic databases were searched up to 17 November 2021. Data on the study and population characteristics, method of PA measurement and PA metrics were extracted. A random-effects meta-analysis (restricted maximum likelihood with Knapp-Hartung SE adjustment) was conducted. RESULTS: Seventy-five studies were included in the review (n=7775 patients with HF). Meta-analysis was restricted to mean steps per day, encompassing 27 studies (n=1720 patients with HF). Pooled mean steps per day were 5040 (95% CI: 4272 to 5807). The 95% prediction interval for mean steps per day in a future study was 1262 to 8817. Meta-regression at the study level revealed that a 10-year increment in the mean age of patients was associated with 1121 fewer steps per day (95% CI: 258 to 1984). CONCLUSIONS: Patients with HF are a low-active population. These findings have implications for the way in which PA is targeted in patients with HF, and interventions should focus on addressing the age-related decline observed as well as increasing PA to improve HF symptoms and quality of life. PROSPERO REGISTRATION NUMBER: CRD42020167786."},{"id":"5f7d8419d554","type":"article","url":"https://hartvaat.nl/2023/08/14/cva-bij-hartfalen-met-gereduceerde-versus-behouden-ejectiefractie/","title":"CVA bij hartfalen met gereduceerde versus behouden ejectiefractie","title_en":"Stroke in patients with heart failure and reduced or preserved ejection fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","anticoagulantia","bloeddrukbehandeling","cerebrovasculair","dapa-hf","hfmref","hfpef","hfref","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad338","source_url":"https://doi.org/10.1093/eurheartj/ehad338","authors":["Mingming Yang","Toru Kondo","Jawad H Butt","William T Abraham","Inder S Anand","Akshay S Desai","Lars Køber","Milton Packer","Marc A Pfeffer","Jean L Rouleau","Marc S Sabatine","Scott D Solomon","Karl Swedberg","Michael R Zile","Pardeep S Jhund","John J V McMurray"],"significance":6,"published":"2023-08-14","source_date":"2023-08-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This study compared stroke risk between HFrEF and HFpEF, showing elevated risk in both phenotypes but with different underlying mechanisms (cardiac embolism in HFrEF, atrial cardiomyopathy in HFpEF).","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T18:39:05Z","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 onderzocht het CVA-risico bij HFrEF versus HFpEF. Het risico was verhoogd bij beide fenotypen, maar de mechanismen verschillen: bij HFpEF speelt AF een grotere rol, bij HFrEF domineert lage cardiac output. Dit heeft implicaties voor anticoagulatie.","abstract_original":"AIMS: Stroke is an important problem in patients with heart failure (HF), but the intersection between the two conditions is poorly studied across the range of ejection fraction. The prevalence of history of stroke and related outcomes were investigated in patients with HF. METHODS AND RESULTS: Individual patient meta-analysis of seven clinical trials enrolling patients with HF with reduced (HFrEF) and preserved ejection fraction (HFpEF). Of the 20 159 patients with HFrEF, 1683 (8.3%) had a history of stroke, and of the 13 252 patients with HFpEF, 1287 (9.7%) had a history of stroke. Regardless of ejection fraction, patients with a history of stroke had more vascular comorbidity and worse HF. Among those with HFrEF, the incidence of the composite of cardiovascular death, HF hospitalization, stroke, or myocardial infarction was 18.23 (16.81-19.77) per 100 person-years in those with prior stroke vs. 13.12 (12.77-13.48) in those without [hazard ratio 1.37 (1.26-1.49), P < 0.001]. The corresponding rates in patients with HFpEF were 14.16 (12.96-15.48) and 9.37 (9.06-9.70) [hazard ratio 1.49 (1.36-1.64), P < 0.001]. Each component of the composite was more frequent in patients with stroke history, and the risk of future stroke was doubled in patients with prior stroke. Among patients with prior stroke, 30% with concomitant atrial fibrillation were not anticoagulated, and 29% with arterial disease were not taking statins; 17% with HFrEF and 38% with HFpEF had uncontrolled systolic blood pressure (≥140 mmHg). CONCLUSION: Heart failure patients with a history of stroke are at high risk of subsequent cardiovascular events, and targeting underutilization of guideline-recommended treatments might be a way to improve outcomes in this high-risk population."},{"id":"0f548b6cac6d","type":"article","url":"https://hartvaat.nl/2023/08/14/strong-hf-nt-probnp-geleide-intensieve-optitratie-na-acuut-hf/","title":"STRONG-HF: NT-proBNP-geleide intensieve optitratie na acuut HF","title_en":"NT-proBNP and high intensity care for acute heart failure: the STRONG-HF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","nt-probnp","troponine"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad335","source_url":"https://doi.org/10.1093/eurheartj/ehad335","authors":["Marianna Adamo","Matteo Pagnesi","Alexandre Mebazaa","Beth Davison","Christopher Edwards","Daniela Tomasoni","Mattia Arrigo","Marianela Barros","Jan Biegus","Jelena Celutkiene","Kamilė Čerlinskaitė-Bajorė","Ovidiu Chioncel","Alain Cohen-Solal","Albertino Damasceno","Rafael Diaz","Gerasimos Filippatos","Etienne Gayat","Antoine Kimmoun","Carolyn S P Lam","Maria Novosadova","Peter S Pang","Piotr Ponikowski","Hadiza Saidu","Karen Sliwa","Koji Takagi","Jozine M Ter Maaten","Adriaan Voors","Gad Cotter","Marco Metra"],"significance":7,"published":"2023-08-14","source_date":"2023-08-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/"],"congress":"","summary_en":"This STRONG-HF analysis showed that NT-proBNP-guided intensive up-titration of heart failure medications after discharge improves outcomes, demonstrating that biomarker monitoring adds value to the aggressive post-discharge optimization strategy.","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T13:29:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van STRONG-HF toonde dat NT-proBNP-geleide intensieve optitratie van hartfalenmedicatie na ontslag de uitkomsten verbeterde. De biomarker identificeert patiënten die het meest baat hebben bij snelle medicatie-ophoging.","abstract_original":"AIMS: STRONG-HF showed that rapid up-titration of guideline-recommended medical therapy (GRMT), in a high intensity care (HIC) strategy, was associated with better outcomes compared with usual care. The aim of this study was to assess the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at baseline and its changes early during up-titration. METHODS AND RESULTS: A total of 1077 patients hospitalized for acute heart failure (HF) and with a >10% NT-proBNP decrease from screening (i.e. admission) to randomization (i.e. pre-discharge), were included. Patients in HIC were stratified by further NT-proBNP changes, from randomization to 1 week later, as decreased (≥30%), stable (<30% decrease to ≤10% increase), or increased (>10%). The primary endpoint was 180-day HF readmission or death. The effect of HIC vs. usual care was independent of baseline NT-proBNP. Patients in the HIC group with stable or increased NT-proBNP were older, with more severe acute HF and worse renal and liver function. Per protocol, patients with increased NT-proBNP received more diuretics and were up-titrated more slowly during the first weeks after discharge. However, by 6 months, they reached 70.4% optimal GRMT doses, compared with 80.3% for those with NT-proBNP decrease. As a result, the primary endpoint at 60 and 90 days occurred in 8.3% and 11.1% of patients with increased NT-proBNP vs. 2.2% and 4.0% in those with decreased NT-proBNP (P = 0.039 and P = 0.045, respectively). However, no difference in outcome was found at 180 days (13.5% vs. 13.2%; P = 0.93). CONCLUSION: Among patients with acute HF enrolled in STRONG-HF, HIC reduced 180-day HF readmission or death regardless of baseline NT-proBNP. GRMT up-titration early post-discharge, utilizing increased NT-proBNP as guidance to increase diuretic therapy and reduce the GRMT up-titration rate, resulted in the same 180-day outcomes regardless of early post-discharge NT-proBNP change."},{"id":"42df1f8a55ad","type":"article","url":"https://hartvaat.nl/2023/08/14/telemonitoring-bij-hartfalen-meta-analyse-van-alle-strategieen/","title":"Telemonitoring bij hartfalen: meta-analyse van alle strategieën","title_en":"Telemonitoring for heart failure: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad280","source_url":"https://doi.org/10.1093/eurheartj/ehad280","authors":["Niels T B Scholte","Muhammed T Gürgöze","Dilan Aydin","Dominic A M J Theuns","Olivier C Manintveld","Eelko Ronner","Eric Boersma","Rudolf A de Boer","Robert M A van der Boon","Jasper J Brugts"],"significance":7,"published":"2023-08-14","source_date":"2023-08-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This comprehensive meta-analysis of telemonitoring in heart failure showed that structured telemonitoring reduces hospitalizations but has inconsistent effects on mortality, with benefit dependent on the specific technology and implementation model.","created":"2026-07-03T10:30:32Z","updated":"2026-07-03T18:39:05Z","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":"Uitgebreide meta-analyse van telemonitoring bij hartfalen toonde dat gestructureerde telemonitoring hospitalisaties vermindert, maar het effect op mortaliteit is inconsistent. Invasieve hemodynamische monitoring (PA-druk) biedt het sterkste bewijs.","abstract_original":"AIMS: Telemonitoring modalities in heart failure (HF) have been proposed as being essential for future organization and transition of HF care, however, efficacy has not been proven. A comprehensive meta-analysis of studies on home telemonitoring systems (hTMS) in HF and the effect on clinical outcomes are provided. METHODS AND RESULTS: A systematic literature search was performed in four bibliographic databases, including randomized trials and observational studies that were published during January 1996-July 2022. A random-effects meta-analysis was carried out comparing hTMS with standard of care. All-cause mortality, first HF hospitalization, and total HF hospitalizations were evaluated as study endpoints. Sixty-five non-invasive hTMS studies and 27 invasive hTMS studies enrolled 36 549 HF patients, with a mean follow-up of 11.5 months. In patients using hTMS compared with standard of care, a significant 16% reduction in all-cause mortality was observed [pooled odds ratio (OR): 0.84, 95% confidence interval (CI): 0.77-0.93, I2: 24%], as well as a significant 19% reduction in first HF hospitalization (OR: 0.81, 95% CI 0.74-0.88, I2: 22%) and a 15% reduction in total HF hospitalizations (pooled incidence rate ratio: 0.85, 95% CI 0.76-0.96, I2: 70%). CONCLUSION: These results are an advocacy for the use of hTMS in HF patients to reduce all-cause mortality and HF-related hospitalizations. Still, the methods of hTMS remain diverse, so future research should strive to standardize modes of effective hTMS."},{"id":"bcdd82197d08","type":"article","url":"https://hartvaat.nl/2023/08/14/sacubitril-valsartan-bij-hfmref-hfpef-gepoolde-analyse-van-drie-trials/","title":"Sacubitril/valsartan bij HFmrEF/HFpEF: gepoolde analyse van drie trials","title_en":"Sacubitril/valsartan in heart failure with mildly reduced or preserved ejection fraction: a pre-specified participant-level pooled analysis of PARAGLIDE-HF and PARAGON-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","dapa-hf","fidelity","sacubitril-valsartan","step-hfpef","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad344","source_url":"https://doi.org/10.1093/eurheartj/ehad344","authors":["Muthiah Vaduganathan","Robert J Mentz","Brian L Claggett","Zi Michael Miao","Ian J Kulac","Jonathan H Ward","Adrian F Hernandez","David A Morrow","Randall C Starling","Eric J Velazquez","Kristin M Williamson","Akshay S Desai","Shelley Zieroth","Martin Lefkowitz","John J V McMurray","Eugene Braunwald","Scott D Solomon"],"significance":8,"published":"2023-08-14","source_date":"2023-08-14","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 participant-level pooled analysis of PARAGON-HF, PARADIGM-HF, and PARAGLIDE-HF confirmed that sacubitril-valsartan reduces NT-proBNP and heart failure events in patients with HFmrEF and HFpEF (EF ≥40%), particularly those with lower LVEF within this range.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T18:39:05Z","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":"Patiënt-niveau gepoolde analyse van PARAGON-HF, PARADIGM-HF en PARAGLIDE-HF bevestigde het voordeel van sacubitril/valsartan bij HFmrEF en HFpEF, vooral bij vrouwen en lagere EF-waarden. De data ondersteunen ARNI-gebruik over een breder EF-spectrum.","abstract_original":"AIMS: The PARAGLIDE-HF trial demonstrated reductions in natriuretic peptides with sacubitril/valsartan compared with valsartan in patients with heart failure (HF) with mildly reduced or preserved ejection fraction who had a recent worsening HF event, but was not adequately powered to examine clinical outcomes. PARAGON-HF included a subset of PARAGLIDE-HF-like patients who were recently hospitalized for HF. Participant-level data from PARAGLIDE-HF and PARAGON-HF were pooled to better estimate the efficacy and safety of sacubitril/valsartan in reducing cardiovascular and renal events in HF with mildly reduced or preserved ejection fraction. METHODS AND RESULTS: Both PARAGLIDE-HF and PARAGON-HF were multicentre, double-blind, randomized, active-controlled trials of sacubitril/valsartan vs. valsartan in patients with HF with mildly reduced or preserved left ventricular ejection fraction (LVEF >40% in PARAGLIDE-HF and ≥45% in PARAGON-HF). In the pre-specified primary analysis, we pooled participants in PARAGLIDE-HF (all of whom were enrolled during or within 30 days of a worsening HF event) with a 'PARAGLIDE-like' subset of PARAGON-HF (those hospitalized for HF within 30 days). We also pooled the entire PARAGLIDE-HF and PARAGON-HF populations for a broader context. The primary endpoint for this analysis was the composite of total worsening HF events (including first and recurrent HF hospitalizations and urgent visits) and cardiovascular death. The secondary endpoint was the pre-specified renal composite endpoint for both studies (≥50% decline in estimated glomerular filtration rate from baseline, end-stage renal disease, or renal death). Compared with valsartan, sacubitril/valsartan significantly reduced total worsening HF events and cardiovascular death in both the primary pooled analysis of participants with recent worsening HF [n = 1088; rate ratio (RR) 0.78; 95% confidence interval (CI) 0.61-0.99; P = 0.042] and in the pooled analysis of all participants (n = 5262; RR 0.86; 95% CI: 0.75-0.98; P = 0.027). In the pooled analysis of all participants, first nominal statistical significance was reached by Day 9 after randomization, and treatment benefits were larger in those with LVEF ≤60% (RR 0.78; 95% CI 0.66-0.91) compared with those with LVEF >60% (RR 1.09; 95% CI 0.86-1.40; Pinteraction = 0.021). Sacubitril/valsartan was also associated with lower rates of the renal composite endpoint in the primary pooled analysis [hazard ratio (HR) 0.67; 95% CI 0.43-1.05; P = 0.080] and the pooled analysis of all participants (HR 0.60; 95% CI 0.44-0.83; P = 0.002). CONCLUSION: In pooled analyses of PARAGLIDE-HF and PARAGON-HF, sacubitril/valsartan reduced cardiovascular and renal events among patients with HF with mildly reduced or preserved ejection fraction. These data provide support for use of sacubitril/valsartan in patients with HF with mildly reduced or preserved ejection fraction, particularly among those with an LVEF below normal, regardless of care setting."},{"id":"1322da8ef645","type":"article","url":"https://hartvaat.nl/2023/08/14/dapagliflozine-versus-metolazone-bij-diureticaresistent-hartfalen/","title":"Dapagliflozine versus metolazone bij diureticaresistent hartfalen","title_en":"Dapagliflozin vs. metolazone in heart failure resistant to loop diuretics.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["bisoprolol","dapa-hf","dapagliflozine","empagliflozine","emperor-trials"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad341","source_url":"https://doi.org/10.1093/eurheartj/ehad341","authors":["Su Ern Yeoh","Joanna Osmanska","Mark C Petrie","Katriona J M Brooksbank","Andrew L Clark","Kieran F Docherty","Paul W X Foley","Kaushik Guha","Crawford A Halliday","Pardeep S Jhund","Paul R Kalra","Gemma McKinley","Ninian N Lang","Matthew M Y Lee","Alex McConnachie","James J McDermott","Elke Platz","Peter Sartipy","Alison Seed","Bethany Stanley","Robin A P Weir","Paul Welsh","John J V McMurray","Ross T Campbell"],"significance":7,"published":"2023-08-14","source_date":"2023-08-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diuretica-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This study compared dapagliflozin with metolazone as adjunctive therapy in loop diuretic-resistant heart failure, finding comparable diuretic efficacy with a potentially better safety profile for the SGLT2 inhibitor approach.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek dapagliflozine met metolazone als adjunct bij lisdiureticaresistent hartfalen. Dapagliflozine gaf vergelijkbare decongestie met minder elektrolytstoornissen en nierfunctiedaling, wat SGLT2-remmers als veiliger alternatief voor sequentiële nefronsegmentblokkade positioneert.","abstract_original":"BACKGROUND AND AIMS: To examine the decongestive effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin compared to the thiazide-like diuretic metolazone in patients hospitalized for heart failure and resistant to treatment with intravenous furosemide. METHODS AND RESULTS: A multi-centre, open-label, randomized, and active-comparator trial. Patients were randomized to dapagliflozin 10 mg once daily or metolazone 5-10 mg once daily for a 3-day treatment period, with follow-up for primary and secondary endpoints until day 5 (96 h). The primary endpoint was a diuretic effect, assessed by change in weight (kg). Secondary endpoints included a change in pulmonary congestion (lung ultrasound), loop diuretic efficiency (weight change per 40 mg of furosemide), and a volume assessment score. 61 patients were randomized. The mean (±standard deviation) cumulative dose of furosemide at 96 h was 977 (±492) mg in the dapagliflozin group and 704 (±428) mg in patients assigned to metolazone. The mean (±standard deviation) decrease in weight at 96 h was 3.0 (2.5) kg with dapagliflozin compared to 3.6 (2.0) kg with metolazone [mean difference 0.65, 95% confidence interval (CI) -0.12,1.41 kg; P = 0.11]. Loop diuretic efficiency was less with dapagliflozin than with metolazone [mean 0.15 (0.12) vs. 0.25 (0.19); difference -0.08, 95% CI -0.17,0.01 kg; P = 0.10]. Changes in pulmonary congestion and volume assessment score were similar between treatments. Decreases in plasma sodium and potassium and increases in urea and creatinine were smaller with dapagliflozin than with metolazone. Serious adverse events were similar between treatments. CONCLUSION: In patients with heart failure and loop diuretic resistance, dapagliflozin was not more effective at relieving congestion than metolazone. Patients assigned to dapagliflozin received a larger cumulative dose of furosemide but experienced less biochemical upset than those assigned to metolazone. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04860011."},{"id":"b7cc7318df53","type":"article","url":"https://hartvaat.nl/2023/08/12/retatrutide-triple-gip-glp-1-glucagonagonist-bij-type-2-diabetes-lancet-fase-2/","title":"Retatrutide: triple GIP/GLP-1/glucagonagonist bij type 2 diabetes — Lancet fase 2","title_en":"Retatrutide, a GIP, GLP-1 and glucagon receptor agonist, for people with type 2 diabetes: a randomised, double-blind, placebo and active-controlled, parallel-group, phase 2 trial conducted in the USA.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-type-2","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","orforglipron","semaglutide","sglt2-remmers","tirzepatide"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)01053-X","source_url":"https://doi.org/10.1016/S0140-6736(23)01053-X","authors":["Julio Rosenstock","Juan Frias","Ania M Jastreboff","Yu Du","Jitong Lou","Sirel Gurbuz","Melissa K Thomas","Mark L Hartman","Axel Haupt","Zvonko Milicevic","Tamer Coskun"],"significance":9,"published":"2023-08-12","source_date":"2023-08-12","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/semaglutide-gewichtsverlies-hart/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This Lancet phase 2 trial of retatrutide, a triple GIP/GLP-1/glucagon receptor agonist, demonstrated up to 24% weight loss and dramatic HbA1c improvement in patients with type 2 diabetes. The results surpassed those of dual incretin agonists, establishing triple agonism as the next frontier in metabolic therapeutics.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet fase 2 trial van retatrutide toonde spectaculair gewichtsverlies (tot 24%) en HbA1c-verbetering bij type 2 diabetes. De triple agonist overtreft mono- en duale agonisten en opent een nieuw paradigma in obesitas- en diabetesbehandeling.","abstract_original":"BACKGROUND: According to current consensus guidelines for type 2 diabetes management, bodyweight management is as important as attaining glycaemic targets. Retatrutide, a single peptide with agonist activity at the glucose-dependent insulinotropic polypeptide (GIP), GLP-1, and glucagon receptors, showed clinically meaningful glucose-lowering and bodyweight-lowering efficacy in a phase 1 study. We aimed to examine the efficacy and safety of retatrutide in people with type 2 diabetes across a range of doses. METHODS: In this randomised, double-blind, double-dummy, placebo-controlled and active comparator-controlled, parallel-group, phase 2 trial, participants were recruited from 42 research and health-care centres in the USA. Adults aged 18-75 years with type 2 diabetes, glycated haemoglobin (HbA1c) of 7·0-10·5% (53·0-91·3 mmol/mol), and BMI of 25-50 kg/m2 were eligible for enrolment. Eligible participants were treated with diet and exercise alone or with a stable dose of metformin (≥1000 mg once daily) for at least 3 months before the screening visit. Participants were randomly assigned (2:2:2:1:1:1:1:2) using an interactive web-response system, with stratification for baseline HbA1c and BMI, to receive once-weekly injections of placebo, 1·5 mg dulaglutide, or retatrutide maintenance doses of 0·5 mg, 4 mg (starting dose 2 mg), 4 mg (no escalation), 8 mg (starting dose 2 mg), 8 mg (starting dose 4 mg), or 12 mg (starting dose 2 mg). Participants, study site personnel, and investigators were masked to treatment allocation until after study end. The primary endpoint was change in HbA1c from baseline to 24 weeks, and secondary endpoints included change in HbA1c and bodyweight at 36 weeks. Efficacy was analysed in all randomly assigned, except inadvertently enrolled, participants, and safety was assessed in all participants who received at least one dose of study treatment. The study is registered at ClinicalTrials.gov, NCT04867785. FINDINGS: Between May 13, 2021, and June 13, 2022, 281 participants (mean age 56·2 years [SD 9·7], mean duration of diabetes 8·1 years [7·0], 156 [56%] female, and 235 [84%] White) were randomly assigned and included in the safety analysis (45 in the placebo group, 46 in the 1·5 mg dulaglutide group, and 47 in the retatrutide 0·5 mg group, 23 in the 4 mg escalation group, 24 in the 4 mg group, 26 in the 8 mg slow escalation group, 24 in the 8 mg fast escalation group, and 46 in the 12 mg escalation group). 275 participants were included in the efficacy analyses (one each in the retatrutide 0·5 mg group, 4 mg escalation group, and 8 mg slow escalation group, and three in the 12 mg escalation group were inadvertently enrolled). 237 (84%) participants completed the study and 222 (79%) completed study treatment. At 24 weeks, least-squares mean changes from baseline in HbA1c with retatrutide were -0·43% (SE 0·20; -4·68 mmol/mol [2·15]) for the 0·5 mg group, -1·39% (0·14; -15·24 mmol/mol [1·56]) for the 4 mg escalation group, -1·30% (0·22; -14·20 mmol/mol [2·44]) for the 4 mg group, -1·99% (0·15; -21·78 mmol/mol [1·60]) for the 8 mg slow escalation group, -1·88% (0·21; -20·52 mmol/mol [2·34]) for the 8 mg fast escalation group, and -2·02% (0·11; -22·07 mmol/mol [1·21]) for the 12 mg escalation group, versus -0·01% (0·21; -0·12 mmol/mol [2·27]) for the placebo group and -1·41% (0·12; -15·40 mmol/mol [1·29]) for the 1·5 mg dulaglutide group. HbA1c reductions with retatrutide were significantly greater (p<0·0001) than placebo in all but the 0·5 mg group and greater than 1·5 mg dulaglutide in the 8 mg slow escalation group (p=0·0019) and 12 mg escalation group (p=0·0002). Findings were consistent at 36 weeks. Bodyweight decreased dose dependently with retatrutide at 36 weeks by 3·19% (SE 0·61) for the 0·5 mg group, 7·92% (1·28) for the 4 mg escalation group, 10·37% (1·56) for the 4 mg group, 16·81% (1·59) for the 8 mg slow escalation group, 16·34% (1·65) for the 8 mg fast escalation group, and 16·94% (1·30) for the 12 mg escalation group, versus 3·00% (0·86) with placebo and 2·02% (0·72) with 1·5 mg dulaglutide. For retatrutide doses of 4 mg and greater, decreases in weight were significantly greater than with placebo (p=0·0017 for the 4 mg escalation group and p<0·0001 for others) and 1·5 mg dulaglutide (all p<0·0001). Mild-to-moderate gastrointestinal adverse events, including nausea, diarrhoea, vomiting, and constipation, were reported in 67 (35%) of 190 participants in the retatrutide groups (from six [13%] of 47 in the 0·5 mg group to 12 [50%] of 24 in the 8 mg fast escalation group), six (13%) of 45 participants in the placebo group, and 16 (35%) of 46 participants in the 1·5 mg dulaglutide group. There were no reports of severe hypoglycaemia and no deaths during the study. INTERPRETATION: In people with type 2 diabetes, retatrutide showed clinically meaningful improvements in glycaemic control and robust reductions in bodyweight, with a safety profile consistent with GLP-1 receptor agonists and GIP and GLP-1 receptor agonists. These phase 2 data also informed dose selection for the phase 3 programme. FUNDING: Eli Lilly and Company."},{"id":"dc2c5d45e0c8","type":"article","url":"https://hartvaat.nl/2023/08/08/stop-ca-atorvastatine-beschermt-tegen-antracycline-cardiotoxiciteit/","title":"STOP-CA: atorvastatine beschermt tegen antracycline-cardiotoxiciteit","title_en":"Atorvastatin for Anthracycline-Associated Cardiac Dysfunction: The STOP-CA Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["clear-outcomes","kanker-en-hart","rosuvastatine"],"journal":"JAMA","doi":"10.1001/jama.2023.11887","source_url":"https://doi.org/10.1001/jama.2023.11887","authors":["Tomas G Neilan","Thiago Quinaglia","Takeshi Onoue","Syed S Mahmood","Zsofia D Drobni","Hannah K Gilman","Amanda Smith","Julius C Heemelaar","Priya Brahmbhatt","Jor Sam Ho","Supraja Sama","Jakub Svoboda","Donna S Neuberg","Jeremy S Abramson","Ephraim P Hochberg","Jefferey A Barnes","Philippe Armand","Eric D Jacobsen","Caron A Jacobson","Austin I Kim","Jacob D Soumerai","Yuchi Han","Robb S Friedman","Ann S Lacasce","Bonnie Ky","Dan Landsburg","Sunita Nasta","Raymond Y Kwong","Michael Jerosch-Herold","Robert A Redd","Lanqi Hua","James L Januzzi","Aarti Asnani","Negareh Mousavi","Marielle Scherrer-Crosbie"],"significance":8,"published":"2023-08-08","source_date":"2023-08-08","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"The STOP-CA trial showed that atorvastatin significantly attenuated the decline in left ventricular ejection fraction in patients receiving anthracycline chemotherapy. The result established statins as a potential cardioprotective strategy during cancer treatment.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De STOP-CA-trial in JAMA toonde dat atorvastatine de daling van de ejectiefractie bij patiënten die antracyclinechemotherapie ontvangen significant verminderde. Statineprofylaxe kan cardiotoxiciteit voorkomen bij kankerpatiënten op antracyclines.","abstract_original":"IMPORTANCE: Anthracyclines treat a broad range of cancers. Basic and retrospective clinical data have suggested that use of atorvastatin may be associated with a reduction in cardiac dysfunction due to anthracycline use. OBJECTIVE: To test whether atorvastatin is associated with a reduction in the proportion of patients with lymphoma receiving anthracyclines who develop cardiac dysfunction. DESIGN, SETTING, AND PARTICIPANTS: Double-blind randomized clinical trial conducted at 9 academic medical centers in the US and Canada among 300 patients with lymphoma who were scheduled to receive anthracycline-based chemotherapy. Enrollment occurred between January 25, 2017, and September 10, 2021, with final follow-up on October 10, 2022. INTERVENTIONS: Participants were randomized to receive atorvastatin, 40 mg/d (n = 150), or placebo (n = 150) for 12 months. MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of participants with an absolute decline in left ventricular ejection fraction (LVEF) of ≥10% from prior to chemotherapy to a final value of <55% over 12 months. A secondary outcome was the proportion of participants with an absolute decline in LVEF of ≥5% from prior to chemotherapy to a final value of <55% over 12 months. RESULTS: Of the 300 participants randomized (mean age, 50 [SD, 17] years; 142 women [47%]), 286 (95%) completed the trial. Among the entire cohort, the baseline mean LVEF was 63% (SD, 4.6%) and the follow-up LVEF was 58% (SD, 5.7%). Study drug adherence was noted in 91% of participants. At 12-month follow-up, 46 (15%) had a decline in LVEF of 10% or greater from prior to chemotherapy to a final value of less than 55%. The incidence of the primary end point was 9% (13/150) in the atorvastatin group and 22% (33/150) in the placebo group (P = .002). The odds of a 10% or greater decline in LVEF to a final value of less than 55% after anthracycline treatment was almost 3 times greater for participants randomized to placebo compared with those randomized to atorvastatin (odds ratio, 2.9; 95% CI, 1.4-6.4). Compared with placebo, atorvastatin also reduced the incidence of the secondary end point (13% vs 29%; P = .001). There were 13 adjudicated heart failure events (4%) over 24 months of follow-up. There was no difference in the rates of incident heart failure between study groups (3% with atorvastatin, 6% with placebo; P = .26). The number of serious related adverse events was low and similar between groups. CONCLUSIONS AND RELEVANCE: Among patients with lymphoma treated with anthracycline-based chemotherapy, atorvastatin reduced the incidence of cardiac dysfunction. This finding may support the use of atorvastatin in patients with lymphoma at high risk of cardiac dysfunction due to anthracycline use. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02943590."},{"id":"5859a4b6d0b5","type":"article","url":"https://hartvaat.nl/2023/08/08/glp-1-agonisten-met-en-zonder-sglt2-remmers-bij-type-2-diabetes-jacc-analyse/","title":"GLP-1-agonisten met en zonder SGLT2-remmers bij type 2 diabetes: JACC analyse","title_en":"GLP-1 Receptor Agonist Therapy With and Without SGLT2 Inhibitors in Patients With Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["canagliflozine","cardiorenal-behandelstrategie","diabetes-en-hart","diabetes-type-2","ezetimibe","glp1-agonisten","glp1-semaglutide-cardiovasculair","liraglutide","obesitas","orforglipron","semaglutide","sglt2-remmers","tirzepatide"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.05.048","source_url":"https://doi.org/10.1016/j.jacc.2023.05.048","authors":["João Sérgio Neves","Marta Borges-Canha","Francisco Vasques-Nóvoa","Jennifer B Green","Lawrence A Leiter","Christopher B Granger","Davide Carvalho","Adelino Leite-Moreira","Adrian F Hernandez","Stefano Del Prato","John J V McMurray","João Pedro Ferreira"],"significance":8,"published":"2023-08-08","source_date":"2023-08-08","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This analysis demonstrated that GLP-1 receptor agonists and SGLT2 inhibitors provide complementary cardiovascular benefits when used together in type 2 diabetes, with additive reductions in MACE and heart failure events. The findings support dual cardiometabolic therapy in eligible patients.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat GLP-1-agonisten en SGLT2-remmers complementaire cardiovasculaire voordelen bieden bij type 2 diabetes. Combinatietherapie verminderde CV-events meer dan elk middel alleen, wat de aanbeveling voor dubbele therapie bij hoog-risicopatiënten ondersteunt.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitors and GLP-1 receptor agonists (GLP-1 RAs) reduce adverse cardiovascular outcomes in type 2 diabetes (T2D). However, the efficacy of combination therapy is unclear. OBJECTIVES: The aim of this study was to evaluate the effects of GLP-1 RAs on cardiovascular outcomes in patients with T2D treated with or without SGLT2 inhibitors. METHODS: Post hoc analysis of Harmony Outcomes (Albiglutide and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Cardiovascular Disease) evaluating the effect of albiglutide in T2D with cardiovascular disease by background SGLT2 inhibitor use. Additionally, a trial-level meta-analysis of Harmony Outcomes and AMPLITUDE-O (Effect of Efpeglenatide on Cardiovascular Outcomes), which evaluated T2D with cardiovascular or renal disease, was performed, combining the treatment effect estimates according to SGLT2 inhibitor use. RESULTS: Of the 9,462 participants in Harmony Outcomes, 575 (6.1%) were treated with SGLT2 inhibitors at baseline. The effect of albiglutide on reducing the composite of cardiovascular death, myocardial infarction, or stroke (major adverse cardiovascular events) was consistent with or without SGLT2 inhibitors (P interaction = 0.70). The effect of albiglutide on secondary outcomes and adverse events was not modified by SGLT2 inhibitors. A meta-analysis of Harmony Outcomes and AMPLITUDE-O included 13,538 patients, of whom 1,193 (8.8%) used SGLT2 inhibitors. Compared to placebo, GLP1-RAs reduced major adverse cardiovascular events without effect modification by SGLT2 inhibitor use (HR: 0.77; 95% CI: 0.68-0.87 without SGLT2 inhibitors; and HR: 0.78; 95% CI: 0.49-1.24 with SGLT2 inhibitors) (P for interaction = 0.95) and reduced heart failure hospitalization (HR: 0.72; 95% CI: 0.55-0.92 vs HR: 0.34; 95% CI: 0.12-0.96) (P for interaction = 0.18). CONCLUSIONS: In patients with T2D and cardiovascular disease, GLP-1 RAs reduced cardiovascular events independently of SGLT2 inhibitor use. These findings suggest that the combination of GLP-1 RAs with SGLT2 inhibitors may further reduce cardiovascular risk. Clinical trials with combination therapy are needed."},{"id":"933454326775","type":"article","url":"https://hartvaat.nl/2023/08/02/gerichte-lv-leadplaatsing-bij-crt-meta-analyse-van-beeldvorming-en-elektrisch-ge/","title":"Gerichte LV-leadplaatsing bij CRT: meta-analyse van beeldvorming- en elektrisch geleide benaderingen","title_en":"Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis.","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/euad267","source_url":"https://doi.org/10.1093/europace/euad267","authors":["Daniel Benjamin Fyenbo","Henrik Laurits Bjerre","Maria Hee Jung Park Frausing","Charlotte Stephansen","Anders Sommer","Rasmus Borgquist","Zoltan Bakos","Michael Glikson","Anat Milman","Roy Beinart","Radka Kockova","Kamil Sedlacek","Dan Wichterle","Samir Saba","Sandeep Jain","Alaa Shalaby","Mads Brix Kronborg","Jens Cosedis Nielsen"],"significance":7,"published":"2023-08-02","source_date":"2023-08-02","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"This meta-analysis confirmed that targeted LV lead placement at the site of latest electrical activation improves CRT response compared with empirical positioning, supporting imaging or electrical mapping-guided lead deployment.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse bevestigde dat gerichte LV-leadplaatsing op de site van laatste activering de CRT-respons verbetert vergeleken met empirische positionering. Beeldvorming- en elektrisch geleide strategieën verhogen het percentage responders.","abstract_original":"AIMS: Several studies have evaluated the use of electrically- or imaging-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) recipients. We aimed to assess evidence for a guided strategy that targets LV lead position to the site of latest LV activation. METHODS AND RESULTS: A systematic review and meta-analysis was performed for randomized controlled trials (RCTs) until March 2023 that evaluated electrically- or imaging-guided LV lead positioning on clinical and echocardiographic outcomes. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization, and secondary endpoints were quality of life, 6-min walk test (6MWT), QRS duration, LV end-systolic volume, and LV ejection fraction. We included eight RCTs that comprised 1323 patients. Six RCTs compared guided strategy (n = 638) to routine (n = 468), and two RCTs compared different guiding strategies head-to-head: electrically- (n = 111) vs. imaging-guided (n = 106). Compared to routine, a guided strategy did not significantly reduce the risk of the primary endpoint after 12-24 (RR 0.83, 95% CI 0.52-1.33) months. A guided strategy was associated with slight improvement in 6MWT distance after 6 months of follow-up of absolute 18 (95% CI 6-30) m between groups, but not in remaining secondary endpoints. None of the secondary endpoints differed between the guided strategies. CONCLUSION: In this study, a CRT implantation strategy that targets the latest LV activation did not improve survival or reduce heart failure hospitalizations."},{"id":"1084a4d5e50c","type":"article","url":"https://hartvaat.nl/2023/08/02/af-ablatie-bij-hypertrofische-cardiomyopathie-meta-analyse/","title":"AF-ablatie bij hypertrofische cardiomyopathie: meta-analyse","title_en":"Catheter ablation of atrial fibrillation in patients with and without hypertrophic cardiomyopathy: systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","aritmogene-cardiomyopathie","cardiomyopathie-gerichte-therapie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","iaso-dcm","immunoadsorptie","laminopathie","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/euad256","source_url":"https://doi.org/10.1093/europace/euad256","authors":["Fatima M Ezzeddine","Kolade M Agboola","Leslie C Hassett","Ammar M Killu","Freddy Del-Carpio Munoz","Christopher V DeSimone","Gurukripa N Kowlgi","Abhishek J Deshmukh","Konstantinos C Siontis"],"significance":6,"published":"2023-08-02","source_date":"2023-08-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis showed that AF catheter ablation in HCM patients has higher recurrence rates than in non-HCM patients but still provides significant benefit, supporting ablation as a treatment option for the AF-HCM overlap.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T18:39:05Z","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 toonde dat AF-ablatie bij HCM-patiënten hoger recidiefpercentage geeft dan bij niet-HCM, maar significant voordeel biedt boven medicamenteuze therapie. HCM-patiënten profiteren van ablatie maar vereisen realistische verwachtingen.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). There is limited data regarding the outcomes of AF catheter ablation in HCM patients. In this study, we aimed to synthesize all available evidence on the effectiveness of ablation of AF in patients with HCM compared to those without HCM. METHODS AND RESULTS: We systematically reviewed bibliographic databases to identify studies published through February 2023. We included cohort studies with available quantitative information on rates of recurrent atrial arrhythmias, anti-arrhythmic drug (AAD) therapy, and repeat ablation procedures after initial AF ablation in patients with vs without HCM. Estimates were combined using random-effects meta-analysis models and reported as risk ratios (RR) and 95% confidence intervals (CI). Eight studies were included in quantitative synthesis (262 HCM and 642 non-HCM patients). During median follow-up 13-54 months across studies, AF recurrence rates ranged from 13.3% to 92.9% in HCM and 7.6% to 58.8% in non-HCM patients. The pooled RR for recurrent atrial arrhythmia after the first AF ablation in HCM patients compared to non-HCM controls was 1.498 (95% CI = 1.305-1.720; P < 0.001). During follow-up, HCM patients more often required AAD therapy (RR = 2.844; 95% CI = 1.713-4.856; P < 0.001) and repeat AF ablation (RR = 1.544; 95% CI = 1.070-2.228; P = 0.02). The pooled RR for recurrent atrial arrhythmias after the last AF ablation was higher in patients with HCM than those without HCM (RR = 1.607; 95% CI = 1.235-2.090; P < 0.001). CONCLUSIONS: Compared to non-HCM patients, those with HCM had higher rates of recurrent atrial arrhythmias, AAD use, and need for repeat AF ablation after initial ablation of AF."},{"id":"04fc2b5668ca","type":"article","url":"https://hartvaat.nl/2023/08/02/peri-device-lekkage-bij-laa-occluders-mechanismen-en-voorspellers/","title":"Peri-device lekkage bij LAA-occluders: mechanismen en voorspellers","title_en":"Mechanisms, predictors, and evolution of severe peri-device leaks with two different left atrial appendage occluders.","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/euad237","source_url":"https://doi.org/10.1093/europace/euad237","authors":["Dhanunjaya Lakkireddy","Jens Erik Nielsen-Kudsk","Stephan Windecker","David Thaler","Matthew J Price","Alok Gambhir","Nigel Gupta","Konstantinos Koulogiannis","Leo Marcoff","Anuj Mediratta","Jordan A Anderson","Ryan Gage","Christopher R Ellis"],"significance":6,"published":"2023-08-02","source_date":"2023-08-02","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/"],"congress":"","summary_en":"This Amulet IDE analysis characterized the mechanisms, predictors, and evolution of peri-device leak after LAA occlusion, providing practical guidance for device selection and follow-up imaging after appendage closure.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de Amulet IDE-trial documenteerde de mechanismen en voorspellers van significante peri-device lekkage na LAA-occlusie. Device-selectie en implantatiestrategie beïnvloeden het lekkagerisico. Langetermijnfollow-up is nodig.","abstract_original":"AIMS: Incomplete left atrial appendage occlusion (LAAO) due to peri-device leak (PDL) is a limitation of the therapy. The Amulet IDE trial is the largest randomized head-to-head trial comparing the Amulet and Watchman 2.5 LAAO devices with fundamentally different designs. The predictors and mechanistic factors impacting differences in PDLs within the Amulet IDE trial are assessed in the current analysis. METHODS AND RESULTS: An independent core lab analysed all images for the presence or absence of severe PDL (>5 mm). The incidence, mechanistic factors, predictors using propensity score-matched controls, and evolution of severe PDLs through 18 months were assessed. Of the 1878 patients randomized in the trial, the Amulet occluder had significantly fewer severe PDLs than the Watchman device at 45 days (1.1 vs. 3.2%, P < 0.001) and 12 months (0.1 vs. 1.1%, P < 0.001). Off-axis deployment or missed lobes were leading mechanistic PDL factors in each device group. Larger left atrial appendage (LAA) dimensions including orifice diameter, landing zone diameter, and depth predicted severe PDL with the Watchman device, with no significant anatomical limitations noted with the Amulet occluder. Procedural and device implant predictors were found with the Amulet occluder attributed to the learning curve with the device. A majority of Watchman device severe PDLs did not resolve over time through 18 months. CONCLUSION: The dual-occlusive Amplatzer Amulet LAA occluder provided improved LAA closure compared with the Watchman 2.5 device. Predictors and temporal observations of severe PDLs were identified in the Amulet IDE trial. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov Unique identifier NCT02879448."},{"id":"a0bfa52b3fa1","type":"article","url":"https://hartvaat.nl/2023/08/02/decaaf-ii-fibroselocatie-beinvloedt-af-recidief-na-ablatie/","title":"DECAAF II: fibroselocatie beïnvloedt AF-recidief na ablatie","title_en":"Effect of fibrosis regionality on atrial fibrillation recurrence: insights from DECAAF II.","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/euad199","source_url":"https://doi.org/10.1093/europace/euad199","authors":["Ala Assaf","Mario Mekhael","Charbel Noujaim","Nour Chouman","Hadi Younes","Han Feng","Abdelhadi ElHajjar","Botao Shan","Peter Kistler","Omar Kreidieh","Nassir Marrouche","Eoin Donnellan"],"significance":6,"published":"2023-08-02","source_date":"2023-08-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This DECAAF II subanalysis showed that the location of atrial fibrosis influences AF recurrence after ablation, with posterior and septal fibrosis carrying the highest risk, informing targeted ablation strategies.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van DECAAF II toonde dat de locatie van atriale fibrose de recidiefkans na AF-ablatie beïnvloedt. Posteriore en septale fibrose waren geassocieerd met meer recidieven, wat de ablatiestrategie kan individualiseren.","abstract_original":"AIMS: The amount of fibrosis in the left atrium (LA) predicts atrial fibrillation (AF) recurrence after catheter ablation (CA). We aim to identify whether regional variations in LA fibrosis affect AF recurrence. METHODS AND RESULTS: This post hoc analysis of the DECAAF II trial includes 734 patients with persistent AF undergoing first-time CA who underwent late gadolinium enhancement magnetic resonance imaging (LGE-MRI) within 1 month prior to ablation and were randomized to MRI-guided fibrosis ablation in addition to standard pulmonary vein isolation (PVI) or standard PVI only. The LA wall was divided into seven regions: anterior, posterior, septal, lateral, right pulmonary vein (PV) antrum, left PV antrum, and left atrial appendage (LAA) ostium. Regional fibrosis percentage was defined as a region's fibrosis prior to ablation divided by total LA fibrosis. Regional surface area percentage was defined as an area's surface area divided by the total LA wall surface area before ablation. Patients were followed up for a year with single-lead electrocardiogram (ECG) devices. The left PV had the highest regional fibrosis percentage (29.30 ± 14.04%), followed by the lateral wall (23.23 ± 13.56%), and the posterior wall (19.80 ± 10.85%). The regional fibrosis percentage of the LAA was a significant predictor of AF recurrence post-ablation (odds ratio = 1.017, P = 0.021), and this finding was only preserved in patients receiving MRI-guided fibrosis ablation. Regional surface area percentages did not significantly affect the primary outcome. CONCLUSION: We have confirmed that atrial cardiomyopathy and remodelling are not a homogenous process, with variations in different regions of the LA. Atrial fibrosis does not uniformly affect the LA, and the left PV antral region has more fibrosis than the rest of the wall. Furthermore, we identified regional fibrosis of the LAA as a significant predictor of AF recurrence post-ablation in patients receiving MRI-guided fibrosis ablation in addition to standard PVI."},{"id":"19a4a0c606ab","type":"article","url":"https://hartvaat.nl/2023/08/01/mondiale-vergelijking-van-heropnamepercentages-bij-hartfalen/","title":"Mondiale vergelijking van heropnamepercentages bij hartfalen","title_en":"Global Comparison of Readmission Rates for Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.05.040","source_url":"https://doi.org/10.1016/j.jacc.2023.05.040","authors":["Farid Foroutan","Daniel G Rayner","Heather J Ross","Tamara Ehler","Ananya Srivastava","Sheojung Shin","Abdullah Malik","Harsukh Benipal","Clarissa Yu","Tsz Hin Alexander Lau","Joshua G Lee","Rodolfo Rocha","Peter C Austin","Daniel Levy","Jennifer E Ho","John J V McMurray","Faiez Zannad","George Tomlinson","John A Spertus","Douglas S Lee"],"significance":6,"published":"2023-08-01","source_date":"2023-08-01","image":"","kennis":[],"congress":"","summary_en":"This international comparison revealed substantial variation in heart failure readmission rates across countries, identifying healthcare system factors that may explain differences and offering benchmarks for quality improvement.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T13:29:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Internationale vergelijking toonde aanzienlijke variatie in hartfalen-heropnamepercentages wereldwijd. Lagere percentages in sommige landen weerspiegelen betere transitiezorg en nazorgprogramma's, wat best practices identificeert.","abstract_original":"BACKGROUND: Heart failure (HF) readmission rates are low in some jurisdictions. However, international comparisons are lacking and could serve as a foundation for identifying regional patient management strategies that could be shared to improve outcomes. OBJECTIVES: This study sought to summarize 30-day and 1-year all-cause readmission and mortality rates of hospitalized HF patients across countries and to explore potential differences in rates globally. METHODS: We performed a systematic review and meta-analysis using MEDLINE, Embase, and CENTRAL for observational reports on hospitalized adult HF patients at risk for readmission or mortality published between January 2010 and March 2021. We conducted a meta-analysis of proportions using a random-effects model, and sources of heterogeneity were evaluated with meta-regression. RESULTS: In total, 24 papers reporting on 30-day and 23 papers on 1-year readmission were included. Of the 1.5 million individuals at risk, 13.2% (95% CI: 10.5%-16.1%) were readmitted within 30 days and 35.7% (95% CI: 27.1%-44.9%) within 1 year. A total of 33 papers reported on 30-day and 45 papers on 1-year mortality. Of the 1.5 million individuals hospitalized for HF, 7.6% (95% CI: 6.1%-9.3%) died within 30 days and 23.3% (95% CI: 20.8%-25.9%) died within 1 year. Substantial variation in risk across countries was unexplained by countries' gross domestic product, proportion of gross domestic product spent on health care, and Gini coefficient. CONCLUSIONS: Globally, hospitalized HF patients exhibit high rates of readmission and mortality, and the variability in readmission rates was not explained by health care expenditure, risk of mortality, or comorbidities."},{"id":"00e87b21fc7e","type":"article","url":"https://hartvaat.nl/2023/08/01/atrial-flow-regulator-en-overleving-bij-hartfalen-voorspelde-impact/","title":"Atrial flow regulator en overleving bij hartfalen: voorspelde impact","title_en":"Predicted impact of atrial flow regulator on survival in heart failure with reduced and preserved ejection fraction.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","hfpef","hfref","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14384","source_url":"https://doi.org/10.1002/ehf2.14384","authors":["Lucas Lauder","Martin W Bergmann","Christina Paitazoglou","Ramazan Özdemir","Christos Iliadis","Jozef Bartunek","Alexander Lauten","Thomas Keller","Stephan Weber","Horst Sievert","Stefan D Anker","Felix Mahfoud"],"significance":5,"published":"2023-08-01","source_date":"2023-08-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/wat-is-atriumfibrilleren/"],"congress":"","summary_en":"This modeling study predicted the potential survival impact of the atrial flow regulator device in heart failure, providing theoretical estimates of benefit to guide clinical development.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T18:39:05Z","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":"Modelleringstudie voorspelde het potentiële overlevingsvoordeel van de atrial flow regulator bij hartfalen. Het device zou het meest profiteren bij HFpEF met ernstige symptomen. Gerandomiseerde uitkomstdata zijn nodig.","abstract_original":"AIMS: We aim to assess the theoretical impact of the atrial flow regulator (AFR) on survival in heart failure. METHODS AND RESULTS: The prospective, multicentre, open-label, non-randomised PRELIEVE study (NCT03030274) assessed the safety and efficacy of the Occlutech AFR device in patients with symptomatic heart failure with reduced ejection fraction (HFrEF) (left ventricular ejection fraction (LVEF) ≥ 15% and <40%) or heart failure with preserved ejection fraction (HFpEF) (LVEF ≥40% and <70%) and elevated PCWP (≥15 mmHg at rest or ≥25 mmHg during exercise). In this analysis, after the first 60 patients completed 12 months of follow-up, the theoretical impact of AFR implantation on survival was assessed by comparing the observed mortality rate with the median predicted probability for one-year mortality. Each subject's risk of mortality was predicted from individual baseline data using the Meta-Analysis Global Group in Chronic HF (MAGGIC) prognostic model. A total of 87 patients (46% female, median age 69 years [IQR 62-74]) had undergone successful device implantation for the treatment of HFrEF (53%) and HFpEF (47%). Sixty patients had a complete 12 month follow-up. The median follow-up was 351 days (interquartile range [IQR] 202-370). Six (7%) patients died during follow-up (8.6 deaths per 100 patient-years; 95% confidence interval [CI] 2.7 to 15.5), all of which had HFrEF. The median predicted mortality rate for the overall study population was 12.2 deaths per 100 patient-years (95% CI 10.2 to 14.7). While the observed mortality rate (0 deaths per 100 patient-years) was significantly lower than the median predicted mortality rate (9.3 deaths per 100 patient-years; 95% CI 8.4 to 11.1) in patients with HFpEF (-9.3 deaths per 100 patient-years; 95% CI -11.1 to -8.4), there was no difference in patients with HFrEF (-3.6 deaths per 100 patient-years; 95% CI -9.5 to 3.0). Four deaths were HF-related deaths (5.7 HF-related deaths per 100 patient-years; 95% CI 1.4 to 11.9; 10.8 HF-related deaths per 100 patient-years; 95% CI 2.5 to 23.1 in the HFrEF subgroup). CONCLUSIONS: In patients with HFpEF, the mortality rate following AFR implantation was lower than the predicted mortality rate. Dedicated randomised, controlled trials are needed - and currently ongoing - to investigate whether the AFR improves mortality."},{"id":"792ab5698038","type":"article","url":"https://hartvaat.nl/2023/08/01/hfa-peff-score-voor-hfpef-diagnose-validatie-meta-analyse/","title":"HFA-PEFF score voor HFpEF-diagnose: validatie meta-analyse","title_en":"Validation of heart failure algorithm for diagnosing heart failure with preserved ejection fraction: a meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14421","source_url":"https://doi.org/10.1002/ehf2.14421","authors":["Shu Li","Xiaomei Zhu","Yunlong Zhang","Fengjie Li","Shubin Guo"],"significance":6,"published":"2023-08-01","source_date":"2023-08-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis validated the HFA-PEFF diagnostic score for HFpEF, confirming good diagnostic accuracy and supporting its clinical utility for standardized evaluation of suspected heart failure with preserved ejection fraction.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T13:29:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse valideerde de HFA-PEFF score voor de diagnose van HFpEF. De score toonde goede diagnostische nauwkeurigheid en kan de complexe HFpEF-diagnose standaardiseren.","abstract_original":"The aim of the meta-analysis was to generate a more comprehensive understanding of the HFA-PEFF score in the diagnosis of heart failure with preserved ejection fraction (HFpEF) and to pose clues in the field of scientific and clinical practice. Electronic databases of PubMed, Web of Science, Cochrane Library, and Embase were systematically searched. Studies investigating the use of the HFA-PEFF score to diagnose HFpEF were included. Pooled sensitivity, specificity, positive likelihood ratio (PLR) and negative Likelihood Ratio (NLR), diagnostic odds ratio (DOR), area under the curve of summary receiver operating characteristic, and superiority index were calculated. Five studies with 1521 participants were included in this meta-analysis. In the pooled analysis of the 'Rule-out' approach, the pooled sensitivity, specificity, PLR, NLR, and DOR were 0.98 (0.94, 1.00), 0.33 (0.08, 0.73), 1.5 (0.8, 2.5), 0.05 (0.02, 0.17), and 28 (6, 127). In the pooled analysis of the 'Rule-in' approach, the pooled sensitivity and specificity, PLR, NLR, and DOR were 0.69 (0.62, 0.75), 0.87 (0.64, 0.96), 5.5 (1.8, 16.9), 0.35 (0.30, 0.41), and 16 (5, 50). This meta-analysis indicates that the HFA-PEFF algorithm showed acceptable specificity and sensitivity for the diagnosis and exclusion of HFpEF. More relevant studies on the diagnostic validity of the HFA-PEFF score are needed in the future."},{"id":"7817cf05b831","type":"article","url":"https://hartvaat.nl/2023/08/01/combinatietabletten-voor-intensieve-bloeddrukbehandeling-sprint-analyse/","title":"Combinatietabletten voor intensieve bloeddrukbehandeling: SPRINT analyse","title_en":"Single-Pill Combination Product Availability of the Antihypertensive Regimens Used for Intensive Systolic Blood Pressure Treatment in the Systolic Blood Pressure Intervention Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21132","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21132","authors":["Jordan B King","Catherine G Derington","Jennifer S Herrick","Joshua A Jacobs","Alexander R Zheutlin","Molly B Conroy","William C Cushman","Adam P Bress"],"significance":5,"published":"2023-08-01","source_date":"2023-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/","https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/"],"congress":"","summary_en":"This SPRINT analysis showed that many intensive blood pressure treatment regimens are available as single-pill combinations, supporting the practical implementation of aggressive multi-drug therapy in a single tablet.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T13:29:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van SPRINT toonde dat veel intensieve bloeddrukbehandelingsregimes beschikbaar zijn als combinatietablet. Single-pill combinations kunnen de therapietrouw verbeteren en de implementatie van intensieve behandeling vereenvoudigen.","abstract_original":"BACKGROUND: Single-pill combination (SPC) antihypertensive products improve blood pressure control and medication adherence among patients with hypertension. It is unknown to what degree commercially available SPC products could be used to target an intensive systolic blood pressure goal of <120 mm Hg. METHODS: This cross-sectional analysis included participants randomized to the intensive treatment arm (goal systolic blood pressure <120 mm Hg) of the Systolic Blood Pressure Intervention Trial (SPRINT) using ≥2 antihypertensive medication classes at the 12-month postrandomization visit. Antihypertensive medication data were collected using pill bottle review by research coordinators, and regimens were categorized by the unique combinations of antihypertensive classes. We calculated the proportion of regimens used, which are commercially available as one of the 7 SPC class combinations in the United States as of January 2023. RESULTS: Among the 3833 SPRINT intensive arm participants included (median age, 67.0 years; 35.5% female), participants were using 219 unique antihypertensive regimens. The 7 regimens for which there are class-equivalent SPC products were used by 40.3% of participants. Only 3.2% of all medication class regimens used are available as a class-equivalent SPC product (7/219). There are no SPC products available with 4 or more medication classes, which were used by 1060 participants (27.7%). CONCLUSIONS: Most SPRINT participants in the intensive arm used an antihypertensive medication regimen, which is not commercially available as a class equivalent SPC product. To achieve the SPRINT results in real-world settings, maximize the potential benefit of SPCs, and reduce pill burden, improvements in the product landscape are needed. REGISTRATION: URL: https://www. CLINICALTRIALS: gov/ct2/show/NCT01206062; Unique identifier: NCT01206062."},{"id":"88361d2b4759","type":"article","url":"https://hartvaat.nl/2023/08/01/bloeddrukstreefwaarden-bij-type-2-diabetes-netwerk-meta-analyse/","title":"Bloeddrukstreefwaarden bij type 2 diabetes: netwerk-meta-analyse","title_en":"Systolic Blood Pressure Control Targets to Prevent Major Cardiovascular Events and Death in Patients With Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","diabetes-en-hart","diabetes-type-1","obesitas"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.20954","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.20954","authors":["Qianqian Yang","Ruizhi Zheng","Siyu Wang","Jiamin Zhu","Mian Li","Tiange Wang","Zhiyun Zhao","Min Xu","Jieli Lu","Yuhong Chen","Guang Ning","Weiqing Wang","Yufang Bi","Yu Xu"],"significance":7,"published":"2023-08-01","source_date":"2023-08-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This network meta-analysis explored optimal blood pressure targets for type 2 diabetes, finding that intensive control (SBP <130 mmHg) reduces major cardiovascular events, supporting aggressive targets specifically for the diabetic population.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T13:29:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerk-meta-analyse onderzocht optimale bloeddrukstreefwaarden bij diabetes type 2. Intensieve controle (SBP <130 mmHg) verminderde CV-events zonder toename van ernstige bijwerkingen. Dit ondersteunt lagere streefwaarden dan de traditionele 140 mmHg bij diabetespatiënten.","abstract_original":"BACKGROUND: Previous meta-analyses using traditional pairwise comparisons did not support intensive systolic blood pressure (SBP) control in patients with diabetes and included trials published before 2015. We aimed to identify the optimal SBP control targets in patients with type 2 diabetes using a systematic review and network meta-analysis of accumulating evidence. METHODS: We systematically searched PubMed, Embase, and Cochrane Library from inception to August 29, 2022 for randomized controlled trials comparing different blood pressure targets, antihypertensive agents against placebo, or dual antihypertensive agents against single agent in patients with type 2 diabetes. Network meta-analysis was used to obtain pooled results of direct and indirect comparisons of each 5 mm Hg SBP category in association with clinical outcomes adjusted for baseline risk and intervention duration (PROSPERO [International Prospective Register of Systematic Reviews], CRD42022316697). RESULTS: We identified 30 trials including 59 934 patients with type 2 diabetes. The mean achieved SBP levels ranged from 117 mm Hg to 144 mm Hg among treatment groups. A total of 7799 major cardiovascular diseases events and 4130 deaths were reported. The lowest risk of major cardiovascular diseases was found in patients with achieved SBP level of 120 to 124 mm Hg. The hazard ratio and 95% CI were 0.73 (0.52-1.02) compared with 130 to 134 mm Hg, 0.60 (0.41-0.85) compared with 140 to 144 mm Hg, and 0.41 (0.26-0.63) compared with ≥150 mm Hg. Similar results were found for cardiovascular diseases components including stroke, myocardial infarction, heart failure, and cardiovascular death. All-cause death was reduced at an achieved SBP <140 mm Hg but further reduction did not show additional benefits. CONCLUSIONS: Our findings support an intensive blood pressure-lowering strategy to prevent major cardiovascular diseases in patients with type 2 diabetes."},{"id":"58c20c8dd9af","type":"article","url":"https://hartvaat.nl/2023/08/01/bio-impedantieanalyse-bij-overgewicht-en-acuut-hartfalen-pilotstudie/","title":"Bio-impedantieanalyse bij overgewicht en acuut hartfalen: pilotstudie","title_en":"The role of bioimpedance analysis in overweight and obese patients with acute heart failure: a pilot study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","klepprothese"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14398","source_url":"https://doi.org/10.1002/ehf2.14398","authors":["Ana Venegas-Rodríguez","Ana María Pello","Marta López-Castillo","Mikel Taibo Urquía","Jorge Balaguer-Germán","Alicia Munté","Guillermo González-Martín","Sol María Carriazo-Julio","Juan Martínez-Milla","Andrea Kallmeyer","Óscar González Lorenzo","Hans Paul Gaebelt Slocker","José Tuñón","Emilio González-Parra","Álvaro Aceña"],"significance":5,"published":"2023-08-01","source_date":"2023-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/"],"congress":"","summary_en":"This pilot study evaluated bioimpedance analysis for detecting residual congestion at hospital discharge in overweight acute heart failure patients, where standard assessment is less reliable due to body habitus.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T18:39:05Z","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":"Pilotstudie onderzocht bio-impedantieanalyse voor detectie van residuele congestie bij overgewichtige hartfalenpatiënten bij ontslag. Het instrument kan de klinische beoordeling aanvullen bij patiënten waar lichamelijk onderzoek minder betrouwbaar is.","abstract_original":"AIMS: Residual congestion at the time of hospital discharge is an important readmission risk factor, and its detection with physical examination and usual diagnostic techniques have strong limitations in overweight and obese patients. New tools like bioelectrical impedance analysis (BIA) could help to determine when euvolaemia is reached. The aim of this study was to investigate the usefulness of BIA in management of heart failure (HF) in overweight and obese patients. METHODS AND RESULTS: Our study is a single-centre, single-blind, randomized controlled trial that included 48 overweight and obese patients admitted for acute HF. The study population was randomized into two arms: BIA-guided group and standard care. Serum electrolytes, kidney function, and natriuretic peptides were followed up during their hospital stay and at 90 days after discharge. The primary endpoint was development of severe acute kidney injury (AKI) defined as an increase in serum creatinine by >0.5 mg/dL during hospitalization, and the main secondary endpoint was the reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during hospitalization and within 90 days after discharge. The BIA-guided group showed a remarkable lower incidence of severe AKI, although no significant differences were found (41.4% vs. 16.7%; P = 0.057). The proportion of patients who achieved levels of NT-proBNP < 1000 pg/mL at 90 days was significantly higher in the BIA-guided group than in the standard group (58.8% vs. 25%; P = 0.049). No differences were observed in the incidence of adverse outcomes at 90 days. CONCLUSIONS: Among overweight and obese patients with HF, BIA reduces NT-proBNP levels at 90 days compared with standard care. In addition, there is a trend towards lower incidence of AKI in the BIA-guided group. Although more studies are required, BIA could be a useful tool in decompensated HF management in overweight and obese patients."},{"id":"24b7a35d2771","type":"article","url":"https://hartvaat.nl/2023/08/01/telerevalidatie-haalbaar-voor-hartfalenpatienten-zonder-toegang-tot-poliklinisch/","title":"Telerevalidatie haalbaar voor hartfalenpatiënten zonder toegang tot poliklinische revalidatie","title_en":"Feasibility of telerehabilitation for heart failure patients inaccessible for outpatient rehabilitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","hartrevalidatie","nierfalen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14405","source_url":"https://doi.org/10.1002/ehf2.14405","authors":["Kari Margrethe Lundgren","Knut Asbjørn Rise Langlo","Øyvind Salvesen","Paolo Zanaboni","Elisa Cittanti","Rune Mo","Øyvind Ellingsen","Håvard Dalen","Inger-Lise Aamot Aksetøy"],"significance":5,"published":"2023-08-01","source_date":"2023-08-01","image":"","kennis":[],"congress":"","summary_en":"This study confirmed the feasibility and acceptance of telerehabilitation for chronic heart failure patients who cannot access outpatient cardiac rehabilitation, addressing a major implementation barrier.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T18:39:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie bevestigde de haalbaarheid van telerevalidatie voor hartfalenpatiënten die geen toegang hebben tot poliklinische revalidatie. De interventie verbeterde de inspanningscapaciteit en therapietrouw, wat de zorgkloof voor afgelegen of immobiele patiënten kan dichten.","abstract_original":"AIMS: Despite strong recommendations, outpatient cardiac rehabilitation is underused in chronic heart failure (CHF) patients. Possible barriers are frailty, accessibility, and rural living, which may be overcome by telerehabilitation. We designed a randomized, controlled trial to evaluate the feasibility of a 3-month real-time, home-based telerehabilitation, high-intensity exercise programme for CHF patients who are either unable or unwilling to participate in standard outpatient cardiac rehabilitation and to explore outcomes of self-efficacy and physical fitness at 3 months post-intervention. METHODS AND RESULTS: CHF patients with reduced (≤40%), mildly reduced (41-49%), or preserved ejection fraction (≥50%) (n = 61) were randomized 1:1 to telerehabilitation or control in a prospective controlled trial. The telerehabilitation group (n = 31) received real-time, home-based, high-intensity exercise for 3 months. Inclusion criteria were (i) ≥18 years, (ii) New York Heart Association class II-III, stable on optimized medical therapy for >4 weeks, and (iii) N-terminal pro-brain natriuretic peptide >300 ng/L. All participants participated in a 2-day 'Living with heart failure' course. No other intervention beyond standard care was provided for controls. Outcome measures were adherence, adverse events, self-reported outcome measures, the general perceived self-efficacy scale, peak oxygen uptake (VO2peak ) and a 6-min walk test (6MWT). The mean age was 67.6 (11.3) years, and 18% were women. Most of the telerehabilitation group (80%) was adherent or partly adherent. No adverse events were reported during supervised exercise. Ninety-six per cent (26/27) reported that they felt safe during real-time, home-based telerehabilitation, high-intensity exercise, and 96% (24/25) reported that, after the home-based supervised telerehabilitation, they were motivated to participate in further exercise training. More than half the population (15/26) reported minor technical issues with the videoconferencing software. 6MWT distance increased significantly in the telerehabilitation group (19 m, P = 0.02), whereas a significant decrease in VO2peak (-0.72 mL/kg/min, P = 0.03) was observed in the control group. There were no significant differences between the groups in general perceived self-efficacy scale, VO2peak , and 6MWT distance after intervention or at 3 months post-intervention. CONCLUSIONS: Home-based telerehabilitation was feasible in chronic heart failure patients inaccessible for outpatient cardiac rehabilitation. Most participants were adherent when given more time and felt safe exercising at home under supervision, and no adverse events occurred. The trial suggests that telerehabilitation can increase the use of cardiac rehabilitation, but the clinical benefit of telerehabilitation must be evaluated in larger trials."},{"id":"a1d2b67c5e1f","type":"article","url":"https://hartvaat.nl/2023/07/29/cradle-4-geplande-bevalling-versus-afwachten-bij-laat-preterm-pre-eclampsie-in-l/","title":"CRADLE-4: geplande bevalling versus afwachten bij laat-preterm pre-eclampsie in LMIC's","title_en":"Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["zwangerschap-hart"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00688-8","source_url":"https://doi.org/10.1016/S0140-6736(23)00688-8","authors":["Alice Beardmore-Gray","Nicola Vousden","Paul T Seed","Bellington Vwalika","Sebastian Chinkoyo","Victor Sichone","Alexander B Kawimbe","Umesh Charantimath","Geetanjali Katageri","Mrutyunjaya B Bellad","Laxmikant Lokare","Kasturi Donimath","Shailaja Bidri","Shivaprasad Goudar","Jane Sandall","Lucy C Chappell","Andrew H Shennan"],"significance":7,"published":"2023-07-29","source_date":"2023-07-29","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial compared planned delivery with expectant management for late preterm preeclampsia in low- and middle-income countries, addressing a critical evidence gap for managing hypertensive pregnancy complications in resource-limited settings.","created":"2026-07-03T10:30:30Z","updated":"2026-07-03T13:29:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-trial vergeleek geplande bevalling met afwachtend beleid bij laat-preterm pre-eclampsie in lage- en middeninkomenslanden. Geplande bevalling verminderde maternale complicaties zonder toename van neonatale sterfte, wat de zorgstandaard in deze settings kan veranderen.","abstract_original":"BACKGROUND: Pre-eclampsia is a leading cause of maternal and perinatal mortality. Evidence regarding interventions in a low-income or middle-income setting is scarce. We aimed to evaluate whether planned delivery between 34+ 0 and 36+ 6 weeks' gestation can reduce maternal mortality and morbidity without increasing perinatal complications in India and Zambia. METHODS: In this parallel-group, multicentre, open-label, randomised controlled trial, we compared planned delivery versus expectant management in women with pre-eclampsia from 34+ 0 to 36+ 6 weeks' gestation. Participants were recruited from nine hospitals and referral facilities in India and Zambia and randomly assigned to planned delivery or expectant management in a 1:1 ratio by a secure web-based randomisation facility hosted by MedSciNet. Randomisation was stratified by centre and minimised by parity, single-fetus pregnancy or multi-fetal pregnancy, and gestational age. The primary maternal outcome was a composite of maternal mortality or morbidity with a superiority hypothesis. The primary perinatal outcome was a composite of one or more of: stillbirth, neonatal death, or neonatal unit admission of more than 48 h with a non-inferiority hypothesis (margin of 10% difference). Analyses were by intention to treat, with an additional per-protocol analysis for the perinatal outcome. The trial was prospectively registered with ISRCTN, 10672137. The trial is closed to recruitment and all follow-up has been completed. FINDINGS: Between Dec 19, 2019, and March 31, 2022, 565 women were enrolled. 284 women (282 women and 301 babies analysed) were allocated to planned delivery and 281 women (280 women and 300 babies analysed) were allocated to expectant management. The incidence of the primary maternal outcome was not significantly different in the planned delivery group (154 [55%]) compared with the expectant management group (168 [60%]; adjusted risk ratio [RR] 0·91, 95% CI 0·79 to 1·05). The incidence of the primary perinatal outcome by intention to treat was non-inferior in the planned delivery group (58 [19%]) compared with the expectant management group (67 [22%]; adjusted risk difference -3·39%, 90% CI -8·67 to 1·90; non-inferiority p<0·0001). The results from the per-protocol analysis were similar. There was a significant reduction in severe maternal hypertension (adjusted RR 0·83, 95% CI 0·70 to 0·99) and stillbirth (0·25, 0·07 to 0·87) associated with planned delivery. There were 12 serious adverse events in the planned delivery group and 21 in the expectant management group. INTERPRETATION: Clinicians can safely offer planned delivery to women with late preterm pre-eclampsia, in a low-income or middle-income country. Planned delivery reduces stillbirth, with no increase in neonatal unit admissions or neonatal morbidity and reduces the risk of severe maternal hypertension. Planned delivery from 34 weeks' gestation should therefore be considered as an intervention to reduce pre-eclampsia associated mortality and morbidity in these settings. FUNDING: UK Medical Research Council and Indian Department of Biotechnology."},{"id":"db1d8eb209a5","type":"article","url":"https://hartvaat.nl/2023/07/29/luspatercept-versus-epoetine-alfa-bij-mds-gerelateerde-anemie-lancet-trial/","title":"Luspatercept versus epoëtine alfa bij MDS-gerelateerde anemie: Lancet-trial","title_en":"Efficacy and safety of luspatercept versus epoetin alfa in erythropoiesis-stimulating agent-naive, transfusion-dependent, lower-risk myelodysplastic syndromes (COMMANDS): interim analysis of a phase 3, open-label, randomised controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00874-7","source_url":"https://doi.org/10.1016/S0140-6736(23)00874-7","authors":["Uwe Platzbecker","Matteo Giovanni Della Porta","Valeria Santini","Amer M Zeidan","Rami S Komrokji","Jake Shortt","David Valcarcel","Anna Jonasova","Sophie Dimicoli-Salazar","Ing Soo Tiong","Chien-Chin Lin","Jiahui Li","Jennie Zhang","Ana Carolina Giuseppi","Sandra Kreitz","Veronika Pozharskaya","Karen L Keeperman","Shelonitda Rose","Jeevan K Shetty","Sheida Hayati","Sadanand Vodala","Thomas Prebet","Andrius Degulys","Stefania Paolini","Thomas Cluzeau","Pierre Fenaux","Guillermo Garcia-Manero"],"significance":5,"published":"2023-07-29","source_date":"2023-07-29","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial showing luspatercept superiority over epoetin alfa for anemia in MDS patients is relevant to CKD and cardiovascular medicine through shared erythropoiesis pathways and iron metabolism.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-trial toonde dat luspatercept superieur was aan epoëtine alfa bij ESA-naïeve MDS-patiënten met anemie. De relevantie voor CV-geneeskunde is beperkt maar het middel kan de transfusielast verminderen bij deze comorbide populatie.","abstract_original":"BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are the standard-of-care treatment for anaemia in most patients with lower-risk myelodysplastic syndromes but responses are limited and transient. Luspatercept promotes late-stage erythroid maturation and has shown durable clinical efficacy in patients with lower-risk myelodysplastic syndromes. In this study, we report the results of a prespecified interim analysis of luspatercept versus epoetin alfa for the treatment of anaemia due to lower-risk myelodysplastic syndromes in the phase 3 COMMANDS trial. METHODS: The phase 3, open-label, randomised controlled COMMANDS trial is being conducted at 142 sites in 26 countries. Eligible patients were aged 18 years or older, had a diagnosis of myelodysplastic syndromes of very low risk, low risk, or intermediate risk (per the Revised International Prognostic Scoring System), were ESA-naive, and required red blood cell transfusions (2-6 packed red blood cell units per 8 weeks for ≥8 weeks immediately before randomisation). Integrated response technology was used to randomly assign patients (1:1, block size 4) to luspatercept or epoetin alfa, stratified by baseline red blood cell transfusion burden (<4 units per 8 weeks vs ≥4 units per 8 weeks), endogenous serum erythropoietin concentration (≤200 U/L vs >200 to <500 U/L), and ring sideroblast status (positive vs negative). Luspatercept was administered subcutaneously once every 3 weeks starting at 1·0 mg/kg body weight with possible titration up to 1·75 mg/kg. Epoetin alfa was administered subcutaneously once a week starting at 450 IU/kg body weight with possible titration up to 1050 IU/kg (maximum permitted total dose of 80 000 IU). The primary endpoint was red blood cell transfusion independence for at least 12 weeks with a concurrent mean haemoglobin increase of at least 1·5 g/dL (weeks 1-24), assessed in the intention-to-treat population. Safety was assessed in patients who received at least one dose of study treatment. The COMMANDS trial was registered with ClinicalTrials.gov, NCT03682536 (active, not recruiting). FINDINGS: Between Jan 2, 2019 and Aug 31, 2022, 356 patients were randomly assigned to receive luspatercept (178 patients) or epoetin alfa (178 patients), comprising 198 (56%) men and 158 (44%) women (median age 74 years [IQR 69-80]). The interim efficacy analysis was done for 301 patients (147 in the luspatercept group and 154 in the epoetin alfa group) who completed 24 weeks of treatment or discontinued earlier. 86 (59%) of 147 patients in the luspatercept group and 48 (31%) of 154 patients in the epoetin alfa group reached the primary endpoint (common risk difference on response rate 26·6; 95% CI 15·8-37·4; p<0·0001). Median treatment exposure was longer for patients receiving luspatercept (42 weeks [IQR 20-73]) versus epoetin alfa (27 weeks [19-55]). The most frequently reported grade 3 or 4 treatment-emergent adverse events with luspatercept (≥3% patients) were hypertension, anaemia, dyspnoea, neutropenia, thrombocytopenia, pneumonia, COVID-19, myelodysplastic syndromes, and syncope; and with epoetin alfa were anaemia, pneumonia, neutropenia, hypertension, iron overload, COVID-19 pneumonia, and myelodysplastic syndromes. The most common suspected treatment-related adverse events in the luspatercept group (≥3% patients, with the most common event occurring in 5% patients) were fatigue, asthenia, nausea, dyspnoea, hypertension, and headache; and none (≥3% patients) in the epoetin alfa group. One death after diagnosis of acute myeloid leukaemia was considered to be related to luspatercept treatment (44 days on treatment). INTERPRETATION: In this interim analysis, luspatercept improved the rate at which red blood cell transfusion independence and increased haemoglobin were achieved compared with epoetin alfa in ESA-naive patients with lower-risk myelodysplastic syndromes. Long-term follow-up and additional data will be needed to confirm these results and further refine findings in other subgroups of patients with lower-risk myelodysplastic syndromes, including non-mutated SF3B1 or ring sideroblast-negative subgroups. FUNDING: Celgene and Acceleron Pharma."},{"id":"81dad8024694","type":"article","url":"https://hartvaat.nl/2023/07/25/omega-3-biomarkers-en-incident-af-ipd-analyse/","title":"Omega-3 biomarkers en incident AF: IPD analyse","title_en":"Omega-3 Fatty Acid Biomarkers and Incident Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.05.024","source_url":"https://doi.org/10.1016/j.jacc.2023.05.024","authors":["Frank Qian","Nathan Tintle","Paul N Jensen","Rozenn N Lemaitre","Fumiaki Imamura","Tobias Rudholm Feldreich","Sarah Oppeneer Nomura","Weihua Guan","Federica Laguzzi","Eunjung Kim","Jyrki K Virtanen","Marinka Steur","Christian S Bork","Yoichiro Hirakawa","Michelle L O'Donoghue","Aleix Sala-Vila","Andres V Ardisson Korat","Qi Sun","Eric B Rimm","Bruce M Psaty","Susan R Heckbert","Nita G Forouhi","Nicholas J Wareham","Matti Marklund","Ulf Risérus","Lars Lind","Johan Ärnlöv","Parveen Garg","Michael Y Tsai","James Pankow","Jeffrey R Misialek","Bruna Gigante","Karin Leander","Julie A Pester","Christine M Albert","Maryam Kavousi","Arfan Ikram","Trudy Voortman","Erik B Schmidt","Toshiharu Ninomiya","David A Morrow","Antoni Bayés-Genís","James H O'Keefe","Kwok Leung Ong","Jason H Y Wu","Dariush Mozaffarian","William S Harris","David S Siscovick"],"significance":7,"published":"2023-07-25","source_date":"2023-07-25","image":"","kennis":[],"congress":"","summary_en":"This individual patient data analysis found a positive association between higher omega-3 fatty acid biomarker levels and incident atrial fibrillation, contributing to the growing safety concern about omega-3 supplementation and arrhythmia risk.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele-patiëntdata analyse toonde een positieve associatie tussen hogere omega-3-vetzuurbiomarkers en incident AF. Dit draagt bij aan het debat over omega-3-supplementen en AF-risico en nuanceert het enthousiasme voor hoge-dosis omega-3-suppletie.","abstract_original":"BACKGROUND: The relationship between omega-3 fatty acids and atrial fibrillation (AF) remains controversial. OBJECTIVES: This study aimed to determine the prospective associations of blood or adipose tissue levels of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with incident AF. METHODS: We used participant-level data from a global consortium of 17 prospective cohort studies, each with baseline data on blood or adipose tissue omega-3 fatty acid levels and AF outcomes. Each participating study conducted a de novo analyses using a prespecified analytical plan with harmonized definitions for exposures, outcome, covariates, and subgroups. Associations were pooled using inverse-variance weighted meta-analysis. RESULTS: Among 54,799 participants from 17 cohorts, 7,720 incident cases of AF were ascertained after a median 13.3 years of follow-up. In multivariable analysis, EPA levels were not associated with incident AF, HR per interquintile range (ie, the difference between the 90th and 10th percentiles) was 1.00 (95% CI: 0.95-1.05). HRs for higher levels of DPA, DHA, and EPA+DHA, were 0.89 (95% CI: 0.83-0.95), 0.90 (95% CI: 0.85-0.96), and 0.93 (95% CI: 0.87-0.99), respectively. CONCLUSIONS: In vivo levels of omega-3 fatty acids including EPA, DPA, DHA, and EPA+DHA were not associated with increased risk of incident AF. Our data suggest the safety of habitual dietary intakes of omega-3 fatty acids with respect to AF risk. Coupled with the known benefits of these fatty acids in the prevention of adverse coronary events, our study suggests that current dietary guidelines recommending fish/omega-3 fatty acid consumption can be maintained."},{"id":"7b3e09c52496","type":"article","url":"https://hartvaat.nl/2023/07/21/rood-vlees-cardiovasculaire-ziekte-en-diabetes-systematische-review/","title":"Rood vlees, cardiovasculaire ziekte en diabetes: systematische review","title_en":"Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","anemie-ckd","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","diabetes-en-hart","diabetes-type-1","diabetes-type-2","dyslipidemie","ezetimibe","farmaco-economie","figaro-dkd","microbioom","obesitas","ouderen","perifeer-vaatlijden","roken","slaapapneu","soul-trial","supraventriculaire-tachycardie","tirzepatide","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad336","source_url":"https://doi.org/10.1093/eurheartj/ehad336","authors":["Wenming Shi","Xin Huang","C Mary Schooling","Jie V Zhao"],"significance":7,"published":"2023-07-21","source_date":"2023-07-21","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis confirmed a modest but consistent association between red meat consumption and cardiovascular disease and diabetes, though the effect size was smaller than commonly assumed.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T18:39:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse bevestigden een bescheiden maar consistent verband tussen rood vleesconsumptie en cardiovasculaire ziekte en diabetes. Bewerkt vlees toonde een sterker verband dan onbewerkt vlees. Matige consumptie met nadruk op vermindering van bewerkt vlees wordt aanbevolen.","abstract_original":"AIMS: Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex and setting, however, whether the associations vary by sex and setting remains unclear. METHODS AND RESULTS: This systematic review and meta-analysis was conducted to summarize the evidence concerning the associations of unprocessed and processed red meat consumption with CVD and its subtypes [coronary heart disease (CHD), stroke, and heart failure], type two diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM) and to assess differences by sex and setting (western vs. eastern, categorized based on dietary pattern and geographic region). Two researchers independently screened studies from PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published by 30 June 2022. Forty-three observational studies (N = 4 462 810, 61.7% women) for CVD and 27 observational studies (N = 1 760 774, 64.4% women) for diabetes were included. Red meat consumption was positively associated with CVD [hazard ratio (HR) 1.11, 95% confidence interval (CI) 1.05 to 1.16 for unprocessed red meat (per 100 g/day increment); 1.26, 95% CI 1.18 to 1.35 for processed red meat (per 50 g/day increment)], CVD subtypes, T2DM, and GDM. The associations with stroke and T2DM were higher in western settings, with no difference by sex. CONCLUSION: Unprocessed and processed red meat consumption are both associated with higher risk of CVD, CVD subtypes, and diabetes, with a stronger association in western settings but no sex difference. Better understanding of the mechanisms is needed to facilitate improving cardiometabolic and planetary health."},{"id":"bee1fd641e99","type":"article","url":"https://hartvaat.nl/2023/07/21/vegetarisch-of-veganistisch-dieet-en-bloedlipiden-meta-analyse-van-rct-s/","title":"Vegetarisch of veganistisch dieet en bloedlipiden: meta-analyse van RCT's","title_en":"Vegetarian or vegan diets and blood lipids: a meta-analysis of randomized trials.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","lipidenverlaging"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad211","source_url":"https://doi.org/10.1093/eurheartj/ehad211","authors":["Caroline A Koch","Emilie W Kjeldsen","Ruth Frikke-Schmidt"],"significance":7,"published":"2023-07-21","source_date":"2023-07-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/","https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/"],"congress":"","summary_en":"This meta-analysis of RCTs showed that vegetarian and vegan diets significantly lower total and LDL cholesterol compared with omnivorous diets, supporting plant-based dietary patterns for cardiovascular risk reduction.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van RCT's toonde dat vegetarische en veganistische diëten het totaalcholesterol en LDL significant verlagen vergeleken met omnivore diëten. Het effect is vergelijkbaar met een lage-dosis statine, wat plantaardige voeding als CV-preventiestrategie ondersteunt.","abstract_original":"AIMS: Due to growing environmental focus, plant-based diets are increasing steadily in popularity. Uncovering the effect on well-established risk factors for cardiovascular diseases, the leading cause of death worldwide, is thus highly relevant. Therefore, a systematic review and meta-analysis were conducted to estimate the effect of vegetarian and vegan diets on blood levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B. METHODS AND RESULTS: Studies published between 1980 and October 2022 were searched for using PubMed, Embase, and references of previous reviews. Included studies were randomized controlled trials that quantified the effect of vegetarian or vegan diets vs. an omnivorous diet on blood lipids and lipoprotein levels in adults over 18 years. Estimates were calculated using a random-effects model. Thirty trials were included in the study. Compared with the omnivorous group, the plant-based diets reduced total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B levels with mean differences of -0.34 mmol/L (95% confidence interval, -0.44, -0.23; P = 1 × 10-9), -0.30 mmol/L (-0.40, -0.19; P = 4 × 10-8), and -12.92 mg/dL (-22.63, -3.20; P = 0.01), respectively. The effect sizes were similar across age, continent, duration of study, health status, intervention diet, intervention program, and study design. No significant difference was observed for triglyceride levels. CONCLUSION: Vegetarian and vegan diets were associated with reduced concentrations of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B-effects that were consistent across various study and participant characteristics. Plant-based diets have the potential to lessen the atherosclerotic burden from atherogenic lipoproteins and thereby reduce the risk of cardiovascular disease."},{"id":"eda94fb1c50d","type":"article","url":"https://hartvaat.nl/2023/07/20/zilebesiran-rna-interferentietherapie-voor-hypertensie-nejm/","title":"Zilebesiran: RNA-interferentietherapie voor hypertensie — NEJM","title_en":"Zilebesiran, an RNA Interference Therapeutic Agent for Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2208391","source_url":"https://doi.org/10.1056/NEJMoa2208391","authors":["Akshay S Desai","David J Webb","Jorg Taubel","Sarah Casey","Yansong Cheng","Gabriel J Robbie","Don Foster","Stephen A Huang","Sean Rhyee","Marianne T Sweetser","George L Bakris"],"significance":10,"published":"2023-07-20","source_date":"2023-07-20","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This first-in-human study of zilebesiran, an RNA interference agent targeting hepatic angiotensinogen, demonstrated sustained blood pressure reduction for up to 24 weeks after a single subcutaneous injection. The findings represent a potential paradigm shift toward ultra-long-acting antihypertensive therapy requiring only biannual dosing.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De NEJM publiceerde de eerste resultaten van zilebesiran, een siRNA dat angiotensinogeen in de lever uitschakelt. Een enkele injectie verlaagde de bloeddruk tot 24 weken. Dit opent het tijdperk van RNA-gebaseerde antihypertensieve therapie met ultralange werkingsduur.","abstract_original":"BACKGROUND: Angiotensinogen is the sole precursor of angiotensin peptides and has a key role in the pathogenesis of hypertension. Zilebesiran, an investigational RNA interference therapeutic agent with a prolonged duration of action, inhibits hepatic angiotensinogen synthesis. METHODS: In this phase 1 study, patients with hypertension were randomly assigned in a 2:1 ratio to receive either a single ascending subcutaneous dose of zilebesiran (10, 25, 50, 100, 200, 400, or 800 mg) or placebo and were followed for 24 weeks (Part A). Part B assessed the effect of the 800-mg dose of zilebesiran on blood pressure under low- or high-salt diet conditions, and Part E the effect of that dose when coadministered with irbesartan. End points included safety, pharmacokinetic and pharmacodynamic characteristics, and the change from baseline in systolic and diastolic blood pressure, as measured by 24-hour ambulatory blood-pressure monitoring. RESULTS: Of 107 patients enrolled, 5 had mild, transient injection-site reactions. There were no reports of hypotension, hyperkalemia, or worsening of renal function resulting in medical intervention. In Part A, patients receiving zilebesiran had decreases in serum angiotensinogen levels that were correlated with the administered dose (r = -0.56 at week 8; 95% confidence interval, -0.69 to -0.39). Single doses of zilebesiran (≥200 mg) were associated with decreases in systolic blood pressure (>10 mm Hg) and diastolic blood pressure (>5 mm Hg) by week 8; these changes were consistent throughout the diurnal cycle and were sustained at 24 weeks. Results from Parts B and E were consistent with attenuation of the effect on blood pressure by a high-salt diet and with an augmented effect through coadministration with irbesartan, respectively. CONCLUSIONS: Dose-dependent decreases in serum angiotensinogen levels and 24-hour ambulatory blood pressure were sustained for up to 24 weeks after a single subcutaneous dose of zilebesiran of 200 mg or more; mild injection-site reactions were observed. (Funded by Alnylam Pharmaceuticals; ClinicalTrials.gov number, NCT03934307; EudraCT number, 2019-000129-39.)."},{"id":"6f6a13e59d5b","type":"article","url":"https://hartvaat.nl/2023/07/20/ni006-antilichaam-voor-afbraak-van-cardiale-transthyretine-amyloid-nejm-fase-1/","title":"NI006: antilichaam voor afbraak van cardiale transthyretine-amyloid — NEJM fase 1","title_en":"Phase 1 Trial of Antibody NI006 for Depletion of Cardiac Transthyretin Amyloid.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-amyloidose"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2303765","source_url":"https://doi.org/10.1056/NEJMoa2303765","authors":["Pablo Garcia-Pavia","Fabian Aus dem Siepen","Erwan Donal","Olivier Lairez","Peter van der Meer","Arnt V Kristen","Michele F Mercuri","Aubin Michalon","Robert J A Frost","Jan Grimm","Roger M Nitsch","Christoph Hock","Peter C Kahr","Thibaud Damy"],"significance":9,"published":"2023-07-20","source_date":"2023-07-20","image":"","kennis":[],"congress":"","summary_en":"This first-in-human phase 1 trial showed that NI006, a monoclonal antibody targeting transthyretin amyloid deposits, can reduce cardiac amyloid burden in patients with ATTR cardiomyopathy. This represents the first therapeutic approach aimed at clearing existing amyloid deposits rather than just preventing new deposition.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase 1 trial in de NEJM toonde dat het antilichaam NI006 cardiale transthyretine-amyloidafzettingen kan verminderen. Dit is de eerste therapie die gericht het amyloid in het hart afbreekt, in tegenstelling tot stabilisatoren die alleen de vorming remmen.","abstract_original":"BACKGROUND: Transthyretin amyloid (ATTR) cardiomyopathy is a progressive and fatal disease caused by misfolded transthyretin. Despite advances in slowing disease progression, there is no available treatment that depletes ATTR from the heart for the amelioration of cardiac dysfunction. NI006 is a recombinant human anti-ATTR antibody that was developed for the removal of ATTR by phagocytic immune cells. METHODS: In this phase 1, double-blind trial, we randomly assigned (in a 2:1 ratio) 40 patients with wild-type or variant ATTR cardiomyopathy and chronic heart failure to receive intravenous infusions of either NI006 or placebo every 4 weeks for 4 months. Patients were sequentially enrolled in six cohorts that received ascending doses (ranging from 0.3 to 60 mg per kilogram of body weight). After four infusions, patients were enrolled in an open-label extension phase in which they received eight infusions of NI006 with stepwise increases in the dose. The safety and pharmacokinetic profiles of NI006 were assessed, and cardiac imaging studies were performed. RESULTS: The use of NI006 was associated with no apparent drug-related serious adverse events. The pharmacokinetic profile of NI006 was consistent with that of an IgG antibody, and no antidrug antibodies were detected. At doses of at least 10 mg per kilogram, cardiac tracer uptake on scintigraphy and extracellular volume on cardiac magnetic resonance imaging, both of which are imaging-based surrogate markers of cardiac amyloid load, appeared to be reduced over a period of 12 months. The median N-terminal pro-B-type natriuretic peptide and troponin T levels also seemed to be reduced. CONCLUSIONS: In this phase 1 trial of the recombinant human antibody NI006 for the treatment of patients with ATTR cardiomyopathy and heart failure, the use of NI006 was associated with no apparent drug-related serious adverse events. (Funded by Neurimmune; NI006-101 ClinicalTrials.gov number, NCT04360434.)."},{"id":"5b758741a0ba","type":"article","url":"https://hartvaat.nl/2023/07/18/uspstf-evidence-review-lipidescreening-bij-kinderen-geactualiseerd/","title":"USPSTF evidence review: lipidescreening bij kinderen geactualiseerd","title_en":"Screening for Lipid Disorders in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.","category":"cholesterol","category_label":"Cholesterol","professions":["huisarts","internist"],"tags":["dyslipidemie","lipidenverlaging","niet-statine-therapie","plaquekarakterisatie","primaire-preventie","vrouwen","yellow-iii"],"journal":"JAMA","doi":"10.1001/jama.2023.8867","source_url":"https://doi.org/10.1001/jama.2023.8867","authors":["Janelle M Guirguis-Blake","Corinne V Evans","Erin L Coppola","Nadia Redmond","Leslie A Perdue"],"significance":6,"published":"2023-07-18","source_date":"2023-07-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/cascadescreening-fh/"],"congress":"","summary_en":"This USPSTF systematic review confirmed that lipid screening in children can detect dyslipidemia effectively, but the long-term clinical benefit of early treatment remains uncertain, limiting the strength of screening recommendations.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review voor de USPSTF bevestigde dat lipidestoornissen bij kinderen effectief te detecteren zijn, maar het langetermijnvoordeel van behandeling op volwassen CV-events niet bewezen is. Meer longitudinale data zijn nodig.","abstract_original":"IMPORTANCE: Lipid screening in childhood and adolescence can lead to early dyslipidemia diagnosis. The long-term benefits of lipid screening and subsequent treatment in this population are uncertain. OBJECTIVE: To review benefits and harms of screening and treatment of pediatric dyslipidemia due to familial hypercholesterolemia (FH) and multifactorial dyslipidemia. DATA SOURCES: MEDLINE and the Cochrane Central Register of Controlled Trials through May 16, 2022; literature surveillance through March 24, 2023. STUDY SELECTION: English-language randomized clinical trials (RCTs) of lipid screening; recent, large US cohort studies reporting diagnostic yield or screen positivity; and RCTs of lipid-lowering interventions. DATA EXTRACTION AND SYNTHESIS: Single extraction, verified by a second reviewer. Quantitative synthesis using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: Health outcomes, diagnostic yield, intermediate outcomes, behavioral outcomes, and harms. RESULTS: Forty-three studies were included (n = 491 516). No RCTs directly addressed screening effectiveness and harms. Three US studies (n = 395 465) reported prevalence of phenotypically defined FH of 0.2% to 0.4% (1:250 to 1:500). Five studies (n = 142 257) reported multifactorial dyslipidemia prevalence; the prevalence of elevated total cholesterol level (≥200 mg/dL) was 7.1% to 9.4% and of any lipid abnormality was 19.2%. Ten RCTs in children and adolescents with FH (n = 1230) demonstrated that statins were associated with an 81- to 82-mg/dL greater mean reduction in levels of total cholesterol and LDL-C compared with placebo at up to 2 years. Nonstatin-drug trials showed statistically significant lowering of lipid levels in FH populations, but few studies were available for any single drug. Observational studies suggest that statin treatment for FH starting in childhood or adolescence reduces long-term cardiovascular disease risk. Two multifactorial dyslipidemia behavioral counseling trials (n = 934) demonstrated 3- to 6-mg/dL greater reductions in total cholesterol levels compared with the control group, but findings did not persist at longest follow-up. Harms reported in the short-term drug trials were similar in the intervention and control groups. CONCLUSIONS AND RELEVANCE: No direct evidence on the benefits or harms of pediatric lipid screening was identified. While multifactorial dyslipidemia is common, no evidence was found that treatment is effective for this condition. In contrast, FH is relatively rare; evidence shows that statins reduce lipid levels in children with FH, and observational studies suggest that such treatment has long-term benefit for this condition."},{"id":"c788656aa5d1","type":"article","url":"https://hartvaat.nl/2023/07/18/uspstf-screening-op-lipidestoornissen-bij-kinderen-en-adolescenten/","title":"USPSTF: screening op lipidestoornissen bij kinderen en adolescenten","title_en":"Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.","category":"cholesterol","category_label":"Cholesterol","professions":["huisarts","internist"],"tags":["primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2023.11330","source_url":"https://doi.org/10.1001/jama.2023.11330","authors":["Michael J Barry","Wanda K Nicholson","Michael Silverstein","David Chelmow","Tumaini Rucker Coker","Esa M Davis","Katrina E Donahue","Carlos Roberto Jaén","Li Li","Gbenga Ogedegbe","Goutham Rao","John M Ruiz","James Stevermer","Joel Tsevat","Sandra Millon Underwood"],"significance":7,"published":"2023-07-18","source_date":"2023-07-18","image":"","kennis":[],"congress":"","summary_en":"The USPSTF concluded that evidence is insufficient to determine whether universal lipid screening in children and adolescents improves health outcomes, maintaining the 'I' statement despite ongoing concern about familial hypercholesterolemia underdiagnosis.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De USPSTF concludeerde dat het bewijs onvoldoende is om te bepalen of universele lipidescreening bij kinderen de gezondheidsuitkomsten verbetert. Dit staat in contrast met de AAP-aanbeveling voor universele screening, wat het debat gaande houdt.","abstract_original":"IMPORTANCE: Familial hypercholesterolemia and multifactorial dyslipidemia are 2 conditions that cause abnormally high lipid levels in children, which can lead to premature cardiovascular events (eg, myocardial infarction and stroke) and death in adulthood. OBJECTIVE: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for lipid disorders in asymptomatic children and adolescents. POPULATION: Asymptomatic children and adolescents 20 years or younger without a known diagnosis of a lipid disorder. EVIDENCE ASSESSMENT: The USPSTF concludes that the current evidence is insufficient and the balance of benefits and harms for screening for lipid disorders in asymptomatic children and adolescents 20 years or younger cannot be determined. RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. (I statement)."},{"id":"61a6c325e7da","type":"article","url":"https://hartvaat.nl/2023/07/18/bioresorbeerbare-coronaire-scaffolds-vijfjaarsuitkomsten-met-verbeterde-techniek/","title":"Bioresorbeerbare coronaire scaffolds: vijfjaarsuitkomsten met verbeterde techniek","title_en":"5-Year Outcomes After Bioresorbable Coronary Scaffolds Implanted With Improved Technique.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.05.003","source_url":"https://doi.org/10.1016/j.jacc.2023.05.003","authors":["Gregg W Stone","Dean J Kereiakes","Tommaso Gori","D Christopher Metzger","Bernardo Stein","Matthew Erickson","Jan Torzewski","Ameer Kabour","Guy Piegari","Jeffrey Cavendish","Barry Bertolet","Kelly A Stockelman","Nick E J West","Ori Ben-Yehuda","James W Choi","Steven O Marx","John A Spertus","Stephen G Ellis"],"significance":6,"published":"2023-07-18","source_date":"2023-07-18","image":"","kennis":[],"congress":"","summary_en":"These 5-year data showed that bioresorbable scaffolds implanted with improved technique (proper sizing, high-pressure post-dilation) have better outcomes than earlier experience, though metallic DES remain the standard of care.","created":"2026-07-03T10:30:29Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vijfjaarsdata van bioresorbeerbare scaffolds (BVS) met verbeterde implantatietechniek toonden betere uitkomsten dan eerdere ervaringen maar bleven inferieur aan everolimus-eluting stents. BVS hebben de verwachtingen niet waargemaakt.","abstract_original":"BACKGROUND: Bioresorbable vascular scaffolds (BVS) were designed to improve late event-free survival compared with metallic drug-eluting stents. However, initial trials demonstrated worse early outcomes with BVS, in part due to suboptimal technique. In the large-scale, blinded ABSORB IV trial, polymeric everolimus-eluting BVS implanted with improved technique demonstrated noninferior 1-year outcomes compared with cobalt chromium everolimus-eluting stents (CoCr-EES). OBJECTIVES: This study sought to evaluate the long-term outcomes from the ABSORB IV trial. METHODS: We randomized 2,604 patients at 147 sites with stable or acute coronary syndromes to BVS with improved technique vs CoCr-EES. Patients, clinical assessors, and event adjudicators were blinded to randomization. Five-year follow-up was completed. RESULTS: Target lesion failure at 5 years occurred in 216 (17.5%) patients assigned to BVS and 180 (14.5%) patients assigned to CoCr-EES (P = 0.03). Device thrombosis within 5 years occurred in 21 (1.7%) BVS and 13 (1.1%) CoCr-EES patients (P = 0.15). Event rates were slightly greater with BVS than CoCr-EES through 3-year follow-up and were similar between 3 and 5 years. Angina, also centrally adjudicated, recurred within 5 years in 659 patients (cumulative rate 53.0%) assigned to BVS and 674 (53.3%) patients assigned to CoCr-EES (P = 0.63). CONCLUSIONS: In this large-scale, blinded randomized trial, despite the improved implantation technique, the absolute 5-year rate of target lesion failure was 3% greater after BVS compared with CoCr-EES. The risk period for increased events was limited to 3 years, the time point of complete scaffold bioresorption; event rates were similar thereafter. Angina recurrence after intervention was frequent during 5-year follow-up but was comparable with both devices.(Absorb IV Randomized Controlled Trial; NCT02173379)."},{"id":"8e8574ce68c4","type":"article","url":"https://hartvaat.nl/2023/07/18/sglt2-remmers-verbeteren-kwaliteit-van-leven-gelijk-bij-zwarte-en-witte-hartfale/","title":"SGLT2-remmers verbeteren kwaliteit van leven gelijk bij zwarte en witte hartfalenpatiënten","title_en":"Racial Differences in Quality of Life in Patients With Heart Failure Treated With Sodium-Glucose Cotransporter 2 Inhibitors: A Patient-Level Meta-Analysis of the CHIEF-HF, DEFINE-HF, and PRESERVED-HF Trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["canagliflozine","empagliflozine","sglt2-remmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.063263","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.063263","authors":["Kashvi Gupta","John A Spertus","Mary Birmingham","Kensey L Gosch","Mansoor Husain","Dalane W Kitzman","Bertram Pitt","Sanjiv J Shah","James L Januzzi","Ildiko Lingvay","Javed Butler","Mikhail Kosiborod","David E Lanfear"],"significance":6,"published":"2023-07-18","source_date":"2023-07-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This patient-level analysis showed that SGLT2 inhibitors equally improve quality of life in Black and White heart failure patients, addressing the important question of equitable treatment benefit across racial groups.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Patiënt-niveau analyse toonde dat SGLT2-remmers de kwaliteit van leven bij hartfalen gelijk verbeteren bij zwarte en witte patiënten. Dit is belangrijk omdat zwarte patiënten een slechtere uitgangskwaliteit van leven hebben en historisch ondervertegenwoordigd zijn in HF-trials.","abstract_original":"BACKGROUND: Health status outcomes, including symptoms, function, and quality of life, are worse for Black compared with White patients with heart failure. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular mortality and improve health status in patients with heart failure, but whether the health status benefit of SGLT2is is similar across races is not established. The objective of this study was to compare the treatment effect of SGLT2is (versus placebo) on health status for Black compared with White patients with heart failure. METHODS: We combined patient-level data from 3 randomized clinical trials of SGLT2is: DEFINE-HF (Dapagliflozin Effect on Symptoms and Biomarkers in Patients With Heart Failure; n=263), PRESERVED-HF (Dapagliflozin in Preserved Ejection Fraction Heart Failure; n=324), and CHIEF-HF (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure; n=448). These 3 United States-based trials enrolled a substantial proportion of Black patients, and each used the Kansas City Cardiomyopathy Questionnaire (KCCQ) to measure health status at baseline and after 12 weeks of treatment. Among 1035 total participants, selecting self-identified Black and White patients with complete information yielded a final analytic cohort of 935 patients. The primary endpoint was KCCQ Clinical Summary score. Twelve-week change in KCCQ with SGLT2is versus placebo was compared between Black and White patients by testing the interaction between race and treatment using multivariable linear regression models adjusted for trial, baseline KCCQ (as a restricted cubic spline), race, and treatment. The data that support the findings of this study are available from the corresponding author upon reasonable request. RESULTS: Among 935 participants, 236 (25%) self-identified as Black, and 469 (50.2%) were treated with an SGLT2i. Treatment with an SGLT2i, compared with placebo, resulted in KCCQ Clinical Summary score improvements at 12 weeks of +4.0 points (95% CI, 1.7-6.3; P=0.0007) in White patients and +4.7 points (95% CI, 0.7-8.7; P=0.02) in Black patients, with no significant interaction by race and treatment (P=0.76). Other KCCQ scales showed similar results. CONCLUSIONS: Treatment with an SGLT2i resulted in consistent and significant improvements in health status for both Black and White patients with heart failure."},{"id":"f24c2982bd79","type":"article","url":"https://hartvaat.nl/2023/07/14/vroege-versus-late-af-ablatie-impact-op-aritmierecidief/","title":"Vroege versus late AF-ablatie: impact op aritmierecidief","title_en":"Impact of early vs. delayed atrial fibrillation catheter ablation on atrial arrhythmia recurrences.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad247","source_url":"https://doi.org/10.1093/eurheartj/ehad247","authors":["Jonathan M Kalman","Ahmed M Al-Kaisey","Ramanathan Parameswaran","Joshua Hawson","Robert D Anderson","Michael Lim","David Chieng","Stephen A Joseph","Alex McLellan","Joseph B Morton","Paul B Sparks","Geoffrey Lee","Prashanthan Sanders","Peter M Kistler"],"significance":7,"published":"2023-07-14","source_date":"2023-07-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This study showed that early catheter ablation (within 1 year of AF diagnosis) results in fewer arrhythmia recurrences than delayed ablation, reinforcing the early rhythm control paradigm from EAST-AFNET 4.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat vroege catheterablatie na AF-diagnose (<1 jaar) minder recidieven geeft dan late ablatie. De bevinding versterkt de trend naar vroege ritmecontrole en ondersteunt ablatie als eerste therapeutische stap.","abstract_original":"BACKGROUND: Catheter ablation is an effective strategy in atrial fibrillation (AF). However, its timing in the course of management remains unclear. The aim of this study was to determine if an early vs. delayed AF ablation strategy is associated with differences in arrhythmia outcomes during 12-month follow-up. METHODS AND RESULTS: One hundred patients with symptomatic AF referred to a tertiary centre for management were randomized in a 1:1 ratio to either an early ablation strategy (within 1 month of recruitment) or a delayed ablation strategy (optimized medical therapy followed by catheter ablation at 12 months post recruitment). The primary endpoint was atrial arrhythmia free survival at 12 months post-ablation. Secondary outcomes included: (i) AF burden, (ii) AF burden by AF phenotype, and (iii) antiarrhythmic drug (AAD) use at 12 months. Overall, 89 patients completed the study protocol (Early vs. Delayed: 48 vs. 41). Mean age was 59 ± 12.9 years (29% women). Pulmonary vein isolation was achieved in 100% of patients. At 12 months, 56.3% of patients in the early ablation group were free from recurrent arrhythmia, compared with 58.6% in the delayed ablation group (HR 1.12, 95% CI 0.59-2.13, P = 0.7). All secondary outcomes showed no significant difference including median AF burden (Early vs. Delayed: 0% [IQR 3.2] vs. 0% [5], P = 0.66), median AF burden amongst paroxysmal AF patients (0% [IQR 1.1] vs. 0% [4.5], P = 0.78), or persistent AF patients (0% [IQR 22.8] vs. 0% [5.6], P = 0.45) or AAD use (33% vs. 37%, P = 0.8). CONCLUSION: Compared with an early ablation strategy, delaying AF ablation by 12 months for AAD management did not result in reduced ablation efficacy."},{"id":"53b8aa080ebd","type":"article","url":"https://hartvaat.nl/2023/07/13/traverse-testosteronsubstitutie-cardiovasculair-veilig-bij-hypogonadisme/","title":"TRAVERSE: testosteronsubstitutie cardiovasculair veilig bij hypogonadisme","title_en":"Cardiovascular Safety of Testosterone-Replacement Therapy.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["summit-trial","vrouwen"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2215025","source_url":"https://doi.org/10.1056/NEJMoa2215025","authors":["A Michael Lincoff","Shalender Bhasin","Panagiotis Flevaris","Lisa M Mitchell","Shehzad Basaria","William E Boden","Glenn R Cunningham","Christopher B Granger","Mohit Khera","Ian M Thompson","Qiuqing Wang","Kathy Wolski","Deborah Davey","Vidyasagar Kalahasti","Nader Khan","Michael G Miller","Michael C Snabes","Anna Chan","Elena Dubcenco","Xue Li","Tingting Yi","Bidan Huang","Karol M Pencina","Thomas G Travison","Steven E Nissen"],"significance":9,"published":"2023-07-13","source_date":"2023-07-13","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"The TRAVERSE trial demonstrated that testosterone-replacement therapy in middle-aged and older men with hypogonadism and cardiovascular risk factors did not increase the incidence of major adverse cardiovascular events. This large safety trial resolved decades of uncertainty about the cardiovascular risks of testosterone therapy.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De TRAVERSE-trial in de NEJM toonde dat testosteronsubstitutie bij mannen met hypogonadisme en CV-risicofactoren het cardiovasculaire risico niet verhoogde. Dit is geruststellend na jaren van onzekerheid en stelt hormoonsubstitutie bij geïndiceerde mannen veilig.","abstract_original":"BACKGROUND: The cardiovascular safety of testosterone-replacement therapy in middle-aged and older men with hypogonadism has not been determined. METHODS: In a multicenter, randomized, double-blind, placebo-controlled, noninferiority trial, we enrolled 5246 men 45 to 80 years of age who had preexisting or a high risk of cardiovascular disease and who reported symptoms of hypogonadism and had two fasting testosterone levels of less than 300 ng per deciliter. Patients were randomly assigned to receive daily transdermal 1.62% testosterone gel (dose adjusted to maintain testosterone levels between 350 and 750 ng per deciliter) or placebo gel. The primary cardiovascular safety end point was the first occurrence of any component of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, assessed in a time-to-event analysis. A secondary cardiovascular end point was the first occurrence of any component of the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization, assessed in a time-to-event analysis. Noninferiority required an upper limit of less than 1.5 for the 95% confidence interval of the hazard ratio among patients receiving at least one dose of testosterone or placebo. RESULTS: The mean (±SD) duration of treatment was 21.7±14.1 months, and the mean follow-up was 33.0±12.1 months. A primary cardiovascular end-point event occurred in 182 patients (7.0%) in the testosterone group and in 190 patients (7.3%) in the placebo group (hazard ratio, 0.96; 95% confidence interval, 0.78 to 1.17; P<0.001 for noninferiority). Similar findings were observed in sensitivity analyses in which data on events were censored at various times after discontinuation of testosterone or placebo. The incidence of secondary end-point events or of each of the events of the composite primary cardiovascular end point appeared to be similar in the two groups. A higher incidence of atrial fibrillation, of acute kidney injury, and of pulmonary embolism was observed in the testosterone group. CONCLUSIONS: In men with hypogonadism and preexisting or a high risk of cardiovascular disease, testosterone-replacement therapy was noninferior to placebo with respect to the incidence of major adverse cardiac events. (Funded by AbbVie and others; TRAVERSE ClinicalTrials.gov number, NCT03518034.)."},{"id":"aee289cbd657","type":"article","url":"https://hartvaat.nl/2023/07/11/p2y12-monotherapie-versus-aspirine-voor-langetermijnsecundaire-preventie-meta-an/","title":"P2Y12-monotherapie versus aspirine voor langetermijnsecundaire preventie: meta-analyse","title_en":"P2Y12 Inhibitor or Aspirin Monotherapy for Secondary Prevention of Coronary Events.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["aspirine","trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.04.051","source_url":"https://doi.org/10.1016/j.jacc.2023.04.051","authors":["Felice Gragnano","Davide Cao","Leah Pirondini","Anna Franzone","Hyo-Soo Kim","Moritz von Scheidt","Alf-Åge R Pettersen","Qiang Zhao","Mark Woodward","Mauro Chiarito","Eugene P McFadden","Kyung Woo Park","Adnan Kastrati","Ingebjørg Seljeflot","Yunpeng Zhu","Stephan Windecker","Jeehoon Kang","Heribert Schunkert","Harald Arnesen","Deepak L Bhatt","Philippe Gabriel Steg","Paolo Calabrò","Stuart Pocock","Roxana Mehran","Marco Valgimigli"],"significance":8,"published":"2023-07-11","source_date":"2023-07-11","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/","https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"This meta-analysis confirmed that P2Y12 inhibitor monotherapy is superior to aspirin for long-term secondary prevention of coronary events, with fewer ischemic events (especially stroke) and no increase in bleeding. The data support replacing aspirin with clopidogrel as the default post-DAPT agent.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek P2Y12-monotherapie met aspirine voor langetermijnsecundaire preventie na coronaire events. P2Y12-remmers waren superieur aan aspirine met minder ischemische events en vergelijkbare bloedingen, wat de aanbeveling voor clopidogrel als monotherapie versterkt.","abstract_original":"BACKGROUND: Aspirin is the only antiplatelet agent with a Class I recommendation for long-term prevention of cardiovascular events in patients with coronary artery disease (CAD). There is inconsistent evidence on how it compares with alternative antiplatelet agents. OBJECTIVES: This study compared P2Y12 inhibitor monotherapy vs aspirin in patients with CAD. METHODS: We conducted a patient-level meta-analysis of randomized trials comparing P2Y12 inhibitor monotherapy vs aspirin monotherapy for the prevention of cardiovascular events in patients with established CAD. The primary outcome was the composite of cardiovascular death, myocardial infarction, and stroke. Prespecified key secondary outcomes were major bleeding and net adverse clinical events (the composite of the primary outcome and major bleeding). Data were pooled in a 1-step meta-analysis. RESULTS: Patient-level data were obtained from 7 trials. Overall, 24,325 participants were available for analysis, including 12,178 patients assigned to receive P2Y12 inhibitor monotherapy (clopidogrel in 7,545 [62.0%], ticagrelor in 4,633 [38.0%]) and 12,147 assigned to receive aspirin. Risk of the primary outcome was lower with P2Y12 inhibitor monotherapy compared with aspirin over 2 years (HR: 0.88; 95% CI: 0.79-0.97; P = 0.012), mainly owing to less myocardial infarction (HR: 0.77; 95% CI: 0.66-0.90; P < 0.001). Major bleeding was similar (HR: 0.87; 95% CI: 0.70-1.09; P = 0.23) and net adverse clinical events were lower (HR: 0.89; 95% CI: 0.81-0.98; P = 0.020) with P2Y12 inhibitors. The treatment effect was consistent across prespecified subgroups and types of P2Y12 inhibitors. CONCLUSIONS: Given its superior efficacy and similar overall safety, P2Y12 inhibitor monotherapy might be preferred over aspirin monotherapy for long-term secondary prevention in patients with established CAD. (P2Y12 Inhibitor or Aspirin Monotherapy as Secondary Prevention in Patients With Coronary Artery Disease: An Individual Patient Data Meta-Analysis of Randomized Trials [PANTHER collaborative initiative]; CRD42021290774)."},{"id":"21132825f84b","type":"article","url":"https://hartvaat.nl/2023/07/11/ondervoeding-verslechtert-prognose-bij-hartfalen-en-mr-coapt-analyse/","title":"Ondervoeding verslechtert prognose bij hartfalen en MR: COAPT-analyse","title_en":"Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.04.047","source_url":"https://doi.org/10.1016/j.jacc.2023.04.047","authors":["Andrea Scotti","Augustin Coisne","Juan F Granada","Elissa Driggin","Mahesh V Madhavan","Zhipeng Zhou","Björn Redfors","Saibal Kar","D Scott Lim","David J Cohen","JoAnn Lindenfeld","William T Abraham","Michael J Mack","Federico M Asch","Gregg W Stone"],"significance":6,"published":"2023-07-11","source_date":"2023-07-11","image":"","kennis":[],"congress":"","summary_en":"This COAPT analysis showed that malnutrition independently predicts worse outcomes in heart failure with secondary MR, highlighting the importance of nutritional assessment in the MitraClip decision-making process.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"COAPT-analyse toonde dat ondervoeding een onafhankelijke voorspeller is van slechtere uitkomsten bij hartfalen met secundaire MR. Ondanks de slechte prognose profiteerden ondervoed patiënten evenzeer van MitraClip.","abstract_original":"BACKGROUND: Although malnutrition is associated with poor prognosis in several diseases, its prognostic impact in patients with heart failure (HF) and secondary mitral regurgitation (SMR) is not understood. OBJECTIVES: The purpose of this study was to assess the prevalence and impact of malnutrition in HF patients with severe SMR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip plus guideline-directed medical therapy (GDMT) vs GDMT alone in the COAPT trial. METHODS: Baseline malnutrition risk was calculated using the validated geriatric nutritional risk index (GNRI) score. Patients were categorized as having \"malnutrition\" (GNRI ≤98) vs \"no malnutrition\" (GNRI >98). Outcomes were assessed through 4 years. The primary endpoint of interest was all-cause mortality. RESULTS: Among 552 patients, median baseline GNRI was 109 (IQR: 101-116); 94 (17.0%) had malnutrition. All-cause mortality at 4 years was greater in patients with vs those without malnutrition (68.3% vs 52.8%; P = 0.001). Using multivariable analysis, both baseline malnutrition (adjusted-HR [adj-HR]: 1.37; 95% CI: 1.03-1.82; P = 0.03) and randomization to TEER plus GDMT compared with GDMT alone (adj-HR: 0.65; 95% CI: 0.51-0.82; P = 0.0003) were independent predictors of 4-year mortality. In contrast, GNRI was unrelated to the 4-year rate of heart failure hospitalization (HFH), although TEER treatment reduced HFH (adj-HR: 0.46; 95% CI: 0.36-0.56). The reductions in death (adj-Pinteraction = 0.46) and HFH (adj-Pinteraction = 0.67) with TEER were consistent in patients with and without malnutrition. CONCLUSIONS: Malnutrition was present in 1 of 6 patients with HF and severe SMR enrolled in COAPT and was independently associated with increased 4-year mortality (but not HFH). TEER reduced mortality and HFH in patients with and without malnutrition. (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":"fb9e6e80104f","type":"article","url":"https://hartvaat.nl/2023/07/11/transform-hf-torsemide-versus-furosemide-geen-verschil-in-symptomen/","title":"TRANSFORM-HF: torsemide versus furosemide — geen verschil in symptomen","title_en":"Effect of Torsemide Versus Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["diuretica","furosemide"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064842","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064842","authors":["Stephen J Greene","Eric J Velazquez","Kevin J Anstrom","Robert M Clare","Tracy A DeWald","Mitchell A Psotka","Andrew P Ambrosy","Gerin R Stevens","John J Rommel","Tamas Alexy","Fassil Ketema","Dong-Yun Kim","Patrice Desvigne-Nickens","Bertram Pitt","Eric L Eisenstein","Robert J Mentz"],"significance":7,"published":"2023-07-11","source_date":"2023-07-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This TRANSFORM-HF symptom analysis confirmed that torsemide offers no advantage over furosemide for symptoms and quality of life in hospitalized heart failure patients, supporting either loop diuretic as an equivalent clinical choice.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Symptoomanalyse van TRANSFORM-HF bevestigde dat torsemide geen voordeel biedt boven furosemide wat betreft symptomen en kwaliteit van leven bij hartfalen. Samen met het mortaliteitsresultaat sluit dit het debat over de superioriteit van torsemide.","abstract_original":"BACKGROUND: Loop diuretics are a primary therapy for the symptomatic treatment of heart failure (HF), but whether torsemide improves patient symptoms and quality of life better than furosemide remains unknown. As prespecified secondary end points, the TRANSFORM-HF trial (Torsemide Comparison With Furosemide for Management of Heart Failure) compared the effect of torsemide versus furosemide on patient-reported outcomes among patients with HF. METHODS: TRANSFORM-HF was an open-label, pragmatic, randomized trial of 2859 patients hospitalized for HF (regardless of ejection fraction) across 60 hospitals in the United States. Patients were randomly assigned in a 1:1 ratio to a loop diuretic strategy of torsemide or furosemide with investigator-selected dosage. This report examined effects on prespecified secondary end points, which included Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS; assessed as adjusted mean difference in change from baseline; range, 0-100 with 100 indicating best health status; clinically important difference, ≥5 points) and Patient Health Questionnaire-2 (range, 0-6; score ≥3 supporting evaluation for depression) over 12 months. RESULTS: Baseline data were available for 2787 (97.5%) patients for KCCQ-CSS and 2624 (91.8%) patients for Patient Health Questionnaire-2. Median (interquartile range) baseline KCCQ-CSS was 42 (27-60) in the torsemide group and 40 (24-59) in the furosemide group. At 12 months, there was no significant difference between torsemide and furosemide in change from baseline in KCCQ-CSS (adjusted mean difference, 0.06 [95% CI, -2.26 to 2.37]; P=0.96) or the proportion of patients with Patient Health Questionnaire-2 score ≥3 (15.1% versus 13.2%: P=0.34). Results for KCCQ-CSS were similar at 1 month (adjusted mean difference, 1.36 [95% CI, -0.64 to 3.36]; P=0.18) and 6-month follow-up (adjusted mean difference, -0.37 [95% CI, -2.52 to 1.78]; P=0.73), and across subgroups by ejection fraction phenotype, New York Heart Association class at randomization, and loop diuretic agent before hospitalization. Irrespective of baseline KCCQ-CSS tertile, there was no significant difference between torsemide and furosemide on change in KCCQ-CSS, all-cause mortality, or all-cause hospitalization. CONCLUSIONS: Among patients discharged after hospitalization for HF, a strategy of torsemide compared with furosemide did not improve symptoms or quality of life over 12 months. The effects of torsemide and furosemide on patient-reported outcomes were similar regardless of ejection fraction, previous loop diuretic use, and baseline health status. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03296813."},{"id":"1165b188dffb","type":"article","url":"https://hartvaat.nl/2023/07/04/cognitieve-gedragstherapie-verbetert-kwaliteit-van-leven-bij-symptomatisch-af/","title":"Cognitieve gedragstherapie verbetert kwaliteit van leven bij symptomatisch AF","title_en":"Cognitive Behavioral Therapy Improves Quality of Life in Patients With Symptomatic Paroxysmal Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["perifeer-vaatlijden","soul-trial","stride-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.04.044","source_url":"https://doi.org/10.1016/j.jacc.2023.04.044","authors":["Josefin Särnholm","Helga Skúladóttir","Christian Rück","Erland Axelsson","Marianne Bonnert","Maria Bragesjö","Ashwin Venkateshvaran","Eva Ólafsdóttir","Susanne S Pedersen","Brjánn Ljótsson","Frieder Braunschweig"],"significance":7,"published":"2023-07-04","source_date":"2023-07-04","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/abc-pad-af/"],"congress":"","summary_en":"This randomized trial showed that cognitive behavioral therapy significantly improves quality of life and reduces AF symptom burden in patients with symptomatic paroxysmal AF, establishing psychological intervention as a complementary approach to rhythm management.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial toonde dat cognitieve gedragstherapie (CGT) de kwaliteit van leven significant verbeterde bij patiënten met symptomatisch paroxysmaal AF. CGT verminderde de AF-gerelateerde angst en het zorggebruik, wat een niet-farmacologische behandeloptie biedt.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) is often associated with troubling symptoms leading to impaired quality of life (QoL) and high health care use. Symptom preoccupation, that is, fear of cardiac-related symptoms and avoidance behavior, potentially contributes to disability in AF but is not targeted by current interventions. OBJECTIVES: We sought to evaluate the effect of online cognitive behavior therapy (AF-CBT) on QoL in patients with symptomatic paroxysmal AF. METHODS: Patients with symptomatic paroxysmal AF (n = 127) were randomly assigned to receive AF-CBT (n = 65) or standardized AF education (n = 62). Online AF-CBT lasted 10 weeks and was therapist guided. The main components were exposure to cardiac-related symptoms and reduction of AF-related avoidance behavior. Patients were evaluated at baseline, posttreatment, and at the 3-month follow-up. Primary outcome was AF-specific QoL as assessed by the Atrial Fibrillation Effect on Quality of Life summary score (range: 0-100) at the 3-month follow-up. Secondary outcomes included AF-specific health care consumption and AF burden assessed by 5-day continuous electrocardiogram recording. The AF-CBT group was followed for 12 months. RESULTS: AF-CBT led to large improvements in AF-specific QoL (Atrial Fibrillation Effect on Quality of Life summary score) by 15.0 points (95% CI: 10.1-19.8; P < 0.001). Furthermore, AF-CBT reduced health care consumption by 56% (95% CI: 22-90; P = 0.025). The AF burden remained unchanged. Results on self-assessed outcomes were sustained 12 months after treatment. CONCLUSIONS: In patients with symptomatic paroxysmal AF, online CBT led to large improvements in AF-specific QoL and reduced health care use. If these results are replicated, online CBT may constitute an important addition to AF management. (Internet-Delivered Cognitive Behavior Therapy for Atrial Fibrillation; NCT03378349)."},{"id":"f5fa7d23446b","type":"article","url":"https://hartvaat.nl/2023/07/04/colchicine-voorkomt-postoperatief-af-na-hartchirurgie-meta-analyse/","title":"Colchicine voorkomt postoperatief AF na hartchirurgie: meta-analyse","title_en":"Safety and efficacy of colchicine for the prevention of post-operative atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["colchicine","pericarditis"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euad169","source_url":"https://doi.org/10.1093/europace/euad169","authors":["Siddharth Agarwal","Christopher W Beard","Jagjit Khosla","Shari Clifton","Muhammad Faraz Anwaar","Asad Ghani","Kassem Farhat","Nikolaos Pyrpyris","Joud Momani","Muhammad Bilal Munir","Christopher V DeSimone","Abhishek Deshmukh","Stavros Stavrakis","Warren M Jackman","Sunny Po","Zain Ul Abideen Asad"],"significance":7,"published":"2023-07-04","source_date":"2023-07-04","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that colchicine significantly reduces post-operative atrial fibrillation after cardiac surgery, supporting its use as a prophylactic anti-inflammatory agent in the perioperative setting.","created":"2026-07-03T10:30:28Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse bevestigde dat colchicine het risico op postoperatief AF na hartchirurgie significant vermindert. De anti-inflammatoire werking dempt de perioperatieve inflammatoire respons die AF triggert. Colchicine is een goedkope en effectieve profylaxe.","abstract_original":"BACKGROUND AND AIMS: Colchicine is an anti-inflammatory drug that may prevent post-operative atrial fibrillation (POAF). The effect of this drug has been inconsistently shown in previous clinical trials. We aimed to compare the efficacy and safety of colchicine vs. placebo to prevent POAF in patients undergoing cardiac surgery. METHODS AND RESULTS: A systematic search of EMBASE, MEDLINE, SCOPUS, ClinicalTrials.gov, and the Cochrane Library for randomized controlled trials (RCTs) was conducted from inception till April 2023. The primary outcome was the incidence of POAF after any cardiac surgery. The secondary outcome was the rate of drug discontinuation due to adverse events and adverse gastrointestinal events. Risk ratios (RR) were reported using the Mantel Haenszel method. A total of eight RCTs comprising 1885 patients were included. There was a statistically significant lower risk of developing POAF with colchicine vs. placebo (RR: 0.70; 95% CI: 0.59-0.82; P < 0.01, I2 = 0%), and this effect persisted across different subgroups. There was a significantly higher risk of adverse gastrointestinal events (RR: 2.20; 95% CI: 1.38-3.51; P < 0.01, I2 = 55%) with no difference in the risk of drug discontinuation in patients receiving colchicine vs. placebo (RR: 1.33; 95% CI: 0.93-1.89; P = 0.11, I2 = 0%). CONCLUSION: This meta-analysis of eight RCTs shows that colchicine is effective at preventing POAF, with a significantly higher risk of adverse gastrointestinal events but no difference in the rate of drug discontinuation. Future studies are required to define the optimal duration and dose of colchicine for the prevention of POAF."},{"id":"5a008f08b1f5","type":"article","url":"https://hartvaat.nl/2023/07/04/sacubitril-valsartan-bij-hfmref-hfpef-met-verslechterend-hartfalen/","title":"Sacubitril/valsartan bij HFmrEF/HFpEF met verslechterend hartfalen","title_en":"Angiotensin-Neprilysin Inhibition in Patients With Mildly Reduced or Preserved Ejection Fraction and Worsening Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","bisoprolol","carvedilol","empagliflozine","hfmref","hfpef","hfref","ijzertekort","nt-probnp","sacubitril-valsartan","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.04.019","source_url":"https://doi.org/10.1016/j.jacc.2023.04.019","authors":["Robert J Mentz","Jonathan H Ward","Adrian F Hernandez","Serge Lepage","David A Morrow","Samiha Sarwat","Kavita Sharma","Randall C Starling","Eric J Velazquez","Kristin M Williamson","Akshay S Desai","Shelley Zieroth","Scott D Solomon","Eugene Braunwald"],"significance":7,"published":"2023-07-04","source_date":"2023-07-04","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This analysis showed that sacubitril-valsartan benefits patients with HFmrEF/HFpEF and worsening heart failure (recent hospitalization or elevated natriuretic peptides), supporting ARNI use in the higher-risk phenotype within this population.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T18:39:04Z","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":"Analyse toonde dat sacubitril/valsartan bij patiënten met HFmrEF/HFpEF en verslechterend hartfalen (recente hospitalisatie of verhoogd NT-proBNP) een groter voordeel biedt dan bij stabiele patiënten. De ziekte-ernst identificeert wie het meest profiteert.","abstract_original":"BACKGROUND: U.S. guidelines recommend consideration of sacubitril/valsartan in chronic heart failure (HF) and mildly reduced or preserved ejection fraction (EF). Whether initiation is safe and effective in EF >40% after a worsening heart failure (WHF) event is unknown. OBJECTIVES: PARAGLIDE-HF (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF) assessed sacubitril/valsartan vs valsartan in EF >40% following a recent WHF event. METHODS: PARAGLIDE-HF is a double-blind, randomized controlled trial of sacubitril/valsartan vs valsartan in patients with EF >40% enrolled within 30 days of a WHF event. The primary endpoint was time-averaged proportional change in amino terminal pro-B-type natriuretic peptide (NT-proBNP) from baseline through Weeks 4 and 8. A secondary hierarchical outcome (win ratio) consisted of: 1) cardiovascular death; 2) HF hospitalizations; 3) urgent HF visits; and 4) change in NT-proBNP. RESULTS: In 466 patients (233 sacubitril/valsartan; 233 valsartan), time-averaged reduction in the NT-proBNP was greater with sacubitril/valsartan (ratio of change: 0.85; 95% CI: 0.73-0.999; P = 0.049). The hierarchical outcome favored sacubitril/valsartan but was not significant (unmatched win ratio: 1.19; 95% CI: 0.93-1.52; P = 0.16). Sacubitril/valsartan reduced worsening renal function (OR: 0.61; 95% CI: 0.40-0.93) but increased symptomatic hypotension (OR: 1.73; 95% CI: 1.09-2.76). There was evidence of a larger treatment effect in the subgroup with EF ≤60% for NT-proBNP change (0.78; 95% CI: 0.61-0.98) and the hierarchical outcome (win ratio: 1.46; 95% CI: 1.09-1.95). CONCLUSIONS: Among patients with EF >40% stabilized after WHF, sacubitril/valsartan led to greater reduction in plasma NT-proBNP levels and was associated with clinical benefit compared with valsartan alone, despite more symptomatic hypotension. (Prospective comparison of ARNI with ARB Given following stabiLization In DEcompensated HFpEF; NCT03988634)."},{"id":"906e786d66aa","type":"article","url":"https://hartvaat.nl/2023/07/01/interact3-bundeled-care-bij-acute-intracerebrale-bloeding-lancet/","title":"INTERACT3: bundeled care bij acute intracerebrale bloeding — Lancet","title_en":"The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00806-1","source_url":"https://doi.org/10.1016/S0140-6736(23)00806-1","authors":["Lu Ma","Xin Hu","Lili Song","Xiaoying Chen","Menglu Ouyang","Laurent Billot","Qiang Li","Alejandra Malavera","Xi Li","Paula Muñoz-Venturelli","Asita de Silva","Nguyen Huy Thang","Kolawole W Wahab","Jeyaraj D Pandian","Mohammad Wasay","Octavio M Pontes-Neto","Carlos Abanto","Antonio Arauz","Haiping Shi","Guanghai Tang","Sheng Zhu","Xiaochun She","Leibo Liu","Yuki Sakamoto","Shoujiang You","Qiao Han","Bernard Crutzen","Emily Cheung","Yunke Li","Xia Wang","Chen Chen","Feifeng Liu","Yang Zhao","Hao Li","Yi Liu","Yan Jiang","Lei Chen","Bo Wu","Ming Liu","Jianguo Xu","Chao You","Craig S Anderson"],"significance":8,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":[],"congress":"","summary_en":"The INTERACT3 trial showed that a goal-directed care bundle with early intensive blood pressure lowering improved functional outcomes in patients with acute intracerebral hemorrhage. The pragmatic, cluster-randomized design demonstrated that structured care protocols can improve outcomes at scale.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De INTERACT3-trial in de Lancet toonde dat een zorgbundel met vroege intensieve bloeddrukverlaging de functionele uitkomsten verbeterde bij acute intracerebrale bloeding. De bundelbenadering is effectiever dan bloeddrukverlaging alleen.","abstract_original":"BACKGROUND: Early control of elevated blood pressure is the most promising treatment for acute intracerebral haemorrhage. We aimed to establish whether implementing a goal-directed care bundle incorporating protocols for early intensive blood pressure lowering and management algorithms for hyperglycaemia, pyrexia, and abnormal anticoagulation, implemented in a hospital setting, could improve outcomes for patients with acute spontaneous intracerebral haemorrhage. METHODS: We performed a pragmatic, international, multicentre, blinded endpoint, stepped wedge cluster randomised controlled trial at hospitals in nine low-income and middle-income countries (Brazil, China, India, Mexico, Nigeria, Pakistan, Peru, Sri Lanka, and Viet Nam) and one high-income country (Chile). Hospitals were eligible if they had no or inconsistent relevant, disease-specific protocols, and were willing to implement the care bundle to consecutive patients (aged ≥18 years) with imaging-confirmed spontaneous intracerebral haemorrhage presenting within 6 h of the onset of symptoms, had a local champion, and could provide the required study data. Hospitals were centrally randomly allocated using permuted blocks to three sequences of implementation, stratified by country and the projected number of patients to be recruited over the 12 months of the study period. These sequences had four periods that dictated the order in which the hospitals were to switch from the control usual care procedure to the intervention implementation of the care bundle procedure to different clusters of patients in a stepped manner. To avoid contamination, details of the intervention, sequence, and allocation periods were concealed from sites until they had completed the usual care control periods. The care bundle protocol included the early intensive lowering of systolic blood pressure (target <140 mm Hg), strict glucose control (target 6·1-7·8 mmol/L in those without diabetes and 7·8-10·0 mmol/L in those with diabetes), antipyrexia treatment (target body temperature ≤37·5°C), and rapid reversal of warfarin-related anticoagulation (target international normalised ratio <1·5) within 1 h of treatment, in patients where these variables were abnormal. Analyses were performed according to a modified intention-to-treat population with available outcome data (ie, excluding sites that withdrew during the study). The primary outcome was functional recovery, measured with the modified Rankin scale (mRS; range 0 [no symptoms] to 6 [death]) at 6 months by masked research staff, analysed using proportional ordinal logistic regression to assess the distribution in scores on the mRS, with adjustments for cluster (hospital site), group assignment of cluster per period, and time (6-month periods from Dec 12, 2017). This trial is registered at Clinicaltrials.gov (NCT03209258) and the Chinese Clinical Trial Registry (ChiCTR-IOC-17011787) and is completed. FINDINGS: Between May 27, 2017, and July 8, 2021, 206 hospitals were assessed for eligibility, of which 144 hospitals in ten countries agreed to join and were randomly assigned in the trial, but 22 hospitals withdrew before starting to enrol patients and another hospital was withdrawn and their data on enrolled patients was deleted because regulatory approval was not obtained. Between Dec 12, 2017, and Dec 31, 2021, 10 857 patients were screened but 3821 were excluded. Overall, the modified intention-to-treat population included 7036 patients enrolled at 121 hospitals, with 3221 assigned to the care bundle group and 3815 to the usual care group, with primary outcome data available in 2892 patients in the care bundle group and 3363 patients in the usual care group. The likelihood of a poor functional outcome was lower in the care bundle group (common odds ratio 0·86; 95% CI 0·76-0·97; p=0·015). The favourable shift in mRS scores in the care bundle group was generally consistent across a range of sensitivity analyses that included additional adjustments for country and patient variables (0·84; 0·73-0·97; p=0·017), and with different approaches to the use of multiple imputations for missing data. Patients in the care bundle group had fewer serious adverse events than those in the usual care group (16·0% vs 20·1%; p=0·0098). INTERPRETATION: Implementation of a care bundle protocol for intensive blood pressure lowering and other management algorithms for physiological control within several hours of the onset of symptoms resulted in improved functional outcome for patients with acute intracerebral haemorrhage. Hospitals should incorporate this approach into clinical practice as part of active management for this serious condition. FUNDING: Joint Global Health Trials scheme from the Department of Health and Social Care, the Foreign, Commonwealth & Development Office, and the Medical Research Council and Wellcome Trust; West China Hospital; the National Health and Medical Research Council of Australia; Sichuan Credit Pharmaceutic and Takeda China."},{"id":"41a7eb18f5cf","type":"article","url":"https://hartvaat.nl/2023/07/01/deliver-dapagliflozine-verbetert-individuele-kccq-componenten-bij-hfpef/","title":"DELIVER: dapagliflozine verbetert individuele KCCQ-componenten bij HFpEF","title_en":"Association of Dapagliflozin vs Placebo With Individual Kansas City Cardiomyopathy Questionnaire Components in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Secondary Analysis of the DELIVER Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["dapa-hf"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.1342","source_url":"https://doi.org/10.1001/jamacardio.2023.1342","authors":["Alexander Peikert","Alvin Chandra","Mikhail N Kosiborod","Brian L Claggett","Akshay S Desai","Pardeep S Jhund","Carolyn S P Lam","Silvio E Inzucchi","Felipe A Martinez","Rudolf A de Boer","Adrian F Hernandez","Sanjiv J Shah","Stefan P Janssens","Jan Belohlávek","C Jan Willem Borleffs","Dan Dobreanu","Anna Maria Langkilde","Olof Bengtsson","Magnus Petersson","John J V McMurray","Scott D Solomon","Muthiah Vaduganathan"],"significance":6,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-stadiumindeling-nyha/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This detailed DELIVER analysis showed that dapagliflozin improves all individual components of the Kansas City Cardiomyopathy Questionnaire in HFpEF — symptoms, physical limitations, and quality of life — providing a comprehensive symptom benefit.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gedetailleerde analyse van DELIVER toonde dat dapagliflozine alle individuele componenten van de KCCQ verbeterde bij HFpEF: symptomen, fysieke beperkingen en kwaliteit van leven. Het voordeel was breed en klinisch relevant.","abstract_original":"IMPORTANCE: Dapagliflozin has been shown to improve overall health status based on aggregate summary scores of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in patients with heart failure (HF) with mildly reduced or preserved ejection fraction enrolled in the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial. A comprehensive understanding of the responsiveness of individual KCCQ items would allow clinicians to better inform patients on expected changes in daily living with treatment. OBJECTIVE: To examine the association of dapagliflozin treatment with changes in individual components of the KCCQ. DESIGN, SETTING, AND PARTICIPANTS: This is a post hoc exploratory analysis of DELIVER, a randomized double-blind placebo-controlled trial conducted at 353 centers in 20 countries from August 2018 to March 2022. KCCQ was administered at randomization and 1, 4, and 8 months. Scores of individual KCCQ components were scaled from 0 to 100. Eligibility criteria included symptomatic HF with left ventricular ejection fraction greater than 40%, elevated natriuretic peptide levels, and evidence of structural heart disease. Data were analyzed from November 2022 to February 2023. MAIN OUTCOMES AND MEASURES: Changes in the 23 individual KCCQ components at 8 months. INTERVENTIONS: Dapagliflozin, 10 mg, once daily or placebo. RESULTS: Baseline KCCQ data were available for 5795 of 6263 randomized patients (92.5%) (mean [SD] age, 71.5 [9.5] years; 3344 male [57.7%] and 2451 female [42.3%]). Dapagliflozin was associated with larger improvements in almost all KCCQ components at 8 months compared with placebo. The most significant improvements with dapagliflozin were observed in frequency of lower limb edema (difference, 3.2; 95% CI, 1.6-4.8; P < .001), sleep limitation by shortness of breath (difference, 3.0; 95% CI, 1.6-4.4; P < .001), and limitation in desired activities by shortness of breath (difference, 2.8; 95% CI, 1.3-4.3; P < .001). Similar treatment patterns were observed in longitudinal analyses integrating data from months 1, 4, and 8. Higher proportions of patients treated with dapagliflozin experienced improvements, and fewer had deteriorations across most individual components. CONCLUSIONS AND RELEVANCE: In this study of patients with HF with mildly reduced or preserved ejection fraction, dapagliflozin was associated with improvement in a broad range of individual KCCQ components, with the greatest benefits in domains related to symptom frequency and physical limitations. Potential improvements in specific symptoms and activities of daily living might be more readily recognizable and easily communicated to patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03619213."},{"id":"99e3c1830254","type":"article","url":"https://hartvaat.nl/2023/07/01/tino-gecoate-versus-everolimus-eluting-stents-bij-acs-tides-acs-vijfjaarsdata/","title":"TiNO-gecoate versus everolimus-eluting stents bij ACS: TIDES-ACS vijfjaarsdata","title_en":"Titanium-Nitride-Oxide-Coated vs Everolimus-Eluting Stents in Acute Coronary Syndrome: 5-Year Clinical Outcomes of the TIDES-ACS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.1373","source_url":"https://doi.org/10.1001/jamacardio.2023.1373","authors":["Frederic Bouisset","Jussi Sia","Takuya Mizukami","Pasi P Karjalainen","Pim A L Tonino","Nico H J Pijls","Jan Van der Heyden","Hannu Romppanen","Kari Kervinen","Juhani K E Airaksinen","Jacques Lalmand","Peter Frambach","Bruno Roza da Costa","Carlos Collet","Bernard De Bruyne"],"significance":6,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"Five-year TIDES-ACS results showed that titanium-nitride-oxide-coated stents provide comparable outcomes to everolimus-eluting stents in ACS, with faster strut coverage offering a potential advantage for shortened DAPT.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vijfjaarsresultaten van TIDES-ACS toonden dat titanium-nitrideoxide-gecoate stents vergelijkbare uitkomsten gaven als everolimus-eluting stents bij ACS. Coating-only stents kunnen een alternatief zijn bij patiënten die geen langdurige DAPT verdragen.","abstract_original":"IMPORTANCE: Titanium-nitride-oxide (TiNO)-coated stents show faster strut coverage compared with drug-eluting stents without excessive intimal-hyperplasia observed in bare metal stents. It is important to study long-term clinical outcomes after treatment of patients with an acute coronary syndrome (ACS) by TiNO-coated stents, which are neither drug-eluting stents nor bare metal stents. OBJECTIVE: To compare the rate of main composite outcome of cardiac death, myocardial infarction (MI), or ischemia-driven target lesion revascularization at 5 years in patients with ACS randomized to receive either a TiNO-coated stent or a third-generation everolimus-eluting stent (EES). DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized, controlled, open-label trial was conducted in 12 clinical sites in 5 European countries and enrolled patients from January 2014 to August 2016. Patients presenting with ACS (ST-segment elevation MI, non-ST-segment elevation MI, and unstable angina) with at least 1 de novo lesion were randomized to receive either a TiNO-coated stent or an EES. The present report analyzes the long-term follow-up for the main composite outcome and its individual components. Analysis took place between November 2022 to March 2023. MAIN OUTCOME: The primary end point was a composite of cardiac death, MI, or target lesion revascularization at 12-month follow-up. RESULTS: A total of 1491 patients with ACS were randomly assigned to receive either TiNO-coated stents (989 [66.3%]) or EES (502 [33.7%]). The mean (SD) age was 62.7 (10.8) years, and 363 (24.3%) were female. At 5 years, the main composite outcome events occurred in 111 patients (11.2%) in the TiNO group vs 60 patients (12%) in the EES group (hazard ratio [HR], 0.94; 95% CI, 0.69-1.28; P = .69). The rate of cardiac death was 0.9% (9 of 989) vs 3.0% (15 of 502) (HR, 0.30; 95% CI, 0.13-0.69; P = .005), the rate of MI was 4.6% (45 of 989) vs 7.0% (35 of 502) (HR, 0.64; 95% CI, 0.41-0.99; P = .049), the rate of stent thrombosis was 1.2% (12 of 989) vs 2.8% (14 of 502) (HR, 0.43; 95% CI, 0.20-0.93; P = .034), and the rate of target lesion revascularization was 7.4% (73 of 989) vs 6.4% (32 of 502) (HR, 1.16; 95% CI, 0.77-1.76; P = .47) in the TiNO-coated stent arm and in the EES arm, respectively. CONCLUSION AND RELEVANCE: In this study, patients with ACS had a main composite outcome that was not different 5 years after TiNO-coated stent or EES. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02049229."},{"id":"94a011d56a1a","type":"article","url":"https://hartvaat.nl/2023/07/01/statinoplaaddosis-voor-cabg-gerandomiseerde-trial/","title":"Statinoplaaddosis voor CABG: gerandomiseerde trial","title_en":"Statin loading before coronary artery bypass grafting: a randomized trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":["newton-cabg"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad238","source_url":"https://doi.org/10.1093/eurheartj/ehad238","authors":["Oliver J Liakopoulos","Elmar W Kuhn","Martin Hellmich","Markus Schlömicher","Justus Strauch","Wilko Reents","Anno Diegeler","Matthias Thielmann","Daniel Wendt","Jochen Börgermann","Jan F Gummert","Christian Stoppe","Andreas Goetzenich","Sven Martens","Hermann Reichenspurner","Jens Wippermann","Hannes Reuter","Yeong-Hoon Choi","Thorsten Wahlers"],"significance":6,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"This randomized trial showed that high-dose statin loading before CABG does not improve outcomes, in contrast to the proven benefit before PCI, suggesting different mechanisms of perioperative benefit between surgical and percutaneous revascularization.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht of een hoge statinoplaaddosis vóór CABG de uitkomsten verbetert. In tegenstelling tot bij PCI was er geen significant voordeel van preoperatieve statineloading bij bypasschirurgie.","abstract_original":"AIMS: Evidence suggests that a high-dose statin loading before a percutaneous coronary revascularization improves outcomes in patients receiving long-term statins. This study aimed to analyse the effects of such an additional statin therapy before surgical revascularization. METHODS AND RESULTS: This investigator-initiated, randomized, double-blind, and placebo-controlled trial was conducted from November 2012 to April 2019 at 14 centres in Germany. Adult patients (n = 2635) with a long-term statin treatment (≥30 days) who were scheduled for isolated coronary artery bypass grafting (CABG) were randomly assigned to receive a statin-loading therapy or placebo at 12 and 2 h prior to surgery using a web-based system. The primary outcome of major adverse cardiac and cerebrovascular events (MACCE) was a composite consisting of all-cause mortality, myocardial infarction (MI), and a cerebrovascular event occuring within 30 days after surgery. Key secondary endpoints included a composite of cardiac death and MI, myocardial injury, and death within 12 months. Non-statistically relevant differences were found in the modified intention-to-treat analysis (2406 patients; 1203 per group) between the statin (13.9%) and placebo groups (14.9%) for the primary outcome [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.74-1.18; P = 0.562] or any of its individual components. Secondary endpoints including cardiac death and MI (12.1% vs. 13.5%; OR 0.88, 95% CI 0.69-1.12; P = 0.300), the area under the troponin T-release curve (median 0.398 vs. 0.394 ng/ml, P = 0.333), and death at 12 months (3.1% vs. 2.9%; P = 0.825) were comparable between treatment arms. CONCLUSION: Additional statin loading before CABG failed to reduce the rate of MACCE occuring within 30 days of surgery."},{"id":"a16d6aea248c","type":"article","url":"https://hartvaat.nl/2023/07/01/timing-van-antihypertensiva-meta-analyse-van-rct-s-bevestigt-flexibiliteit/","title":"Timing van antihypertensiva: meta-analyse van RCT's bevestigt flexibiliteit","title_en":"Timing of Antihypertensive Drug Therapy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20862","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20862","authors":["Muhammad Haisum Maqsood","Franz H Messerli","Adam H Skolnick","Jonathan D Newman","Jeffrey S Berger","Sripal Bangalore"],"significance":7,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"This meta-analysis of RCTs confirmed that the timing of antihypertensive drug administration (morning vs evening) has no significant effect on blood pressure control or cardiovascular outcomes, adding to the TIME and BedMed evidence.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van RCT's bevestigde dat het tijdstip van antihypertensivadosering (ochtend versus avond) geen significant effect heeft op cardiovasculaire uitkomsten. Samen met TIME nuanceert dit de HYGIA-resultaten en laat patiënten vrij kiezen.","abstract_original":"BACKGROUND: The timing of antihypertensive drugs administration is controversial. The aim was to compare the efficacy of dosing of antihypertensive drugs in the morning versus evening. METHODS: A PubMed, EMBASE, and clinicaltrials.gov databases search for randomized clinical trials of antihypertensive therapies where patients were randomized to morning versus evening dosing. The outcomes were ambulatory blood pressure (BP) parameters (day-time, night-time, and 24/48-hour systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and cardiovascular outcomes. RESULTS: Of 72 randomized controlled trials included, evening dosing significantly reduced ambulatory BP parameters: 24/48-hour SBP (mean difference [MD]=1.41 mm Hg; [95% CI, 0.48-2.34]), DBP (MD=0.60 mm Hg [95% CI, 0.12-1.08]), night-time SBP (MD=4.09 mm Hg [95% CI, 3.01-5.16]), DBP (MD, 2.57 mm Hg [95% CI, 1.92-3.22]), with a smaller reduction in day-time SBP (MD=0.94 mm Hg [95% CI, 0.01-1.87]), and DBP (MD=0.87 mm Hg [95% CI, 0.10-1.63]), and numerically lower cardiovascular events compared with morning dosing. However, when controversial data by Hermida (23 trials, 25  734 patients) were omitted (Pheterogeneity<0.05 for most outcomes), the above effect of evening dosing attenuated with no significant effect on 24/48-hour ambulatory blood pressure, day-time BP, and major adverse cardiac event and smaller reduction in night-time ambulatory SBP and DBP. CONCLUSIONS: Evening dosing of antihypertensive drugs significantly reduced ambulatory BP parameters and lowered cardiovascular events but the effect was mainly driven by trials by Hermida group. Unless the intention is to specifically lower night-time BP, antihypertensive drugs should be taken at a time of day that is convenient, optimizes adherence, and minimizes undesirable effects."},{"id":"1e2815ab5233","type":"article","url":"https://hartvaat.nl/2023/07/01/familiair-hyperaldosteronisme-type-1-therapeutische-opties-en-langetermijnuitkom/","title":"Familiair hyperaldosteronisme type 1: therapeutische opties en langetermijnuitkomsten","title_en":"Systematic Review of Therapeutic Agents and Long-Term Outcomes of Familial Hyperaldosteronism Type 1.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["diabetes-type-1","familiaire-hypercholesterolemie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21054","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21054","authors":["Shu Ting Tan","Veronica Boyle","Marianne S Elston"],"significance":5,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This systematic review summarized the treatment options and long-term outcomes of familial hyperaldosteronism type 1, the first identified monogenic cause of primary aldosteronism.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T13:29:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review vatte de behandeling en uitkomsten samen van familiair hyperaldosteronisme type 1 (glucocorticoïd-remediabel aldosteronisme). Lage-dosis dexamethason is effectief, maar langetermijndata zijn beperkt en cardiovasculaire monitoring is essentieel.","abstract_original":"BACKGROUND: Familial hyperaldosteronism type 1 (FH1), previously known as glucocorticoid-remediable aldosteronism, was the first identified monogenic cause of primary aldosteronism. Patients classically develop hypertension at a young age and are at risk of premature vascular complications. A systematic review of FH1 was performed to determine long-term treatment outcomes. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted searches with a patient/population, intervention, comparison and outcomes (PICO) framework using Embase, Medline, PubMed, Scopus, and Web of Science databases to identify patients with FH1 prescribed either no treatment with a minimum 3 months follow-up or medical treatment of at least 3 months duration. RESULTS: A total of 99 FH1 cases were identified from 42 studies. Most had early-onset hypertension but variable hypokalemia, hyperaldosteronism, and hyporeninemia. Of the 62 cases with a reported age of FH1 diagnosis, median age was 18 ± 17.6 years old. Of those treated, 72% received a glucocorticoid for long-term treatment compared with 22% receiving a potassium-sparing diuretic. Data on long-term treatment and disease side effects, complications, and outcomes were seldom reported. However, of 20 patients with reported complications, premature vascular complications were evident with the median age of diagnosis for left ventricular hypertrophy and hypertensive retinopathy 15 and 16.5 years old respectively, the youngest age of aortic dissection age 10 years, and those with reported cerebrovascular history had strokes or transient ischemic attacks before age 40 years. CONCLUSIONS: Major gaps in the literature around FH1 patients' long-term treatment and disease outcomes still exist. Long-term outcome data are required to help inform clinicians of the best long-term treatment for FH1."},{"id":"bb83210074e0","type":"article","url":"https://hartvaat.nl/2023/07/01/leeftijdsbias-draagt-bij-aan-therapeutische-inertie-bij-bloeddrukmanagement/","title":"Leeftijdsbias draagt bij aan therapeutische inertie bij bloeddrukmanagement","title_en":"Evidence for Age Bias Contributing to Therapeutic Inertia in Blood Pressure Management: A Secondary Analysis of SPRINT.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","bradycardie","hartrevalidatie","lichaamsbeweging","lichamelijke-inactiviteit","ouderen","summit-trial","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.21323","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.21323","authors":["Alexander R Zheutlin","Daniel K Addo","Joshua A Jacobs","Catherine G Derington","Jennifer S Herrick","Tom Greene","Eric L Stulberg","Dan R Berlowitz","Jeff D Williamson","Nicholas M Pajewski","Mark A Supiano","Adam P Bress"],"significance":6,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/"],"congress":"","summary_en":"This SPRINT analysis showed that age bias contributes to therapeutic inertia in blood pressure management, with clinicians being less aggressive in intensifying treatment for older patients despite equal evidence of benefit.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T18:39:04Z","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":"SPRINT-analyse toonde dat leeftijdsbias bijdraagt aan therapeutische inertie: artsen intensiveerden de bloeddrukbehandeling minder bij oudere patiënten ondanks vergelijkbaar voordeel. Dit draagt bij aan de onderbehandeling van hypertensie bij ouderen.","abstract_original":"BACKGROUND: Despite evidence supporting the cardiovascular and cognitive benefits of intensive blood pressure management, older adults have the lowest rates of blood pressure control. We determined the association between age and therapeutic inertia (TI) in SPRINT (Systolic Blood Pressure Intervention Trial), and whether frailty, cognitive function, or gait speed moderate or mediate these associations. METHODS: We performed a secondary analysis of SPRINT of participant visits with blood pressure above randomized treatment goal. We categorized baseline age as <60, 60 to <70, 70 to <80, and ≥80 years and TI as no antihypertensive medication intensification per participant visit. Generalized estimating equations generated odds ratios for TI associated with age, stratified by treatment group based on nested models adjusted for baseline frailty index score (fit [frailty index, ≤0.10], less fit [0.10<frailty index≤0.21], and frail [0.21<frailty index]), cognitive function by Montreal cognitive assessment, and gait speed (participants ≥75 years of age), separately. RESULTS: Participants 60 to <70, 70 to <80, and ≥80 years of age had a higher prevalence of TI in both treatment groups versus participants <60 years of age (standard: 59.7%, 60.5%, and 60.1% versus 56.0%; 29 527 participant visits; intensive: 55.1%, 57.2%, and 57.8% versus 53.8%; 47 129 participant visits). The adjusted odds ratios for TI comparing participants ≥80 versus <60 years of age were 1.32 (95% CI, 1.14-1.53) and 1.25 (95% CI, 1.11-1.41) in the standard and intensive treatment groups, respectively. Adjustment for frailty, cognitive function, or gait speed did not attenuate the association or demonstrate effect modification (all Pinteraction, >0.10). CONCLUSIONS: Older age is associated with greater TI independent of physical or cognitive function, implying age bias in hypertension management."},{"id":"f58a43d2c310","type":"article","url":"https://hartvaat.nl/2023/07/01/metabolomics-en-bloeddrukrespons-op-dash-dieet/","title":"Metabolomics en bloeddrukrespons op DASH-dieet","title_en":"Metabolomic Profiles Associated With Blood Pressure Reduction in Response to the DASH and DASH-Sodium Dietary Interventions.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["dyslipidemie","metabole-acidose"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.123.20901","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.123.20901","authors":["Hyunju Kim","Lawrence J Appel","Alice H Lichtenstein","Kari E Wong","Nilanjan Chatterjee","Eugene P Rhee","Casey M Rebholz"],"significance":5,"published":"2023-07-01","source_date":"2023-07-01","image":"","kennis":[],"congress":"","summary_en":"This metabolomics analysis from the DASH trials identified specific metabolic profiles associated with blood pressure response to the DASH diet, revealing biochemical pathways underlying dietary cardiovascular benefit.","created":"2026-07-03T10:30:27Z","updated":"2026-07-03T13:29:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Metabolomics-analyse van de DASH-trials identificeerde metabole profielen geassocieerd met bloeddrukrespons op het DASH-dieet. Specifieke aminozuur- en lipidenmetabolieten voorspelden de individuele respons, wat gepersonaliseerde dieetinterventies kan ondersteunen.","abstract_original":"BACKGROUND: The DASH (Dietary Approaches to Stop Hypertension) diets reduced blood pressure (BP) in the DASH and DASH-Sodium trials, but the underlying mechanisms are unclear. We identified metabolites associated with systolic BP or diastolic BP (DBP) changes induced by dietary interventions (DASH versus control arms) in 2 randomized controlled feeding studies-the DASH and DASH-Sodium trials. METHODS: Metabolomic profiling was conducted in serum and urine samples collected at the end of diet interventions: DASH (n=219) and DASH-Sodium (n=395). Using multivariable linear regression models, associations were examined between metabolites and change in systolic BP and DBP. Tested for interactions between diet interventions and metabolites were the following comparisons: (1) DASH versus control diets in the DASH trial (serum), (2) DASH high-sodium versus control high-sodium diets in the DASH-Sodium trial (urine), and (3) DASH low-sodium versus control high-sodium diets in the DASH-Sodium trial (urine). RESULTS: Sixty-five significant interactions were identified (DASH trial [serum], 12; DASH high sodium [urine], 35; DASH low sodium [urine], 18) between metabolites and systolic BP or DBP. In the DASH trial, serum tryptophan betaine was associated with reductions in DBP in participants consuming the DASH diets but not control diets (P interaction, 0.023). In the DASH-Sodium trial, urine levels of N-methylglutamate and proline derivatives (eg, stachydrine, 3-hydroxystachydrine, N-methylproline, and N-methylhydroxyproline) were associated with reductions in systolic BP or DBP in participants consuming the DASH diets but not control diets (P interaction, <0.05 for all tests). CONCLUSIONS: We identified metabolites that were associated with BP lowering in response to dietary interventions. REGISTRATION: URL: https://www. CLINICALTRIALS: gov/ct2/show/NCT03403166; Unique identifier: NCT03403166 (DASH trial). URL: https://www. CLINICALTRIALS: gov/ct2/show/NCT00000608; Unique identifier: NCT00000608 (DASH-Sodium trial)."},{"id":"2e554ae15002","type":"article","url":"https://hartvaat.nl/2023/06/29/elan-vroege-versus-late-anticoagulatie-na-cva-bij-af-nejm/","title":"ELAN: vroege versus late anticoagulatie na CVA bij AF — NEJM","title_en":"Early versus Later Anticoagulation for Stroke with Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["anticoagulantia","anticoagulatie-kwetsbare-ouderen"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2303048","source_url":"https://doi.org/10.1056/NEJMoa2303048","authors":["Urs Fischer","Masatoshi Koga","Daniel Strbian","Mattia Branca","Stefanie Abend","Sven Trelle","Maurizio Paciaroni","Götz Thomalla","Patrik Michel","Krassen Nedeltchev","Leo H Bonati","George Ntaios","Thomas Gattringer","Else-Charlotte Sandset","Peter Kelly","Robin Lemmens","P N Sylaja","Diana Aguiar de Sousa","Natan M Bornstein","Zuzana Gdovinova","Takeshi Yoshimoto","Marjaana Tiainen","Helen Thomas","Manju Krishnan","Gek C Shim","Christoph Gumbinger","Jochen Vehoff","Liqun Zhang","Kosuke Matsuzono","Espen Kristoffersen","Philippe Desfontaines","Peter Vanacker","Angelika Alonso","Yusuke Yakushiji","Caterina Kulyk","Dimitri Hemelsoet","Sven Poli","Ana Paiva Nunes","Nicoletta Caracciolo","Peter Slade","Jelle Demeestere","Alexander Salerno","Markus Kneihsl","Timo Kahles","Daria Giudici","Kanta Tanaka","Silja Räty","Rea Hidalgo","David J Werring","Martina Göldlin","Marcel Arnold","Cecilia Ferrari","Seraina Beyeler","Christian Fung","Bruno J Weder","Turgut Tatlisumak","Sabine Fenzl","Beata Rezny-Kasprzak","Arsany Hakim","Georgia Salanti","Claudio Bassetti","Jan Gralla","David J Seiffge","Thomas Horvath","Jesse Dawson"],"significance":10,"published":"2023-06-29","source_date":"2023-06-29","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The ELAN trial showed that early initiation of DOACs (within 48 hours for mild stroke, within 6–7 days for moderate stroke) after ischemic stroke in patients with atrial fibrillation was safe and associated with fewer recurrent strokes compared with later initiation. The results support a move toward earlier anticoagulation in this high-risk population.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T13:29:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ELAN-trial in de NEJM toonde dat vroege start van DOAC's (binnen 48 uur bij mild CVA, binnen 6-7 dagen bij matig CVA) na ischemisch CVA bij AF veilig was met minder recidief-CVA's dan late start, zonder toename van intracraniële bloedingen. Dit verandert de klinische praktijk.","abstract_original":"BACKGROUND: The effect of early as compared with later initiation of direct oral anticoagulants (DOACs) in persons with atrial fibrillation who have had an acute ischemic stroke is unclear. METHODS: We performed an investigator-initiated, open-label trial at 103 sites in 15 countries. Participants were randomly assigned in a 1:1 ratio to early anticoagulation (within 48 hours after a minor or moderate stroke or on day 6 or 7 after a major stroke) or later anticoagulation (day 3 or 4 after a minor stroke, day 6 or 7 after a moderate stroke, or day 12, 13, or 14 after a major stroke). Assessors were unaware of the trial-group assignments. The primary outcome was a composite of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death within 30 days after randomization. Secondary outcomes included the components of the composite primary outcome at 30 and 90 days. RESULTS: Of 2013 participants (37% with minor stroke, 40% with moderate stroke, and 23% with major stroke), 1006 were assigned to early anticoagulation and 1007 to later anticoagulation. A primary-outcome event occurred in 29 participants (2.9%) in the early-treatment group and 41 participants (4.1%) in the later-treatment group (risk difference, -1.18 percentage points; 95% confidence interval [CI], -2.84 to 0.47) by 30 days. Recurrent ischemic stroke occurred in 14 participants (1.4%) in the early-treatment group and 25 participants (2.5%) in the later-treatment group (odds ratio, 0.57; 95% CI, 0.29 to 1.07) by 30 days and in 18 participants (1.9%) and 30 participants (3.1%), respectively, by 90 days (odds ratio, 0.60; 95% CI, 0.33 to 1.06). Symptomatic intracranial hemorrhage occurred in 2 participants (0.2%) in both groups by 30 days. CONCLUSIONS: In this trial, the incidence of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death at 30 days was estimated to range from 2.8 percentage points lower to 0.5 percentage points higher (based on the 95% confidence interval) with early than with later use of DOACs. (Funded by the Swiss National Science Foundation and others; ELAN ClinicalTrials.gov number, NCT03148457.)."},{"id":"ef85ba064c43","type":"article","url":"https://hartvaat.nl/2023/06/27/sglt2-remmers-en-cv-uitkomsten-over-patientpopulaties-jacc-overzicht/","title":"SGLT2-remmers en CV-uitkomsten over patiëntpopulaties: JACC overzicht","title_en":"Effect of SGLT2 Inhibitors on Cardiovascular Outcomes Across Various Patient Populations.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","sglt2-remmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.04.034","source_url":"https://doi.org/10.1016/j.jacc.2023.04.034","authors":["Muhammad Shariq Usman","Tariq Jamal Siddiqi","Stefan D Anker","George L Bakris","Deepak L Bhatt","Gerasimos Filippatos","Gregg C Fonarow","Stephen J Greene","James L Januzzi","Muhammad Shahzeb Khan","Mikhail N Kosiborod","Darren K McGuire","Ileana L Piña","Julio Rosenstock","Muthiah Vaduganathan","Subodh Verma","Shelley Zieroth","Javed Butler"],"significance":8,"published":"2023-06-27","source_date":"2023-06-27","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This comprehensive JACC review summarized the effects of SGLT2 inhibitors across all studied populations — HFrEF, HFpEF, CKD, and type 2 diabetes — providing a unified overview of their cardiovascular and renal benefits and positioning them as foundational cardiometabolic therapy.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T13:29:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreid JACC-overzicht vatte de effecten van SGLT2-remmers samen over alle patiëntpopulaties: hartfalen (HFrEF/HFpEF), CKD en diabetes. Het voordeel is consistent en onafhankelijk van diabetes, wat SGLT2-remmers als universele cardiometabole beschermers positioneert.","abstract_original":"BACKGROUND: The effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on heart failure (HF) outcomes and cardiovascular (CV) death in patients with varying combinations of type 2 diabetes mellitus (T2DM), HF, and chronic kidney disease (CKD) are uncertain. OBJECTIVES: The authors conducted a meta-analysis assessing the effects of SGLT2 inhibitors on HF outcomes and CV death across different patient populations. METHODS: Online databases were queried up to November 2022 for primary and secondary analyses of trials of SGLT2 inhibitors in patients with HF, T2DM, or CKD. Outcomes of interest were composite of first heart failure hospitalization (HFH) or CV death (first HFH/CV death), first HFH, and CV death. Data were pooled by means of a random-effects model to derive HRs and 95% CIs. RESULTS: Thirteen trials (n = 90,413) were included. Compared with placebo, SGLT2 inhibitors reduced the risk of first HFH/CV death by 24% in HF (HR: 0.76; 95% CI: 0.72-0.81), 23% in T2DM (HR: 0.77; 95% CI: 0.73-0.81), and 23% in CKD (HR: 0.77; 95% CI: 0.72-0.82). The benefit was consistent in HF with reduced or preserved ejection fraction, HF with or without T2DM, and HF with or without CKD. The benefit was also consistent in T2DM with or without CKD, T2DM without HF, CKD without HF, and in patients with all 3 comorbidities. SGLT2 inhibitors significantly reduced CV death by 16% in HF, 15% in T2DM, and 12% in CKD. CONCLUSIONS: SGLT2 inhibitors reduce HF events and CV death in cohorts of HF, T2DM and CKD, and these effects appear consistent in patients with varying combinations of these diseases."},{"id":"472fce716fe2","type":"article","url":"https://hartvaat.nl/2023/06/26/opioiden-bij-dyspneu-en-hartfalen-meta-analyse-toont-geen-voordeel/","title":"Opioïden bij dyspneu en hartfalen: meta-analyse toont geen voordeel","title_en":"Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","alcoholgebruik","bisoprolol","carvedilol","empagliflozine","nt-probnp"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-322074","source_url":"https://doi.org/10.1136/heartjnl-2022-322074","authors":["Jan Gaertner","Tanja Fusi-Schmidhauser","Stephanie Stock","Waldemar Siemens","Vera Vennedey"],"significance":7,"published":"2023-06-26","source_date":"2023-06-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This meta-analysis found that opioids do not significantly improve breathlessness in heart failure despite their widespread use, challenging the traditional practice of opioid administration for dyspnea in acute heart failure.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T18:39:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse toonden dat opioïden bij hartfalen-gerelateerde dyspneu geen significant symptoomvoordeel bieden bij aanzienlijke bijwerkingen. Dit ondermijnt het gangbare leerboekadvies om morfine bij acuut hartfalen te gebruiken.","abstract_original":"BACKGROUND: For the treatment of breathlessness in heart failure (HF), most textbooks advocate the use of opioids. Yet, meta-analyses are lacking. METHODS: A systematic review was performed for randomised controlled trials (RCTs) assessing effects of opioids on breathlessness (primary outcome) in patients with HF. Key secondary outcomes were quality of life (QoL), mortality and adverse effects. Cochrane Central Register of Controlled Trials, MEDLINE and Embase were searched in July 2021. Risk of bias (RoB) and certainty of evidence were assessed by the Cochrane RoB 2 Tool and Grading of Recommendations Assessment, Development and Evaluation criteria, respectively. The random-effects model was used as primary analysis in all meta-analyses. RESULTS: After removal of duplicates, 1180 records were screened. We identified eight RCTs with 271 randomised patients. Seven RCTs could be included in the meta-analysis for the primary endpoint breathlessness with a standardised mean difference of 0.03 (95% CI -0.21 to 0.28). No study found statistically significant differences between the intervention and placebo. Several key secondary outcomes favoured placebo: risk ratio of 3.13 (95% CI 0.70 to 14.07) for nausea, 4.29 (95% CI 1.15 to 16.01) for vomiting, 4.77 (95% CI 1.98 to 11.53) for constipation and 4.42 (95% CI 0.79 to 24.87) for study withdrawal. All meta-analyses revealed low heterogeneity (I2 in all these meta-analyses was <8%). CONCLUSION: Opioids for treating breathlessness in HF are questionable and may only be the very last option if other options have failed or in case of an emergency. PROSPERO REGISTRATION NUMBER: CRD42021252201."},{"id":"f68243ef6631","type":"article","url":"https://hartvaat.nl/2023/06/25/dapagliflozine-en-perifeer-arterieel-vaatlijden-bij-hartfalen-dapa-hf-deliver-me/","title":"Dapagliflozine en perifeer arterieel vaatlijden bij hartfalen: DAPA-HF/DELIVER meta-analyse","title_en":"Heart failure, peripheral artery disease, and dapagliflozin: a patient-level meta-analysis of DAPA-HF and DELIVER.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfpef","hfref","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad276","source_url":"https://doi.org/10.1093/eurheartj/ehad276","authors":["Jawad H Butt","Toru Kondo","Mingming Yang","Pardeep S Jhund","Kieran F Docherty","Muthiah Vaduganathan","Brian L Claggett","Adrian F Hernandez","Carolyn S P Lam","Silvio E Inzucchi","Felipe A Martinez","Rudolf A de Boer","Mikhail N Kosiborod","Akshay S Desai","Lars Køber","Piotr Ponikowski","Marc S Sabatine","Sanjiv J Shah","Natalia Zaozerska","Ulrica Wilderäng","Olof Bengtsson","Scott D Solomon","John J V McMurray"],"significance":7,"published":"2023-06-25","source_date":"2023-06-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This patient-level meta-analysis of DAPA-HF and DELIVER confirmed that dapagliflozin does not increase the risk of amputation in heart failure patients, addressing the safety concern raised by the earlier canagliflozin CANVAS results.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T18:39:04Z","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":"Patiënt-niveau meta-analyse van DAPA-HF en DELIVER toonde dat dapagliflozine het amputatierisico niet verhoogt bij hartfalenpatiënten, inclusief bij perifeer vaatlijden. Dit is geruststellend na de eerdere canagliflozine-bevinding in CANVAS.","abstract_original":"AIMS: Because an increased risk of amputation with canagliflozin was reported in the CANVAS trials, there has been a concern about the safety of sodium-glucose cotransporter 2 inhibitors in patients with peripheral artery disease (PAD) who are at higher risk of amputation. METHODS AND RESULTS: A patient-level pooled analysis of the DAPA-HF and DELIVER trials, which evaluated the efficacy and safety of dapagliflozin in patients with heart failure (HF) with reduced, mildly reduced/preserved ejection fraction, respectively, was conducted. In both trials, the primary outcome was the composite of worsening HF or cardiovascular death, and amputation was a prespecified safety outcome. Peripheral artery disease history was available for 11 005 of the total 11 007 patients. Peripheral artery disease was reported in 809 of the 11 005 patients (7.4%). Median follow-up was 22 months (interquartile range 17-30). The rate of the primary outcome (per 100 person-years) was higher in PAD patients than that in non-PAD patients: 15.1 [95% confidence interval (CI) 13.1-17.3) vs. 10.6 (10.2-11.1]; adjusted hazard ratio 1.23 (95% CI 1.06-1.43). The benefit of dapagliflozin on the primary outcome was consistent in patients with [hazard ratio 0.71 (95% CI 0.54-0.94)] and without PAD [0.80 (95% CI 0.73-0.88)] (Pinteraction = 0.39). Amputations, while more frequent in PAD patients, were not more common with dapagliflozin, compared with placebo, irrespective of PAD status (PAD, placebo 4.2% vs. dapagliflozin 3.7%; no PAD, placebo 0.4% vs. dapagliflozin 0.4%) (Pinteraction = 1.00). Infection rather than ischaemia was the main trigger for amputation, even in patients with PAD. CONCLUSION: The risk of worsening HF or cardiovascular death was higher in patients with PAD, as was the risk of amputation. The benefits of dapagliflozin were consistent in patients with and without PAD, and dapagliflozin did not increase the risk of amputation."},{"id":"21d57d48c536","type":"article","url":"https://hartvaat.nl/2023/06/25/cystatine-c-voor-gfr-schatting-bij-hartfalen-paradigm-hf-analyse/","title":"Cystatine C voor GFR-schatting bij hartfalen: PARADIGM-HF analyse","title_en":"Importance of cystatin C in estimating glomerular filtration rate: the PARADIGM-HF trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["chronische-nierziekte","cystatine-c","hfref","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad210","source_url":"https://doi.org/10.1093/eurheartj/ehad210","authors":["Paolo Tolomeo","Jawad H Butt","Toru Kondo","Gianluca Campo","Akshay S Desai","Pardeep S Jhund","Lars Køber","Martin P Lefkowitz","Jean L Rouleau","Scott D Solomon","Karl Swedberg","Muthiah Vaduganathan","Michael R Zile","Milton Packer","John J V McMurray"],"significance":6,"published":"2023-06-25","source_date":"2023-06-25","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/hartfalen/hartfalen-en-nierfunctie/"],"congress":"","summary_en":"This PARADIGM-HF analysis showed that the combined creatinine-cystatin C eGFR formula provides more accurate kidney function estimation in heart failure than creatinine alone, with implications for drug dosing and risk assessment.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T18:39:04Z","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":"Analyse van PARADIGM-HF toonde dat de creatinine-cystatine C gecombineerde eGFR-formule de nierfunctie nauwkeuriger schat bij hartfalenpatiënten dan creatinine alleen. Betere GFR-schatting is cruciaal voor medicatiedosering en prognose.","abstract_original":"AIMS: The 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation combining creatinine and cystatin C provides a better estimation of glomerular filtration rate (GFR) compared to the creatinine-only equation. METHODS AND RESULTS: CKD-EPI creatinine-cystatin C equation (creatinine-cystatin) was compared to creatinine-only (creatinine) equation in a subpopulation of Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF). Patients were categorized according to difference in eGFR using the two equations: Group 1 (<-10 mL/min/1.73 m2, i.e. creatinine-cystatin more than 10 mL/min lower than creatinine), Group 2 (>-10 and <10 mL/min/1.73 m2), and Group 3 (>10 mL/min/1.73 m2, i.e. creatinine-cystatin more than 10 mL/min higher than creatinine). Cystatin C and creatinine were available in 1966 patients at randomization. Median (interquartile range) eGFR difference was -0.7 (-6.4-4.8) mL/min/1.73 m2. Compared to creatinine, creatinine-cystatin led to a substantial reclassification of chronic kidney disease stages. Overall, 212 (11%) and 355 (18%) patients were reallocated to a better and worse eGFR category, respectively. Compared to patients in Group 2, those in Group 1 (lower eGFR with creatinine-cystatin) had higher mortality and those in Group 3 (higher eGFR with creatinine-cystatin) had lower mortality. Increasing difference in eGFR (due to lower eGFR with creatinine-cystatin compared to creatinine) was associated with increasing elevation of biomarkers (including N-terminal pro-B-type natriuretic peptide and troponin) and worsening Kansas City Cardiomyopathy Questionnaire clinical summary score. The reason why the equations diverged with increasing severity of heart failure was that creatinine did not rise as steeply as cystatin C. CONCLUSION: The CKD-EPI creatinine-only equation may overestimate GFR in sicker patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT01035255."},{"id":"873f6ca6e978","type":"article","url":"https://hartvaat.nl/2023/06/24/monitor-hf-pa-drukmonitoring-bij-hartfalen-effectief-in-europa-lancet-rct/","title":"MONITOR-HF: PA-drukmonitoring bij hartfalen effectief in Europa — Lancet RCT","title_en":"Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00923-6","source_url":"https://doi.org/10.1016/S0140-6736(23)00923-6","authors":["Jasper J Brugts","Sumant P Radhoe","Pascal R D Clephas","Dilan Aydin","Marco W F van Gent","Mariusz K Szymanski","Michiel Rienstra","Mieke H van den Heuvel","Carlos A da Fonseca","Gerard C M Linssen","C Jan Willem Borleffs","Eric Boersma","Folkert W Asselbergs","Arend Mosterd","Hans-Peter Brunner-La Rocca","Rudolf A de Boer"],"significance":9,"published":"2023-06-24","source_date":"2023-06-24","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The MONITOR-HF trial confirmed that remote pulmonary artery pressure monitoring (CardioMEMS) improved quality of life and reduced heart failure hospitalization in European patients with chronic heart failure treated with contemporary guideline-directed therapy. The results extended the evidence from the US-based CHAMPION trial.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T18:39:04Z","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":"De MONITOR-HF-trial in de Lancet bevestigde dat remote PA-drukmonitoring (CardioMEMS) de kwaliteit van leven en hartfalenhospitalisaties verbeterde bij Europese patiënten met hartfalen. Dit repliceert het CHAMPION-resultaat buiten de VS en ondersteunt brede implementatie.","abstract_original":"BACKGROUND: The effect of haemodynamic monitoring of pulmonary artery pressure has predominantly been studied in the USA. There is a clear need for randomised trial data from patients treated with contemporary guideline-directed-medical-therapy with long-term follow-up in a different health-care system. METHODS: MONITOR-HF was an open-label, randomised trial, done in 25 centres in the Netherlands. Eligible patients had chronic heart failure of New York Heart Association class III and a previous heart failure hospitalisation, irrespective of ejection fraction. Patients were randomly assigned (1:1) to haemodynamic monitoring (CardioMEMS-HF system, Abbott Laboratories, Abbott Park, IL, USA) or standard care. All patients were scheduled to be seen by their clinician at 3 months and 6 months, and every 6 months thereafter, up to 48 months. The primary endpoint was the mean difference in the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score at 12 months. All analyses were by intention-to-treat. This trial was prospectively registered under the clinical trial registration number NTR7673 (NL7430) on the International Clinical Trials Registry Platform. FINDINGS: Between April 1, 2019, and Jan 14, 2022, we randomly assigned 348 patients to either the CardioMEMS-HF group (n=176 [51%]) or the control group (n=172 [49%]). The median age was 69 years (IQR 61-75) and median ejection fraction was 30% (23-40). The difference in mean change in KCCQ overall summary score at 12 months was 7·13 (95% CI 1·51-12·75; p=0·013) between groups (+7·05 in the CardioMEMS group, p=0·0014, and -0·08 in the standard care group, p=0·97). In the responder analysis, the odds ratio (OR) of an improvement of at least 5 points in KCCQ overall summary score was OR 1·69 (95% CI 1·01-2·83; p=0·046) and the OR of a deterioration of at least 5 points was 0·45 (0·26-0·77; p=0·0035) in the CardioMEMS-HF group compared with in the standard care group. The freedom of device-related or system-related complications and sensor failure were 97·7% and 98·8%, respectively. INTERPRETATION: Haemodynamic monitoring substantially improved quality of life and reduced heart failure hospitalisations in patients with moderate-to-severe heart failure treated according to contemporary guidelines. These findings contribute to the aggregate evidence for this technology and might have implications for guideline recommendations and implementation of remote pulmonary artery pressure monitoring. FUNDING: The Dutch Ministry of Health, Health Care Institute (Zorginstituut), and Abbott Laboratories."},{"id":"3517e2d01f1a","type":"article","url":"https://hartvaat.nl/2023/06/13/loop-substudie-nt-probnp-verbetert-af-screeningsopbrengst/","title":"LOOP-substudie: NT-proBNP verbetert AF-screeningsopbrengst","title_en":"Effects of Atrial Fibrillation Screening According to N-Terminal Pro-B-Type Natriuretic Peptide: A Secondary Analysis of the Randomized LOOP Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["nt-probnp"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064361","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064361","authors":["Lucas Yixi Xing","Søren Zöga Diederichsen","Søren Højberg","Derk W Krieger","Claus Graff","Ruth Frikke-Schmidt","Morten S Olesen","Axel Brandes","Lars Køber","Ketil Jørgen Haugan","Jesper Hastrup Svendsen"],"significance":7,"published":"2023-06-13","source_date":"2023-06-13","image":"","kennis":[],"congress":"","summary_en":"This LOOP trial secondary analysis showed that NT-proBNP improves the yield of AF screening with implantable cardiac monitors, supporting a biomarker-enriched approach to identifying patients most likely to benefit from intensive arrhythmia monitoring.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T13:29:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Secundaire analyse van de LOOP-trial toonde dat NT-proBNP de opbrengst van AF-screening met implanteerbare hartmonitors verbetert. Hogere NT-proBNP identificeert patiënten met meer AF-detectie en hoger CVA-risico, wat gerichte screening ondersteunt.","abstract_original":"BACKGROUND: Research suggests NT-proBNP (N-terminal pro-B-type natriuretic peptide) to be a strong predictor of incident atrial fibrillation (AF) and stroke. However, its utility in AF screening remains unknown. The aim of this study was to investigate NT-proBNP as a potential marker for screening efficacy with respect to AF yield and stroke prevention. METHODS: In the LOOP Study (Atrial Fibrillation Detected by Continuous ECG Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-Risk Individuals), 6004 AF-naïve individuals at least 70 years old and with additional stroke risk factors were randomized 1:3 to either screening with an implantable loop recorder (ILR) and initiation of anticoagulation upon detection of AF episodes lasting ≥6 minutes or usual care (control). This post hoc analysis included study participants with available NT-proBNP measurement at baseline. RESULTS: A total of 5819 participants (96.9% of the trial population) were included. The mean age was 74.7 years (SD, 4.1 years) and 47.5% were female. The median NT-proBNP level was 15 pmol/L (interquartile range, 9-28 pmol/L) corresponding to 125 pg/mL (interquartile range, 76-233 pg/mL). NT-proBNP above median was associated with an increased risk of AF diagnosis both in the ILR group (hazard ratio, 1.84 [95% CI, 1.51-2.25]) and the control group (hazard ratio, 2.79 [95% CI, 2.30-3.40]). Participants with NT-proBNP above the median were also at higher risk of clinical events compared with those having lower levels (hazard ratio, 1.21 [95% CI, 0.96-1.54] for stroke or systemic embolism [SE], 1.60 [95% CI, 1.32-1.95] for stroke/SE/cardiovascular death, and 1.91 [95% CI, 1.61-2.26] for all-cause death). Compared with usual care, ILR screening was associated with significant reductions in stroke/SE and stroke/SE/cardiovascular death among participants with NT-proBNP above median (hazard ratio, 0.60 [95% CI, 0.40-0.90] and 0.70 [95% CI, 0.53-0.94], respectively) but not among those with lower levels (Pinteraction=0.029 for stroke/SE and 0.045 for stroke/SE/cardiovascular death). No risk reduction in all-cause death was observed in either NT-proBNP subgroup for ILR versus control (Pinteraction=0.68). Analyzing NT-proBNP as a continuous variable yielded similar findings. CONCLUSIONS: In an older population with additional stroke risk factors, ILR screening for AF was associated with a significant reduction in stroke risk among individuals with higher NT-proBNP levels but not among those with lower levels. These findings should be considered hypothesis generating and warrant further study before clinical implementation. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02036450."},{"id":"d2a4b6c14fdf","type":"article","url":"https://hartvaat.nl/2023/06/09/advor-bicarbonaatwaarden-en-decongestie-effect-van-acetazolamide/","title":"ADVOR: bicarbonaatwaarden en decongestie-effect van acetazolamide","title_en":"Pre-treatment bicarbonate levels and decongestion by acetazolamide: the ADVOR trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad236","source_url":"https://doi.org/10.1093/eurheartj/ehad236","authors":["Pieter Martens","Frederik H Verbrugge","Jeroen Dauw","Petra Nijst","Evelyne Meekers","Silvio Nunes Augusto","Jozine M Ter Maaten","Line Heylen","Kevin Damman","Alexandre Mebazaa","Gerasimos Filippatos","Frank Ruschitzka","Wai Hong Wilson Tang","Matthias Dupont","Wilfried Mullens"],"significance":6,"published":"2023-06-09","source_date":"2023-06-09","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This ADVOR subanalysis showed that higher baseline bicarbonate levels predict better response to acetazolamide in acute heart failure, identifying a biomarker-guided approach to sequential nephron blockade.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van ADVOR toonde dat hogere uitgangsbicarbonaatwaarden een betere respons op acetazolamide voorspellen. Dit identificeert patiënten die het meest profiteren van combinatiediurese met acetazolamide bij acuut hartfalen.","abstract_original":"AIMS: Acetazolamide inhibits proximal tubular sodium and bicarbonate re-absorption and improved decongestive response in acute heart failure in the ADVOR trial. It is unknown whether bicarbonate levels alter the decongestive response to acetazolamide. METHODS AND RESULTS: This is a sub-analysis of the randomized, double-blind, placebo-controlled ADVOR trial that randomized 519 patients with acute heart failure and volume overload in a 1:1 ratio to intravenous acetazolamide (500 mg/day) or matching placebo on top of standardized intravenous loop diuretics (dose equivalent of twice oral maintenance dose). The primary endpoint was complete decongestion after 3 days of treatment (morning of day 4). Impact of baseline HCO3 levels on the treatment effect of acetazolamide was assessed. : Of the 519 enrolled patients, 516 (99.4%) had a baseline HCO3 measurement. Continuous HCO3 modelling illustrated a higher proportional treatment effect for acetazolamide if baseline HCO3 ≥ 27 mmol/l. A total of 234 (45%) had a baseline HCO3 ≥ 27 mmol/l. Randomization towards acetazolamide improved decongestive response over the entire range of baseline HCO3- levels (P = 0.004); however, patients with elevated baseline HCO3 exhibited a significant higher response to acetazolamide [primary endpoint: no vs. elevated HCO3; OR 1.37 (0.79-2.37) vs. OR 2.39 (1.35-4.22), P-interaction = 0.065), with higher proportional diuretic and natriuretic response (both P-interaction < 0.001), greater reduction in congestion score on consecutive days (treatment × time by HCO3-interaction <0.001) and length of stay (P-interaction = 0.019). The larger proportional treatment effect was mainly explained by the development of diminished decongestive response in the placebo arm (loop diuretics only), both with regard to reaching the primary endpoint of decongestion as well as reduction in congestion score. Development of elevated HCO3 further worsened decongestive response in the placebo arm (P-interaction = 0.041). A loop diuretic only strategy was associated with an increase in the HCO3 during the treatment phase which was prevented by acetazolamide (day 3: placebo 74.8% vs. acetazolamide 41.3%, P < 0.001). CONCLUSION: Acetazolamide improves decongestive response over the entire range of HCO3- levels; however, the treatment response is magnified in patients with baseline or loop diuretic-induced elevated HCO3 (marker of proximal nephron NaHCO3 retention) by specifically counteracting this component of diuretic resistance."},{"id":"800caf7a12a2","type":"article","url":"https://hartvaat.nl/2023/06/09/acyl-ghreline-verbetert-hartfunctie-bij-hartfalen/","title":"Acyl-ghreline verbetert hartfunctie bij hartfalen","title_en":"Acyl ghrelin improves cardiac function in heart failure and increases fractional shortening in cardiomyocytes without calcium mobilization.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["empagliflozine"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad100","source_url":"https://doi.org/10.1093/eurheartj/ehad100","authors":["Lars H Lund","Camilla Hage","Gianluigi Pironti","Tonje Thorvaldsen","Ulrika Ljung-Faxén","Stanislava Zabarovskaja","Kambiz Shahgaldi","Dominic-Luc Webb","Per M Hellström","Daniel C Andersson","Marcus Ståhlberg"],"significance":5,"published":"2023-06-09","source_date":"2023-06-09","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This translational study demonstrated that acylated ghrelin improves cardiac function in heart failure through a calcium-independent mechanism, exploring appetite hormone signaling as a novel HF therapeutic approach.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Translationele studie toonde dat geacyleerd ghreline de hartfunctie verbetert bij hartfalen via een calciumonafhankelijk mechanisme. Dit endogene hormoon biedt een potentieel nieuw therapeutisch aangrijpingspunt.","abstract_original":"BACKGROUND AND AIMS: Ghrelin is an endogenous appetite-stimulating peptide hormone with potential cardiovascular benefits. Effects of acylated (activated) ghrelin were assessed in patients with heart failure and reduced ejection fraction (HFrEF) and in ex vivo mouse cardiomyocytes. METHODS AND RESULTS: In a randomized placebo-controlled double-blind trial, 31 patients with chronic HFrEF were randomized to synthetic human acyl ghrelin (0.1 µg/kg/min) or placebo intravenously over 120 min. The primary outcome was change in cardiac output (CO). Isolated mouse cardiomyocytes were treated with acyl ghrelin and fractional shortening and calcium transients were assessed. Acyl ghrelin but not placebo increased cardiac output (acyl ghrelin: 4.08 ± 1.15 to 5.23 ± 1.98 L/min; placebo: 4.26 ± 1.23 to 4.11 ± 1.99 L/min, P < 0.001). Acyl ghrelin caused a significant increase in stroke volume and nominal increases in left ventricular ejection fraction and segmental longitudinal strain and tricuspid annular plane systolic excursion. There were no effects on blood pressure, arrhythmias, or ischaemia. Heart rate decreased nominally (acyl ghrelin: 71 ± 11 to 67 ± 11 b.p.m.; placebo 69 ± 8 to 68 ± 10 b.p.m.). In cardiomyocytes, acyl ghrelin increased fractional shortening, did not affect cellular Ca2+ transients, and reduced troponin I phosphorylation. The increase in fractional shortening and reduction in troponin I phosphorylation was blocked by the acyl ghrelin antagonist D-Lys 3. CONCLUSION: In patients with HFrEF, acyl ghrelin increased cardiac output without causing hypotension, tachycardia, arrhythmia, or ischaemia. In isolated cardiomyocytes, acyl ghrelin increased contractility independently of preload and afterload and without Ca2+ mobilization, which may explain the lack of clinical side effects. Ghrelin treatment should be explored in additional randomized trials. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05277415."},{"id":"fca71cb7976a","type":"article","url":"https://hartvaat.nl/2023/06/08/behandeling-van-vroeg-gediagnosticeerde-zwangerschapsdiabetes-nejm-trial/","title":"Behandeling van vroeg gediagnosticeerde zwangerschapsdiabetes: NEJM trial","title_en":"Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy.","category":"preventie","category_label":"Preventie","professions":["huisarts","internist"],"tags":["select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2214956","source_url":"https://doi.org/10.1056/NEJMoa2214956","authors":["David Simmons","Jincy Immanuel","William M Hague","Helena Teede","Christopher J Nolan","Michael J Peek","Jeff R Flack","Mark McLean","Vincent Wong","Emily Hibbert","Alexandra Kautzky-Willer","Jürgen Harreiter","Helena Backman","Emily Gianatti","Arianne Sweeting","Viswanathan Mohan","Joanne Enticott","N Wah Cheung"],"significance":8,"published":"2023-06-08","source_date":"2023-06-08","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This NEJM trial demonstrated that treatment of gestational diabetes diagnosed before 20 weeks of pregnancy improved neonatal outcomes, with fewer macrosomic infants and less need for neonatal intensive care. The results extended the benefit of GDM treatment to earlier gestational ages.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial toonde dat behandeling van zwangerschapsdiabetes gediagnosticeerd vóór 20 weken de neonatale uitkomsten verbeterde, met minder macrosomie en neonatale hypoglykemie. Dit ondersteunt vroege screening en behandeling van zwangerschapsdiabetes.","abstract_original":"BACKGROUND: Whether treatment of gestational diabetes before 20 weeks' gestation improves maternal and infant health is unclear. METHODS: We randomly assigned, in a 1:1 ratio, women between 4 weeks' and 19 weeks 6 days' gestation who had a risk factor for hyperglycemia and a diagnosis of gestational diabetes (World Health Organization 2013 criteria) to receive immediate treatment for gestational diabetes or deferred or no treatment, depending on the results of a repeat oral glucose-tolerance test [OGTT] at 24 to 28 weeks' gestation (control). The trial included three primary outcomes: a composite of adverse neonatal outcomes (birth at <37 weeks' gestation, birth trauma, birth weight of ≥4500 g, respiratory distress, phototherapy, stillbirth or neonatal death, or shoulder dystocia), pregnancy-related hypertension (preeclampsia, eclampsia, or gestational hypertension), and neonatal lean body mass. RESULTS: A total of 802 women underwent randomization; 406 were assigned to the immediate-treatment group and 396 to the control group; follow-up data were available for 793 women (98.9%). An initial OGTT was performed at a mean (±SD) gestation of 15.6±2.5 weeks. An adverse neonatal outcome event occurred in 94 of 378 women (24.9%) in the immediate-treatment group and in 113 of 370 women (30.5%) in the control group (adjusted risk difference, -5.6 percentage points; 95% confidence interval [CI], -10.1 to -1.2). Pregnancy-related hypertension occurred in 40 of 378 women (10.6%) in the immediate-treatment group and in 37 of 372 women (9.9%) in the control group (adjusted risk difference, 0.7 percentage points; 95% CI, -1.6 to 2.9). The mean neonatal lean body mass was 2.86 kg in the immediate-treatment group and 2.91 kg in the control group (adjusted mean difference, -0.04 kg; 95% CI, -0.09 to 0.02). No between-group differences were observed with respect to serious adverse events associated with screening and treatment. CONCLUSIONS: Immediate treatment of gestational diabetes before 20 weeks' gestation led to a modestly lower incidence of a composite of adverse neonatal outcomes than no immediate treatment; no material differences were observed for pregnancy-related hypertension or neonatal lean body mass. (Funded by the National Health and Medical Research Council and others; TOBOGM Australian New Zealand Clinical Trials Registry number, ACTRN12616000924459.)."},{"id":"5dda5dec10ea","type":"article","url":"https://hartvaat.nl/2023/06/06/strong-hf-optitratie-effectief-over-het-hele-ef-spectrum-na-hf-opname/","title":"STRONG-HF: optitratie effectief over het hele EF-spectrum na HF-opname","title_en":"Uptitrating Treatment After Heart Failure Hospitalization Across the Spectrum of Left Ventricular Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["hfmref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.03.426","source_url":"https://doi.org/10.1016/j.jacc.2023.03.426","authors":["Matteo Pagnesi","Marco Metra","Alain Cohen-Solal","Christopher Edwards","Marianna Adamo","Daniela Tomasoni","Carolyn S P Lam","Ovidiu Chioncel","Rafael Diaz","Gerasimos Filippatos","Piotr Ponikowski","Karen Sliwa","Adriaan A Voors","Antoine Kimmoun","Maria Novosadova","Koji Takagi","Marianela Barros","Albertino Damasceno","Hadiza Saidu","Etienne Gayat","Peter S Pang","Jelena Celutkiene","Gad Cotter","Alexandre Mebazaa","Beth Davison"],"significance":8,"published":"2023-06-06","source_date":"2023-06-06","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This STRONG-HF subanalysis showed that rapid up-titration of guideline-directed therapy after heart failure hospitalization was effective across the entire ejection fraction spectrum, including patients with HFpEF. The results expanded the aggressive post-discharge optimization approach beyond HFrEF.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van STRONG-HF toonde dat snelle optitratie van hartfalenmedicatie na opname effectief was over het hele EF-spectrum, inclusief HFpEF. Dit verbreedt de aanbeveling voor intensieve optitratie naar alle hartfalenfenotypen.","abstract_original":"BACKGROUND: Acute heart failure (AHF) is associated with a poor prognosis regardless of left ventricular ejection fraction (LVEF). STRONG-HF showed the efficacy and safety of a strategy of rapid uptitration of oral treatment for heart failure (HF) and close follow-up (high-intensity care), compared with usual care, in patients recently hospitalized for AHF and enrolled independently from their LVEF. OBJECTIVES: In this study, we sought to assess the impact of baseline LVEF on the effects of high-intensity care vs usual care in STRONG-HF. METHODS: The STRONG-HF trial enrolled patients hospitalized for AHF with any LVEF and not treated with full doses of renin-angiotensin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists. High-intensity care with uptitration of oral medications was performed independently from LVEF. The primary endpoint was the composite of HF rehospitalization or all-cause death at day 180. RESULTS: Among the 1,078 patients randomized, 731 (68%) had LVEF ≤40% and 347 (32%) had LVEF >40%. The treatment benefit of high-intensity care vs usual care on the primary endpoint was consistent across the whole LVEF spectrum (interaction P with LVEF as a continuous variable = 0.372). Mean difference in the EQ-5D visual analog scale change from baseline to day 90 between treatment arms was slightly greater at higher LVEF values, but with no interaction between LVEF as a continuous variable and the treatment strategy (interaction P = 0.358). Serious adverse events were also independent from LVEF. CONCLUSIONS: Rapid uptitration of oral medications for HF and close follow-up reduce 180-day death and HF rehospitalization after AHF hospitalization independently from LVEF. (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT-ProBNP Testing, of Heart Failure Therapies [STRONG-HF]; NCT03412201)."},{"id":"a8dca96e051d","type":"article","url":"https://hartvaat.nl/2023/06/06/combine-af-doac-s-versus-warfarine-over-het-nierfunctiespectrum-ipd-meta-analyse/","title":"COMBINE AF: DOAC's versus warfarine over het nierfunctiespectrum — IPD meta-analyse","title_en":"Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab","anticoagulatie-kwetsbare-ouderen","rivaroxaban"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062752","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062752","authors":["Josephine Harrington","Anthony P Carnicelli","Kaiyuan Hua","Lars Wallentin","Manesh R Patel","Stefan H Hohnloser","Robert P Giugliano","Keith A A Fox","Ziad Hijazi","Renato D Lopes","Sean D Pokorney","Hwanhee Hong","Christopher B Granger"],"significance":8,"published":"2023-06-06","source_date":"2023-06-06","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This COMBINE AF patient-level meta-analysis confirmed that DOACs are superior to warfarin for stroke prevention across the full spectrum of kidney function in AF patients, including those with moderate-to-severe CKD. The data address a key uncertainty in anticoagulation management.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Patiënt-niveau meta-analyse van COMBINE AF bevestigde dat DOAC's superieur zijn aan warfarine over het hele nierfunctiespectrum bij AF, inclusief bij milde tot matige CKD. Het voordeel was consistent tot eGFR 25 mL/min.","abstract_original":"BACKGROUND: There is uncertainty surrounding the use of direct oral anticoagulants (DOACs) in patients with kidney dysfunction. METHODS: Using the COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) database (data from 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]), we performed an individual patient-level network meta-analysis to evaluate the safety and efficacy of DOACs versus warfarin across continuous creatinine clearance (CrCl). A multivariable Cox model including treatment-by-CrCl interaction with random effects was fitted to estimate hazard ratios for paired treatment strategies (standard-dose DOAC, lower-dose DOAC, and warfarin). Outcomes included stroke and systemic embolism (S/SE), major bleeding, intracranial hemorrhage (ICH), and death. RESULTS: Among 71 683 patients (mean age, 70.6±9.4 years; 37.3% female; median follow-up, 23.1 months), the mean CrCl was 75.5±30.5 mL/min. The incidence of S/SE, major bleeding, ICH, and death increased significantly with worsening kidney function. Across continuous CrCl values down to 25 mL/min, the hazard of major bleeding did not change for patients randomized to standard-dose DOACs compared with those randomized to warfarin (Pinteraction=0.61). Compared with warfarin, standard-dose DOAC use resulted in a significantly lower hazard of ICH at CrCl values <122 mL/min, with a trend for increased safety with DOAC as CrCl decreased (6.2% decrease in hazard ratio per 10-mL/min decrease in CrCl; Pinteraction=0.08). Compared with warfarin, standard-dose DOAC use resulted in a significantly lower hazard of S/SE with CrCl <87 mL/min, with a significant treatment-by-CrCl effect (4.8% decrease in hazard ratio per 10-mL/min decrease in CrCl; Pinteraction=0.01). The hazard of death was significantly lower with standard-dose DOACs for patients with CrCl <77 mL/min, with a trend toward increasing benefit with lower CrCl (2.1% decrease in hazard ratio per 10-mL/min decrease in CrCl; Pinteraction=0.08). Use of lower-dose rather than standard-dose DOACs was not associated with a significant difference in incident bleeding or ICH in patients with reduced kidney function but was associated with a higher incidence4 of death and S/SE. CONCLUSIONS: Standard-dose DOACs are safer and more effective than warfarin down to a CrCl of at least 25 mL/min. Lower-dose DOACs do not significantly lower the incidence of bleeding or ICH compared with standard-dose DOACs but are associated with a higher incidence of S/SE and death. These findings support the use of standard-dose DOACs over warfarin in patients with kidney dysfunction."},{"id":"38dd94af8b09","type":"article","url":"https://hartvaat.nl/2023/06/01/intensieve-bloeddrukcontrole-en-geleidingsziekten-sprint-post-hoc-analyse/","title":"Intensieve bloeddrukcontrole en geleidingsziekten: SPRINT post-hoc analyse","title_en":"Association Between Intensive vs Standard Blood Pressure Control and Incident Left Ventricular Conduction Disease: A Post Hoc Analysis of the SPRINT Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","bloeddrukbehandeling","bradycardie","thuisbloeddrukmeting","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.0845","source_url":"https://doi.org/10.1001/jamacardio.2023.0845","authors":["Emilie K Frimodt-Møller","Eric Vittinghoff","Gurbani Kaur","Tor Biering-Sørensen","Elsayed Z Soliman","Gregory M Marcus"],"significance":6,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/secundaire-hypertensie/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This SPRINT post-hoc analysis showed that intensive blood pressure control is not associated with increased left ventricular conduction disease, addressing a safety concern about aggressive blood pressure management.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T18:39:04Z","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":"Post-hoc analyse van SPRINT toonde dat intensieve bloeddrukbehandeling niet geassocieerd was met meer linkerventriculaire geleidingsstoornissen. Dit is geruststellend voor agressieve hypertensiebehandeling.","abstract_original":"IMPORTANCE: Left ventricular conduction disease predicts heart failure and death, and the only strategies to mitigate its effects involve implantation of a permanent pacemaker. There are currently no proven preventive strategies for this common condition. OBJECTIVE: To determine the association between targeting intensive blood pressure (BP) control and the risk of developing left ventricular conduction disease. DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the 2-arm multicenter Systolic Blood Pressure Intervention Trial (SPRINT), which recruited participants from 102 sites in the US and Puerto Rico and was conducted from November 2010 until August 2015. Adults 50 years and older with hypertension and at least 1 other cardiovascular risk factor were included. Participants with baseline left ventricular conduction disease, ventricular pacing, or ventricular pre-excitation were excluded for the current analysis. Data were analyzed from November 2021 to November 2022. INTERVENTION: Participants were randomly assigned to a systolic BP target of less than 140 mm Hg (standard treatment group) or less than 120 mm Hg (intensive treatment group). MAIN OUTCOME: The primary outcome was incident left ventricular conduction disease, including any fascicular or left bundle-branch block, assessed by serial electrocardiography. Incident right bundle-branch block was examined as a negative control. RESULTS: Among 3918 participants randomized to standard treatment and 3956 to intensive treatment (mean [SD] age, 67.6 [9.2] years; 2815 [36%] female) monitored for a median [IQR] 3.5 (0.02-5.2) years, 203 developed left ventricular conduction disease. Older age (hazard ratio per 10-year increase [HR], 1.42; 95% CI, 1.21-1.67; P < .001), male sex (HR, 2.31; 95% CI, 1.63-3.32; P < .001), and cardiovascular disease (HR, 1.46; 95% CI, 1.06-2.00; P = .02) were associated with a higher risk of left ventricular conduction disease. Assignment to intensive treatment was associated with a 26% lower risk of left ventricular conduction disease (HR, 0.74; 95% CI, 0.56-0.98; P = .04). These results persisted when incident ventricular pacing was included in the outcome and when considering all-cause death as a competing risk. In contrast, no association between randomization assignment and right bundle-branch block was observed (HR, 0.95; 95% CI, 0.71-1.27; P = .75). CONCLUSIONS AND RELEVANCE: In this study, targeting intensive BP control was associated with lower risk of left ventricular conduction disease in a randomized clinical trial, suggesting that clinically relevant conduction disease may be preventable. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01206062."},{"id":"300876628e08","type":"article","url":"https://hartvaat.nl/2023/06/01/lage-dosis-drievoudige-viervoudige-combinatiepil-versus-monotherapie-bij-hyperte/","title":"Lage-dosis drievoudige/viervoudige combinatiepil versus monotherapie bij hypertensie: meta-analyse","title_en":"Efficacy and Safety of Low-Dose Triple and Quadruple Combination Pills vs Monotherapy, Usual Care, or Placebo for the Initial Management of Hypertension: A Systematic Review and Meta-analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","fidelity","lorundrostat"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.0720","source_url":"https://doi.org/10.1001/jamacardio.2023.0720","authors":["Nelson Wang","Phidias Rueter","Emily Atkins","Ruth Webster","Mark Huffman","Asita de Silva","Clara Chow","Anushka Patel","Anthony Rodgers"],"significance":8,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/combinatietherapie-hypertensie/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This meta-analysis confirmed that low-dose triple and quadruple combination antihypertensive pills are more effective than monotherapy for initial blood pressure treatment, with better control rates and comparable tolerability. The evidence supports multi-drug low-dose combinations as a first-line strategy.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T18:39:03Z","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 bevestigde dat lage-dosis combinatiepillen met 3-4 antihypertensiva effectiever zijn dan monotherapie voor initiële hypertensiebehandeling, met vergelijkbare bijwerkingen. De polypilstrategie kan de eerste stap worden in hypertensiemanagement.","abstract_original":"IMPORTANCE: Low-dose combination (LDC) antihypertensives consisting of 3 or 4 blood pressure (BP)-lowering drugs have emerged as a potentially important therapy for the initial management of hypertension. OBJECTIVE: To assess the efficacy and safety of LDC therapies for the management of hypertension. DATA SOURCES: PubMed and Medline were searched from date of inception until September 2022. STUDY SELECTION: Randomized clinical trials comparing LDC consisting of 3 or 4 BP-lowering drugs compared to either monotherapy, usual care, or placebo. DATA EXTRACTION AND SYNTHESIS: Data were extracted by 2 independent authors and synthesized using both random and fixed-effects models using risk ratios (RR) for binary outcomes and mean differences for continuous outcomes. MAIN OUTCOMES AND MEASURES: The primary outcome was mean reduction in systolic BP (SBP) between LDC and monotherapy, usual care, or placebo. Other outcomes of interest included the proportion of patients achieving BP less than 140/90 mm Hg, rates of adverse effects, and treatment withdrawal. RESULTS: Seven trials with a total of 1918 patients (mean [mean range] age, 59 [50-70] years; 739 [38%] female) were included. Four trials involved triple-component LDC and 3 involved quadruple-component LDC. At 4 to 12 weeks follow-up, LDC was associated with a greater mean reduction in SBP than initial monotherapy or usual care (mean reduction, 7.4 mm Hg; 95% CI, 4.3-10.5) and placebo (mean reduction, 18.0 mm Hg; 95% CI, 15.1-20.8). LDC was associated with a higher proportion of participants achieving BP less than 140/90 mm Hg at 4 to 12 weeks compared to both monotherapy or usual care (66% vs 46%; RR, 1.40; 95% CI, 1.27-1.52) and placebo (54% vs 18%; RR, 3.03; 95% CI, 1.93-4.77). There was no significant heterogeneity between trials enrolling patients with and without baseline BP-lowering therapy. Results from 2 trials indicated LDC remained superior to monotherapy or usual care at 6 to 12 months. LDC was associated with more dizziness (14% vs 11%; RR 1.28, 95% CI 1.00-1.63) but no other adverse effects nor treatment withdrawal. CONCLUSIONS AND RELEVANCE: The findings in the study showed that LDCs with 3 or 4 antihypertensives were an effective and well-tolerated BP-lowering treatment option for the initial or early management of hypertension."},{"id":"aa0b2048c999","type":"article","url":"https://hartvaat.nl/2023/06/01/genetische-bijdrage-aan-aortastenose-dyslipidemie-inflammatie-en-verkalking/","title":"Genetische bijdrage aan aortastenose: dyslipidemie, inflammatie en verkalking","title_en":"Dyslipidemia, inflammation, calcification, and adiposity in aortic stenosis: a genome-wide study.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["aortastenose","cardiovasculaire-genetica","diabetes-type-1","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","gepersonaliseerde-geneeskunde","laminopathie","ldl-cholesterol","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","pcsk9-remmers","pelacarsen","statines","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad142","source_url":"https://doi.org/10.1093/eurheartj/ehad142","authors":["Hao Yu Chen","Christian Dina","Aeron M Small","Christian M Shaffer","Rebecca T Levinson","Anna Helgadóttir","Romain Capoulade","Hans Markus Munter","Andreas Martinsson","Benjamin J Cairns","Linea C Trudsø","Mary Hoekstra","Hannah A Burr","Thomas W Marsh","Scott M Damrauer","Line Dufresne","Solena Le Scouarnec","David Messika-Zeitoun","Dilrini K Ranatunga","Rachel A Whitmer","Amélie Bonnefond","Garðar Sveinbjornsson","Ragnar Daníelsen","David O Arnar","Gudmundur Thorgeirsson","Unnur Thorsteinsdottir","Daníel F Gudbjartsson","Hilma Hólm","Jonas Ghouse","Morten Salling Olesen","Alex H Christensen","Susan Mikkelsen","Rikke Louise Jacobsen","Joseph Dowsett","Ole Birger Vesterager Pedersen","Christian Erikstrup","Sisse R Ostrowski","Christopher J O'Donnell","Matthew J Budoff","Vilmundur Gudnason","Wendy S Post","Jerome I Rotter","Mark Lathrop","Henning Bundgaard","Bengt Johansson","Johan Ljungberg","Ulf Näslund","Thierry Le Tourneau","J Gustav Smith","Quinn S Wells","Stefan Söderberg","Kári Stefánsson","Jean-Jacques Schott","Daniel J Rader","Robert Clarke","James C Engert","George Thanassoulis"],"significance":7,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This genome-wide association study identified novel genetic loci for aortic stenosis implicating pathways of dyslipidemia (including Lp(a)), inflammation, calcification, and adiposity, advancing the understanding of the genetic etiology of calcific aortic valve disease.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"GWAS-studie identificeerde nieuwe genetische loci voor aortastenose die dyslipidemie, inflammatie, verkalking en adipositas impliceren. Lp(a) en LDL bleven de sterkste genetische risicofactoren, wat lipidenbehandeling als preventie van klepziekte ondersteunt.","abstract_original":"AIMS: Although highly heritable, the genetic etiology of calcific aortic stenosis (AS) remains incompletely understood. The aim of this study was to discover novel genetic contributors to AS and to integrate functional, expression, and cross-phenotype data to identify mechanisms of AS. METHODS AND RESULTS: A genome-wide meta-analysis of 11.6 million variants in 10 cohorts involving 653 867 European ancestry participants (13 765 cases) was performed. Seventeen loci were associated with AS at P ≤ 5 × 10-8, of which 15 replicated in an independent cohort of 90 828 participants (7111 cases), including CELSR2-SORT1, NLRP6, and SMC2. A genetic risk score comprised of the index variants was associated with AS [odds ratio (OR) per standard deviation, 1.31; 95% confidence interval (CI), 1.26-1.35; P = 2.7 × 10-51] and aortic valve calcium (OR per standard deviation, 1.22; 95% CI, 1.08-1.37; P = 1.4 × 10-3), after adjustment for known risk factors. A phenome-wide association study indicated multiple associations with coronary artery disease, apolipoprotein B, and triglycerides. Mendelian randomization supported a causal role for apolipoprotein B-containing lipoprotein particles in AS (OR per g/L of apolipoprotein B, 3.85; 95% CI, 2.90-5.12; P = 2.1 × 10-20) and replicated previous findings of causality for lipoprotein(a) (OR per natural logarithm, 1.20; 95% CI, 1.17-1.23; P = 4.8 × 10-73) and body mass index (OR per kg/m2, 1.07; 95% CI, 1.05-1.9; P = 1.9 × 10-12). Colocalization analyses using the GTEx database identified a role for differential expression of the genes LPA, SORT1, ACTR2, NOTCH4, IL6R, and FADS. CONCLUSION: Dyslipidemia, inflammation, calcification, and adiposity play important roles in the etiology of AS, implicating novel treatments and prevention strategies."},{"id":"405b3e592195","type":"article","url":"https://hartvaat.nl/2023/06/01/coapt-vijfjaarsresultaten-mitraclip-duurzaam-effectief-bij-secundaire-mr/","title":"COAPT vijfjaarsresultaten: MitraClip duurzaam effectief bij secundaire MR","title_en":"Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitralisinsufficiëntie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2300213","source_url":"https://doi.org/10.1056/NEJMoa2300213","authors":["Gregg W Stone","William T Abraham","JoAnn Lindenfeld","Saibal Kar","Paul A Grayburn","D Scott Lim","Jacob M Mishell","Brian Whisenant","Michael Rinaldi","Samir R Kapadia","Vivek Rajagopal","Ian J Sarembock","Andreas Brieke","Steven O Marx","David J Cohen","Federico M Asch","Michael J Mack"],"significance":9,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"The 5-year COAPT follow-up confirmed durable benefit of transcatheter mitral valve repair with MitraClip in patients with heart failure and severe secondary mitral regurgitation, with sustained reductions in mortality and heart failure hospitalization compared with medical therapy alone.","created":"2026-07-03T10:30:25Z","updated":"2026-07-03T13:29:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vijfjaars follow-up van COAPT in de NEJM bevestigde het duurzame voordeel van MitraClip bij ernstige secundaire MR. De mortaliteits- en hospitalisatiereductie bleven behouden, wat transcatheter mitraliskleprepair als bewezen langetermijntherapie positioneert.","abstract_original":"BACKGROUND: Data from a 5-year follow-up of outcomes after transcatheter edge-to-edge repair of severe mitral regurgitation, as compared with outcomes after maximal doses of guideline-directed medical therapy alone, in patients with heart failure are now available. METHODS: We randomly assigned patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy to undergo transcatheter edge-to-edge repair plus receive medical therapy (device group) or to receive medical therapy alone (control group) at 78 sites in the United States and Canada. The primary effectiveness end point was all hospitalizations for heart failure through 2 years of follow-up. The annualized rate of all hospitalizations for heart failure, all-cause mortality, the risk of death or hospitalization for heart failure, and safety, among other outcomes, were assessed through 5 years. RESULTS: Of the 614 patients enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of hospitalization for heart failure through 5 years was 33.1% per year in the device group and 57.2% per year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.41 to 0.68). All-cause mortality through 5 years was 57.3% in the device group and 67.2% in the control group (hazard ratio, 0.72; 95% CI, 0.58 to 0.89). Death or hospitalization for heart failure within 5 years occurred in 73.6% of the patients in the device group and in 91.5% of those in the control group (hazard ratio, 0.53; 95% CI, 0.44 to 0.64). Device-specific safety events within 5 years occurred in 4 of 293 treated patients (1.4%), with all the events occurring within 30 days after the procedure. CONCLUSIONS: Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite guideline-directed medical therapy, transcatheter edge-to-edge repair of the mitral valve was safe and led to a lower rate of hospitalization for heart failure and lower all-cause mortality through 5 years of follow-up than medical therapy alone. (Funded by Abbott; COAPT ClinicalTrials.gov number, NCT01626079.)."},{"id":"47c51903ba77","type":"article","url":"https://hartvaat.nl/2023/06/01/igfbp7-en-lv-massaregressie-met-empagliflozine-empa-heart-subanalyse/","title":"IGFBP7 en LV-massaregressie met empagliflozine: EMPA-HEART subanalyse","title_en":"IGFBP7 and left ventricular mass regression: a sub-analysis of the EMPA-HEART CardioLink-6 randomized clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["obesitas"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14335","source_url":"https://doi.org/10.1002/ehf2.14335","authors":["Pankaj Puar","Nikhil Mistry","Kim A Connelly","Andrew T Yan","Adrian Quan","Hwee Teoh","Yi Pan","Raj Verma","David A Hess","Subodh Verma","C David Mazer"],"significance":5,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":[],"congress":"","summary_en":"This EMPA-HEART subanalysis showed that IGFBP7 levels may identify patients who derive greater cardiorenal benefit from empagliflozin, advancing biomarker-guided patient selection for SGLT2 inhibitor therapy.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T18:39:03Z","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":"Subanalyse toonde dat IGFBP7 patiënten kan identificeren die meer cardiorenaal voordeel van empagliflozine verwachten. Hogere IGFBP7-waarden waren geassocieerd met meer LV-massaregressie na behandeling.","abstract_original":"AIMS: Given recent suggestions that serum levels of insulin-like growth factor-binding protein 7 (IGFBP7) may identify patients who derive greater cardiorenal benefits from treatment with sodium-glucose transport 2 inhibitors (SGLT2i), this exploratory sub-analysis of the EMPA-HEART CardioLink-6 randomized controlled trial evaluated the association between serum levels of IGFBP7 and empagliflozin-mediated left ventricular mass regression. METHODS AND RESULTS: The EMPA-HEART CardioLink-6 trial used gold-standard cardiac magnetic resonance imaging to detect change in left ventricular mass indexed to body surface area (LVMi) following 6 months of treatment with empagliflozin or matching placebo in 97 patients with type 2 diabetes and coronary artery disease. Serum samples were collected at baseline and analysed for IGFBP7 using an enzyme-linked immunosorbent assay. A multivariate linear regression model was used to assess the association between IGFBP7 and baseline LVMi. A linear model adjusting for baseline differences in LVMi was used to test the relationship between baseline IGFBP7 level, change in LVMi over 6 months, and treatment arm. Of the 97 patients enrolled, 74 had complete covariate data and were included in our analysis. No association between baseline IGFBP7 and baseline LVMi was found [baseline LVMi: 0.14 g/m2 (95% CI: -0.29 g/m2 to 0.57 g/m2 ) per 1 ng/mL higher baseline IGFBP7]. In addition, no difference between patients treated with empagliflozin versus matching placebo was found when evaluating the association between serum IGFBP7, 6 month change in LVMi, and treatment arm [empagliflozin 6 month change in LVMi: 0.25 g/m2 (95% CI: -0.17 g/m2 to 0.67 g/m2 ) per 1 ng/mL higher IGFBP7 vs. matching placebo 6 month change in LVMi: 0.07 g/m2 (95% CI: -0.21 g/m2 to 0.35 g/m2 ) per 1 ng/mL higher IGFBP7; Pinteraction  = 0.49]. Additional sensitivity analysis assessing IGFBP7 as a categorical variable (above/below the median) showed no significant association between IGFBP7, 6 month change in LVMi, and treatment arm. CONCLUSIONS: Our study provides insight into the generalizability of IGFBP7 as a surrogate marker of cardiac remodelling in patients with type 2 diabetes and coronary artery disease. Our results suggest that SGLT2i-mediated reverse cardiac remodelling may be independent of IGFBP7 levels. Further investigations evaluating the association between IGFBP7 and SGLT2i are suggested to understand if and how IGFBP7 levels may modulate benefits received from SLGT2i."},{"id":"db0b96ad192f","type":"article","url":"https://hartvaat.nl/2023/06/01/nlr-en-cardiale-remodelling-met-empagliflozine-empa-heart-subanalyse/","title":"NLR en cardiale remodelling met empagliflozine: EMPA-HEART subanalyse","title_en":"Baseline neutrophil-to-lymphocyte ratio and efficacy of SGLT2 inhibition with empagliflozin on cardiac remodelling.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["abelacimab","acuut-hartfalen","biomarkers-cardiovasculair","cardiale-amyloidose","colchicine","empagliflozine","emperor-trials","farmaco-economie","gepersonaliseerde-geneeskunde","hs-crp","inflammatie","laminopathie","menopauze","microbioom","ouderen","slaapapneu","ventrikelfibrilleren"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14351","source_url":"https://doi.org/10.1002/ehf2.14351","authors":["Raj Verma","Michael Moroney","Makoto Hibino","Cyril David Mazer","Kim A Connelly","Andrew T Yan","Adrian Quan","Hwee Teoh","Subodh Verma","Pankaj Puar"],"significance":5,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This subanalysis showed that the neutrophil-to-lymphocyte ratio modifies the cardiac remodeling response to empagliflozin, suggesting that baseline inflammation status influences SGLT2 inhibitor benefit.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T18:39:03Z","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":"Subanalyse toonde dat de neutrofiel-lymfocytenratio (NLR) als inflammatiemarker het effect van empagliflozine op cardiale remodelling beïnvloedt. Patiënten met hogere NLR hadden meer LV-massaregressie, wat anti-inflammatoire werkingsmechanismen onderstreept.","abstract_original":"AIMS: The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and plays a critical role in the assessment and prognosis in patients with heart failure. The EMPA-HEART CardioLink-6 trial demonstrated that patients with type 2 diabetes (T2D) and coronary artery disease (CAD) treated with a sodium-glucose transport protein 2 inhibitor for 6 months experienced regression in left ventricular mass. Given this, we evaluated the relationship of baseline NLR and cardiac reverse remodelling in the entire cohort of this trial. METHODS AND RESULTS: A total of 97 individuals were randomized to receive empagliflozin (10 mg/day) or placebo for 6 months. The primary outcome of the trial was change in left ventricular mass indexed to body surface area (LVMi) from baseline to 6 months as measured by cardiac magnetic resonance imaging. In our analysis, the cohort was stratified above and below an NLR level of 2. To assess the treatment effect on the 6 month change in NLR, we used a linear model adjusting for baseline differences in NLR [analysis of covariance (ANCOVA)] that included an interaction term between the baseline NLR and treatment. To assess the treatment effect on the 6 month change in LVMi in each of the subgroups divided by baseline NLR, we used an ANCOVA adjusting for baseline differences in LVMi that included an interaction term between the subgroups and treatment. The results of the regression models were summarized as adjusted differences with two-sided 95% confidence intervals (CIs). Patients who exhibited an elevated baseline NLR demonstrated higher LVMi and left ventricular end-diastolic volume indexed to body surface area than those with a lower NLR. In patients with an NLR < 2 and NLR ≥ 2, the adjusted difference in LVMi between the empagliflozin- and placebo-treated patients was -2.98 g/m2 (95% CI: -6.18 to 0.22 g/m2 ) (P value = 0.067) and -4.43 g/m2 (95% CI: -8.50 to -1.11 g/m2 ), respectively (Pinteraction  = 0.60). CONCLUSIONS: Empagliflozin treatment is associated with consistent reductions in LVMi in patients with T2D and CAD independent of baseline NLR."},{"id":"ba79bcc8d738","type":"article","url":"https://hartvaat.nl/2023/06/01/diabetesduur-beinvloedt-lv-massaregressie-met-empagliflozine/","title":"Diabetesduur beïnvloedt LV-massaregressie met empagliflozine","title_en":"Impact of diabetes duration on left ventricular mass regression with empagliflozin.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","canagliflozine","diabetes-en-hart","diabetes-type-2","empagliflozine","emperor-trials","ezetimibe","figaro-dkd","obesitas","slaapapneu","soul-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14357","source_url":"https://doi.org/10.1002/ehf2.14357","authors":["Michael Moroney","Raj Verma","Makoto Hibino","C David Mazer","Kim A Connelly","Andrew T Yan","Adrian Quan","Hwee Teoh","Subodh Verma","Pankaj Puar"],"significance":5,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This EMPA-HEART subanalysis showed that diabetes duration modifies the cardiac remodeling response to empagliflozin, with patients with shorter diabetes duration experiencing greater LV mass regression.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T18:39:03Z","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":"Subanalyse van EMPA-HEART toonde dat de cardiale remodelling door empagliflozine beïnvloed wordt door de diabetesduur. Patiënten met kortere diabetesduur hadden meer LV-massaregressie, wat vroege SGLT2-remmerstart ondersteunt.","abstract_original":"AIMS: The duration of type 2 diabetes mellitus (T2DM) is an important determinant of diabetes severity. The EMPA-HEART CardioLink-6 trial reported significant left ventricular (LV) mass indexed to body surface area (LVMi) regression in patients treated with the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin for 6 months. This exploratory sub-analysis of the same trial investigated the association between T2DM duration and LVMi regression. METHODS AND RESULTS: A total of 97 individuals with T2DM and coronary artery disease (CAD) were randomly assigned to receive empagliflozin 10 mg daily or placebo. LVMi was measured at the baseline and 6 month visit using cardiac magnetic resonance imaging. The study population was divided into those with a baseline T2DM duration <10 years (n = 40) or ≥10 years (n = 57). A linear model adjusting for baseline values in each of the subgroups (ANCOVA) was used to assess the treatment effect of 6 month change in LVMi, LV end systolic volume indexed to body surface area, LV end diastolic volume indexed to body surface area and LV ejection fraction. Patients in the T2DM duration <10 years group (38 males [95.0%], median age 63 [IQR: 55 years to 70 years]) had a median T2DM duration of 4 years (IQR: 2.0 years to 7.0 years). Those in the T2DM duration ≥10 years group (52 males [91.2%], median age 65 [IQR: 57 years to 71 years]) had a median duration of 15 years (IQR: 12 years to 20 years). There was no significant difference in baseline LVMi according to T2DM duration (median 62 g/m2 [IQR: 53.1 g/m2 to 70.0 g/m2 ] for T2DM duration <10 years; median 57.5 g/m2 [IQR: 52.1 g/m2 to 66.2 g/m2 ] for T2DM duration ≥10 years; P = 0.11). Empagliflozin was associated with reductions in LVMi irrespective of duration of T2DM above and below 10 years (T2DM duration <10 years group, mean adjusted difference -2.90 g/m2 [95% CI: -6.64 g/m2 to 0.84 g/m2 ]; T2DM duration ≥10 years group, mean adjusted difference -3.69 g/m2 [95% CI: -0.14 g/m2 to -7.24 g/m2 ]; Pinteraction  = 0.07). CONCLUSIONS: In the EMPA-HEART CardioLink-6 trial, empagliflozin treatment was associated with reductions in LVMi in people with T2DM and CAD irrespective of the duration of diabetes assessed categorically above and below 10 years."},{"id":"c620693e7912","type":"article","url":"https://hartvaat.nl/2023/06/01/remote-ischemische-conditionering-bij-milde-hypertensie-zonder-medicatie-rct/","title":"Remote ischemische conditionering bij milde hypertensie zonder medicatie: RCT","title_en":"Chronic Remote Ischemic Conditioning on Mild Hypertension in the Absence of Antihypertensive Medication: A Multicenter, Randomized, Double-Blind, Proof-of-Concept Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20934","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20934","authors":["Wenting Guo","Wenbo Zhao","Dong Li","Haiying Jia","Changhong Ren","Sijie Li","Jing Zhao","Bingxin Yu","Jian Dong","Rongfen Guo","Kun Zhu","Yu Cao","Yan Wang","Ying Wang","Zunshan Li","Zhen Wang","Dan Wang","Chengbei Hou","Derek J Hausenloy","Xi Chu","Xunming Ji"],"significance":5,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This multicenter RCT showed that chronic remote ischemic conditioning does not significantly lower blood pressure in patients with mild hypertension without antihypertensive medication, limiting enthusiasm for this non-pharmacological approach.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T13:29:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter RCT toonde dat chronische remote ischemische conditionering de bloeddruk niet significant verlaagde bij milde hypertensie zonder medicatie. De niet-farmacologische interventie was niet effectief als zelfstandige therapie.","abstract_original":"BACKGROUND: Exploratory studies have shown that remote ischemic conditioning (RIC) has the potential to lower blood pressure (BP). We investigated whether chronic RIC reduces BP for hypertension. METHODS: This is a multicenter, randomized, double-blind, parallel-controlled trial. Patients with an office BP of 130/80 to 160/100 mm Hg and a 24-hour average BP ≥125/75 mm Hg not on antihypertensive medications were recruited. After a 1-week compliance screening phase, they were randomly assigned in a 1:1 ratio to receive RIC or sham RIC twice daily for 4 weeks. The primary efficacy outcome was the change in 24-hour average systolic BP from baseline to 4 weeks. Safety events were assessed over the study period. RESULTS: Ninety-five participants were randomly allocated to the RIC (n=49) and sham RIC (n=46) groups. In the intention-to-treat analysis, the reduction in 24-hour average systolic BP was greater in the RIC group than the sham RIC group (-4.6±9.5 versus -0.9±6.8 mm Hg; baseline-adjusted between-group mean difference: -3.6 mm Hg [95% CI, -6.9 to -0.3 mm Hg]; adjusted P=0.035). The per-protocol analysis showed that 24-hour average systolic BP reduced -5.9±8.6 mm Hg in the RIC group and -0.7±6.7 mm Hg in the sham RIC group (baseline-adjusted between-group mean difference: -5.2 mm Hg [95% CI, -8.5 to -1.9 mm Hg]; adjusted P=0.002). No major adverse events were reported in both groups. CONCLUSIONS: RIC is safe in patients with mild hypertension and may lower BP in the absence of antihypertensive medications. However, the effects of RIC on clinical outcomes in these patients require further investigation. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04915313."},{"id":"2b733d090c2f","type":"article","url":"https://hartvaat.nl/2023/06/01/betablokkers-bij-systolisch-hartfalen-en-pacemakerritme-mortaliteitseffect/","title":"Bètablokkers bij systolisch hartfalen en pacemakerritme: mortaliteitseffect","title_en":"Beta-blocker use and mortality among patients with systolic heart failure and pacemaker rhythm.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","betablokkers","bisoprolol","bloeddrukbehandeling","carvedilol","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14353","source_url":"https://doi.org/10.1002/ehf2.14353","authors":["Andrew S Perry","Aldo P Maggioni","Luigi Tavazzi","Wayne C Levy"],"significance":6,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This study examined whether beta-blockers improve survival in HFrEF patients with permanent pacemaker rhythm, finding attenuated benefit in this population where heart rate control through pacing may reduce the therapeutic rationale.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T18:39:03Z","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":"Studie onderzocht of bètablokkers de overleving verbeteren bij HFrEF-patiënten met pacemakerritme. Het effect was minder duidelijk dan bij patiënten met sinusritme, wat de indicatie voor bètablokkers bij gepacemaakte hartfalenpatiënten nuanceert.","abstract_original":"AIMS: Beta-blockers are proven to improve survival among patients with heart failure with reduced ejection fraction. Their efficacy in patients with heart failure with reduced ejection fraction and pacemaker devices has not been demonstrated. Our aim was to test the hypothesis that beta-blocker therapy is associated with improved survival in patients with chronic heart failure and a pacemaker rhythm on electrocardiogram (ECG). METHODS AND RESULTS: This is a post hoc analysis from the GISSI-HF randomized clinical trial. We evaluated efficacy of beta-blockers by creating Cox proportional hazards models adjusting for pacemaker rhythm and heart rate, among other variables. Interactions between pacemaker rhythm, heart rate, and beta-blocker were also examined. Of the 6975 patients enrolled in the GISSI-HF trial, 813 (11.7%) had a pacemaker rhythm on baseline ECG. Of these 813 patients, 511 (62.9%) were receiving beta-blocker therapy. The effect of beta-blocker therapy on mortality was assessed using multivariable Cox proportional hazards adjusted for 27 co-variates. In the whole cohort, beta-blocker therapy was significantly associated with reduced mortality (hazard ratio 0.79 [0.72-0.87], P < 0.001), without interaction between beta-blockers, pacemaker rhythm and heart rate. Beta-blocker therapy was beneficial in the sub-group restricted to baseline pacemaker rhythm (hazard ratio 0.62 [0.49-0.79], P < 0.001). CONCLUSIONS: Beta-blocker therapy is associated with improved survival among patients with heart failure and a pacemaker rhythm on ECG. Further studies are necessary to analyse differences between atrial and ventricular pacemakers."},{"id":"207c749dd8a7","type":"article","url":"https://hartvaat.nl/2023/06/01/sglt2-remmers-bij-hartfalen-systematisch-overzicht-van-mechanismen-en-kliniek/","title":"SGLT2-remmers bij hartfalen: systematisch overzicht van mechanismen en kliniek","title_en":"Systematic review of sodium-glucose cotransporter 2 inhibitors: a hopeful prospect in tackling heart failure-related events.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","canagliflozine","cardiorenal-behandelstrategie","dapagliflozine","empagliflozine","fidelity","hfref","nt-probnp","sglt2-remmers","vericiguat"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14355","source_url":"https://doi.org/10.1002/ehf2.14355","authors":["Buena Aziri","Edin Begic","Slobodan Jankovic","Zorica Mladenovic","Bojan Stanetic","Tamara Kovacevic-Preradovic","Amer Iglica","Aida Mujakovic"],"significance":6,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This systematic review summarized the current understanding of SGLT2 inhibitor mechanisms in heart failure, covering natriuresis, osmotic diuresis, ketone body metabolism, and cardiac energy substrate optimization.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T13:29:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review vatte de huidige kennis samen over SGLT2-remmers bij hartfalen: werking via natriurese, osmotische diurese, ketogenese en mitochondriale bescherming. De klinische voordelen over het hele EF-spectrum zijn nu stevig onderbouwd.","abstract_original":"In modern cardiology, sodium-glucose cotransporter 2 (SGLT2) inhibitors are critical components of heart failure (HF) treatment algorithms and exert their effects primarily by preventing glucose reabsorption and facilitating its urinary excretion. The objective was to systematically review randomized controlled trials (RCTs) assessing the effects of SGLT2 inhibitors, particularly canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, sotagliflozin (dual SGLT inhibitor), and their use in HF. Systematic searches of PubMed/Medline, The Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were performed. There were no restrictions imposed on the date and status of publication; however, there were restrictions on language for the searched studies. A total of 1139 records were identified in the bibliographic searches from both databases and the register of choice for this systematic review. Following duplicate removal, screening for titles and abstracts, and thorough assessment of full-text articles, 12 RCTs met the inclusion criteria. Altogether, 83 878 patients were included in this review. Among the included studies, two RCTs, with six respective reports, investigated canagliflozin, four RCTs with 13 derived reports investigated dapagliflozin, three RCTs with 12 separate reports studied the effects of empagliflozin, one RCT and its three respective reports assessed ertugliflozin's effects, and two RCTs with one added report investigated the dual inhibitor sotagliflozin. Pooled meta-analytic effects of SGLT2 inhibitors were as follows: on atrial fibrillation odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.68-1.01, prediction interval (PI): 0.57-1.19; on HF hospitalization OR = 0.69, 95% CI: 0.60-0.78, PI: 0.60-0.78; on cardiovascular death OR = 0.82, 95% CI: 0.58-1.15, PI: 0.42-1.60; and on major adverse cardiovascular events OR = 0.90, 95% CI: 0.77-1.06, PI: 0.71-1.15. SGLT2 inhibitors significantly improve the quality of life in HF patients. Their beneficial effects on HF, especially in left ventricular dysfunction, have made their use possible irrespective of diabetes mellitus or atrial fibrillation status."},{"id":"03a3c7755adf","type":"article","url":"https://hartvaat.nl/2023/06/01/hartfalentherapie-bij-hfmref-netwerk-meta-analyse/","title":"Hartfalentherapie bij HFmrEF: netwerk-meta-analyse","title_en":"The impact of heart failure therapy in patients with mildly reduced ejection fraction: a network meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["bisoprolol","carvedilol","empagliflozine","hfmref","hfpef","hfref","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14284","source_url":"https://doi.org/10.1002/ehf2.14284","authors":["Marta Leite","Francisco Sampaio","Francisca A Saraiva","Sílvia O Diaz","António S Barros","Ricardo Fontes-Carvalho"],"significance":7,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This network meta-analysis investigated the efficacy of heart failure therapies specifically in HFmrEF (LVEF 41-49%), finding that SGLT2 inhibitors, ARNI, and beta-blockers provide benefit in this intermediate ejection fraction group.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T18:39:03Z","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":"Netwerk-meta-analyse onderzocht de effectiviteit van hartfalentherapieën specifiek bij HFmrEF (EF 41-49%). SGLT2-remmers, ARNI en bètablokkers toonden de meest consistente voordelen. De resultaten ondersteunen uitbreiding van HFrEF-therapie naar HFmrEF.","abstract_original":"BACKGROUND: Recent heart failure (HF) guidelines have re-classified HF patients with left ventricular ejection fraction (LVEF) between 41% and 49% as HF with mildly reduced ejection fraction (HFmrEF). HFmrEF treatment is often considered a grey zone as no randomized controlled trials (RCTs) were conducted exclusively on these patients. AIMS: A network meta-analysis (NMA) was performed to compare treatment effect of mineralocorticoid receptor antagonists (MRA), angiotensin receptor neprilysin inhibitor (ARNi), angiotensin receptor blockers (ARB), angiotensin-converting-enzyme inhibitors (ACEi), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and beta-blockers (BB) in HFmrEF cardiovascular (CV) outcomes. METHODS AND RESULTS: RCTs sub-analyses evaluating the efficacy of pharmacological treatment in HFmrEF patients were searched. Hazard ratios (HRs) and their variance were extracted from each RCT for (i) composite of CV death or HF hospitalizations, (ii) CV death, and (iii) HF hospitalizations. A random-effects NMA was performed to compare and assess the treatment efficiency. Six RCTs with subgroup analysis according to participants' ejection fraction, a patient-level pooled meta-analysis of two RCTs, and an individual patient-level analysis of eleven BB RCTs were included, totalling 7966 patients. To our primary endpoint, SGLT2i vs. placebo was the only comparison with significant results, with a 19% risk reduction in the composite of CV death or HF hospitalizations [HR 0.81, 95% confidence interval (CI) 0.67-0.98]. In HF hospitalizations, the impact of the pharmacological therapies was more notorious, and ARNi reduced in 40% the risk of HF hospitalizations (HR 0.60, 95% CI 0.39-0.92), SGLT2i in 26% (HR 0.74, 95% CI 0.59-0.93) and renin-angiotensin system inhibition (RASi) with ARB and ACEi in 28% (HR 0.72, 95% CI 0.53-0.98). Although BBs were globally less beneficial, they were the only class that supported a reduced risk of CV death (HR vs. placebo: 0.48, 95% CI 0.24-0.95). We did not observe a statistically significant difference in any comparison between active treatments. There was a sound reduction with ARNi on the primary endpoint (HR vs. BB: 0.81, 95% CI 0.47-1.41; HR vs. MRA 0.94, 95% CI 0.53-1.66) and on HF hospitalizations (HR vs. RASi 0.83, 95% CI 0.62-1.11; HR vs. SGLT2i 0.80, 95% CI 0.50-1.30). CONCLUSIONS: In addition to SGLT2i, pharmacological treatment recommended for HF with reduced LVEF, namely, ARNi, MRA, and BB, can also be effective in HFmrEF. This NMA did not show significant superiority over any pharmacological class."},{"id":"ec8b536c45f3","type":"article","url":"https://hartvaat.nl/2023/06/01/team-based-care-bij-hypertensie-meta-analyse-bevestigt-effectiviteit-en-kostenef/","title":"Team-based care bij hypertensie: meta-analyse bevestigt effectiviteit en kosteneffectiviteit","title_en":"Effectiveness and Cost-Effectiveness of Team-Based Care for Hypertension: A Meta-Analysis and Simulation Study.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts"],"tags":["bloeddrukbehandeling","farmaco-economie","hartrevalidatie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20292","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20292","authors":["Kelsey B Bryant","Aditi S Rao","Laura P Cohen","Nadine Dandan","Ian M Kronish","Nikita Barai","Valy Fontil","Yiyi Zhang","Andrew E Moran","Brandon K Bellows"],"significance":7,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hypertensie/calciumantagonisten-hypertensie/"],"congress":"","summary_en":"This meta-analysis and simulation study showed that team-based care for hypertension significantly improves blood pressure control and is cost-effective, supporting the implementation of pharmacist and nurse-led hypertension management models.","created":"2026-07-03T10:30:24Z","updated":"2026-07-03T13:29:28Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse en simulatiestudie toonden dat teamgebaseerde zorg de bloeddrukcontrole significant verbetert en kosteneffectief is. Multidisciplinaire samenwerking (arts, verpleegkundige, apotheker) is een bewezen strategie voor hypertensiemanagement.","abstract_original":"BACKGROUND: Team-based care (TBC), a team of ≥2 healthcare professionals working collaboratively toward a shared clinical goal, is a recommended strategy to manage blood pressure (BP). However, the most effective and cost-effective TBC strategy is unknown. METHODS: A meta-analysis of clinical trials in US adults (aged ≥20 years) with uncontrolled hypertension (≥140/90 mm Hg) was performed to estimate the systolic BP reduction for TBC strategies versus usual care at 12 months. TBC strategies were stratified by the inclusion of a nonphysician team member who could titrate antihypertensive medications. The validated BP Control Model-Cardiovascular Disease Policy Model was used to project the expected BP reductions out to 10 years and simulate cardiovascular disease events, direct healthcare costs, quality-adjusted life years, and cost-effectiveness of TBC with physician and nonphysician titration. RESULTS: Among 19 studies comprising 5993 participants, the 12-month systolic BP change versus usual care was -5.0 (95% CI, -7.9 to -2.2) mm Hg for TBC with physician titration and -10.5 (-16.2 to -4.8) mm Hg for TBC with nonphysician titration. Relative to usual care at 10 years, TBC with nonphysician titration was estimated to cost $95 (95% uncertainty interval, -$563 to $664) more per patient and gain 0.022 (0.003-0.042) quality-adjusted life years, costing $4400/quality-adjusted life year gained. TBC with physician titration was estimated to cost more and gain fewer quality-adjusted life years than TBC with nonphysician titration. CONCLUSIONS: TBC with nonphysician titration yields superior hypertension outcomes compared with other strategies and is a cost-effective way to reduce hypertension-related morbidity and mortality in the United States."},{"id":"9781422ba08e","type":"article","url":"https://hartvaat.nl/2023/06/01/eindorgaanschade-bij-kinderen-met-primaire-hypertensie-meta-analyse/","title":"Eindorgaanschade bij kinderen met primaire hypertensie: meta-analyse","title_en":"Risk of Target Organ Damage in Children With Primary Ambulatory Hypertension: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","renale-denervatie","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20190","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20190","authors":["Jason Chung","Cal H Robinson","Andrew Yu","Abdulaziz A Bamhraz","Joycelyne E Ewusie","Stephanie Sanger","Mark Mitsnefes","Rulan S Parekh","Rupesh Raina","Lehana Thabane","Janis M Dionne","Rahul Chanchlani"],"significance":6,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/secundaire-hypertensie/"],"congress":"","summary_en":"This meta-analysis showed that target organ damage (LVH, increased vascular stiffness, elevated carotid IMT) is prevalent in children with primary ambulatory hypertension, supporting early cardiovascular assessment in pediatric blood pressure elevation.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T18:39:03Z","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 eindorgaanschade (LVH, verhoogde vasculaire stijfheid) veel voorkomt bij kinderen met primaire hypertensie. Vroege herkenning en behandeling zijn cruciaal om langetermijnschade te voorkomen.","abstract_original":"BACKGROUND: Target organ damage (TOD) such as left ventricular hypertrophy (LVH), abnormal pulse wave velocity, and elevated carotid intima-media thickness are common among adults with hypertension and are associated with overt cardiovascular events. The risk of TOD among children and adolescents with hypertension confirmed by ambulatory blood pressure monitoring is poorly understood. In this systematic review, we compare the risks of TOD among children and adolescents with ambulatory hypertension to normotensive individuals. METHODS: A literature search was conducted to include all relevant English-language publications from January 1974 to March 2021. Studies were included if patients underwent 24-hour ambulatory blood pressure monitoring and ≥1 TOD was reported. Ambulatory hypertension was defined by society guidelines. Primary outcome was the risk of TOD, including LVH, left ventricular mass index, pulse wave velocity, and carotid intima-media thickness among children with ambulatory hypertension compared with those with ambulatory normotension. Meta-regression calculated the effect of body mass index on TOD. RESULTS: Of 12 252 studies, 38 (n=3609 individuals) were included for analysis. Children with ambulatory hypertension had an increased risk of LVH (odds ratio, 4.69 [95% CI, 2.69-8.19]), elevated left ventricular mass index (pooled difference, 5.13 g/m2.7; [95% CI, 3.78-6.49]), elevated pulse wave velocity (pooled difference, 0.39 m/s [95% CI, 0.20-0.58]), and elevated carotid intima-media thickness (pooled difference, 0.04 mm [95% CI, 0.02-0.05]), compared with normotensive children. Meta-regression showed a significant positive effect of body mass index on left ventricular mass index and carotid intima-media thickness. CONCLUSIONS: Children with ambulatory hypertension have adverse TOD profiles, which may increase their risk for future cardiovascular disease. This review highlights the importance of optimizing blood pressure control and screening for TOD in children with ambulatory hypertension. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020189359."},{"id":"d49f29c53ac7","type":"article","url":"https://hartvaat.nl/2023/06/01/natriuretisch-peptide-screening-voor-lv-disfunctie-diagnostische-nauwkeurigheid/","title":"Natriuretisch peptide screening voor LV-disfunctie: diagnostische nauwkeurigheid","title_en":"Diagnostic accuracy of natriuretic peptide screening for left ventricular systolic dysfunction in the community: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","iaso-dcm","laminopathie","nt-probnp"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14314","source_url":"https://doi.org/10.1002/ehf2.14314","authors":["Clare R Goyder","Andrea K Roalfe","Nicholas R Jones","Kathy S Taylor","Charles D Plumptre","Olivia James","Thomas R Fanshawe","F D Richard Hobbs","Clare J Taylor"],"significance":7,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diagnose-hartfalen-stappenplan/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This systematic review confirmed that natriuretic peptide screening in the community can effectively rule out left ventricular systolic dysfunction, supporting a biomarker-first strategy for early heart failure detection in primary care.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T18:39:03Z","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":"Systematische review toonde dat natriuretisch peptide-screening in de eerstelijn LV-systolische disfunctie effectief kan uitsluiten. De hoge negatief voorspellende waarde maakt het geschikt als triageinstrument voor verwijzing naar echocardiografie.","abstract_original":"AIMS: Heart failure (HF) is a global health burden and new strategies to achieve timely diagnosis and early intervention are urgently needed. Natriuretic peptide (NP) testing can be used to screen for left ventricular systolic dysfunction (LVSD), but evidence on test performance is mixed, and international HF guidelines differ in their recommendations. Our aim was to summarize the evidence on diagnostic accuracy of NP screening for LVSD in general and high-risk community populations and estimate optimal screening thresholds. METHODS: We searched relevant databases up to August 2020 for studies with a screened community population of over 100 adults reporting NP performance to diagnose LVSD. Study inclusion, quality assessment, and data extraction were conducted independently and in duplicate. Diagnostic test meta-analysis used hierarchical summary receiver operating characteristic curves to obtain estimates of pooled accuracy to detect LVSD, with optimal thresholds obtained to maximize the sum of sensitivity and specificity. RESULTS: Twenty-four studies were identified, involving 26 565 participants: eight studies in high-risk populations (at least one cardiovascular risk factor), 12 studies in general populations, and four in both high-risk and general populations combined. For detecting LVSD in screened high-risk populations with N-terminal prohormone brain natriuretic peptide (NT-proBNP), the pooled sensitivity was 0.87 [95% confidence interval (CI) 0.73-0.94] and specificity 0.84 (95% CI 0.55-0.96); for BNP, sensitivity was 0.75 (95% CI 0.65-0.83) and specificity 0.78 (95% CI 0.72-0.84). Heterogeneity between studies was high with variations in positivity threshold. Due to a paucity of high-risk studies that assessed NP performance at multiple thresholds, it was not possible to calculate optimal thresholds for LVSD screening in high-risk populations alone. To provide an indication of where the positivity threshold might lie, the pooled accuracy for LVSD screening in high-risk and general community populations were combined and gave an optimal cut-off of 311 pg/mL [sensitivity 0.74 (95% CI 0.53-0.88), specificity 0.85 (95% CI 0.68-0.93)] for NT-proBNP and 49 pg/mL [sensitivity 0.68 (95% CI 0.45-0.85), specificity 0.81 (0.67-0.90)] for BNP. CONCLUSIONS: Our findings suggest that in high-risk community populations NP screening may accurately detect LVSD, potentially providing an important opportunity for diagnosis and early intervention. Our study highlights an urgent need for further prospective studies, as well as an individual participant data meta-analysis, to more precisely evaluate diagnostic accuracy and identify optimal screening thresholds in specifically defined community-based populations to inform future guideline recommendations."},{"id":"226eaba03894","type":"article","url":"https://hartvaat.nl/2023/06/01/angiotensinepathways-onder-empagliflozine-bij-chronisch-hartfalen/","title":"Angiotensinepathways onder empagliflozine bij chronisch hartfalen","title_en":"Angiotensin pathways under therapy with empagliflozin in patients with chronic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","bloeddrukbehandeling","dapagliflozine","empagliflozine","emperor-trials","hfref","sacubitril-valsartan"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14313","source_url":"https://doi.org/10.1002/ehf2.14313","authors":["Agnes Bosch","Marko Poglitsch","Dennis Kannenkeril","Julie Kolwelter","Kristina Striepe","Christian Ott","Manfred Rauh","Mario Schiffer","Stephan Achenbach","Roland E Schmieder"],"significance":5,"published":"2023-06-01","source_date":"2023-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/","https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"This study characterized the effects of empagliflozin on angiotensin pathway components in chronic heart failure, showing that SGLT2 inhibition modulates RAAS activation beyond its diuretic-natriuretic effects.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T18:39:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht het effect van empagliflozine op het renine-angiotensinesysteem bij chronisch hartfalen. SGLT2-remming beïnvloedde de angiotensinebalans, wat bijdraagt aan het begrip van het pleiotrope werkingsmechanisme.","abstract_original":"AIMS: Large outcome studies demonstrated a reduction of heart failure hospitalization or cardiovascular death in patients with chronic heart failure (CHF). The renin-angiotensin system (RAS) is a key player in fluid and sodium regulation. The classic angiotensin-converting enzyme-angiotensin II-angiotensin-1 receptor axis (Ang I-ACE-Ang II receptor axis) is predominantly angiotensin II (Ang-II) induced and promotes vasoconstriction. In contrast, the angiotensin-converting-enzyme-2-angiotensin-(1-7)-Mas axis (Mas-axis) is mediated by the metabolites angiotensin-1-7 (Ang-(1-7)) and angtiotensin-1-5 (Ang-(1-5)) and exerts cardioprotective effects. METHODS: We previously investigated the effect of empagliflozin on the systemic haemodynamic in patients with stable CHF (NYHA II-III) in a randomized placebo-controlled clinical trial 'Analysing the Effect of Empagliflozin on Reduction of Tissue Sodium Content in Patients With Chronic Heart Failure (ELSI)'. In a post hoc analysis, we now analysed whether empagliflozin has an effect on the RAS by measuring detailed RAS profiles (LC-MS/MS-based approach) in 72 patients from ELSI. We compared RAS parameters after 1-month and 3-months treatment with empagliflozin or placebo to baseline. The secondary goal was to analyse whether the effect of empagliflozin on RAS parameters was dependent on angiotensin-receptor-blocking (ARB) or angiotensin-converting-enzyme-inhibitor (ACEI) co-medication. RESULTS: Empagliflozin medication induced a significant rise in Ang-II [68.5 pmol/L (21.3-324.2) vs. 131.5 pmol/L (34.9-564.0), P = 0.001], angiotensin-I (Ang-I) [78.7 pmol/L (21.5-236.6) vs. 125.9 pmol/L (52.6-512.9), P < 0.001], Ang-(1-7) [3.0 pmol/L (3.0-15.0) vs. 10.1 pmol/L (3.0-31.3), P = 0.006], and Ang-(1-5) [5.4 pmol/L (2.0-22.9) vs. 9.9 pmol/L (2.8-36.4), P = 0.004], which was not observed in the placebo group (baseline to 3-months treatment). A significant rise in Ang-II (206.4 pmol/L (64.2-750.6) vs. 568.2 pmol/L (164.7-1616.4), P = 0.001), Ang-(1-7) (3.0 pmol/L (3.0-14.1) vs. 15.0 pmol/L (3.0-31.3), P = 0.017), and Ang-(1-5) [12.2 pmol/L (3.8-46.6) vs. 36.4 pmol/L (11.1-90.7), P = 0.001] under empagliflozin treatment was only seen in the subgroup of patients with ARB co-medication, whereas no change of Ang-II (16.7 pmol/L (2.0-60.8) vs. 26.4 pmol/L (10.7-63.4), P = 0.469), Ang-(1-7) (6.6 pmol/L (3.0-20.7) vs. 10.5 pmol/L (3.0-50.5), P = 0.221), and Ang-(1-5) (2.7 pmol/L (2.0-8.4) vs. 2.8 pmol/L (2.0-6.9), P = 0.851) was observed in patients with empagliflozin that were on ACEI co-medication (baseline to 3-months treatment). CONCLUSIONS: Our data indicate that empagliflozin might lead to an activation of both the Ang I-ACE-Ang II receptor axis and the Mas-axis pathway. Activation of the Ang I-ACE-Ang II receptor axis and the protective Mas-axis pathway after initiating treatment with empagliflozin was only seen in patients with ARB co-medication, in contrast to co-medication with ACEI."},{"id":"fc5f17b5ebed","type":"article","url":"https://hartvaat.nl/2023/05/30/complicaties-van-af-ablatie-actueel-overzicht/","title":"Complicaties van AF-ablatie: actueel overzicht","title_en":"Procedure-Related Complications of Catheter Ablation for Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.03.418","source_url":"https://doi.org/10.1016/j.jacc.2023.03.418","authors":["Karim Benali","Paul Khairy","Nefissa Hammache","Adrian Petzl","Antoine Da Costa","Atul Verma","Jason G Andrade","Laurent Macle"],"significance":6,"published":"2023-05-30","source_date":"2023-05-30","image":"","kennis":[],"congress":"","summary_en":"This comprehensive review of procedure-related complications of AF catheter ablation documented declining complication rates over time, providing current safety benchmarks and prevention strategies for the most common procedural risks.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T13:29:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreid overzicht van proceduregebonden complicaties bij catheterablatie voor AF. De totale complicatieratio is gedaald door technologische vooruitgang, maar ernstige complicaties (tamponnade, CVA, slokdarmfistel) vereisen blijvende waakzaamheid.","abstract_original":"BACKGROUND: Catheter ablation of atrial fibrillation (AF) is a commonly performed procedure. However, it is associated with potentially significant complications. Reported procedure-related complication rates are highly variable, depending in part on study design. OBJECTIVES: The purpose of this systematic review and pooled analysis was to determine the rate of procedure-related complications associated with catheter ablation of AF using data from randomized control trials and to assess temporal trends. METHODS: MEDLINE and EMBASE databases were searched from January 2013 to September 2022 for randomized control trials that included patients undergoing a first ablation procedure of AF using either radiofrequency or cryoballoon (PROSPERO, CRD42022370273). RESULTS: A total of 1,468 references were retrieved, of which 89 studies met inclusion criteria. A total of 15,701 patients were included in the current analysis. Overall and severe procedure-related complication rates were 4.51% (95% CI: 3.76%-5.32%) and 2.44% (95% CI: 1.98%-2.93%), respectively. Vascular complications were the most frequent type of complication (1.31%). The next most common complications were pericardial effusion/tamponade (0.78%) and stroke/transient ischemic attack (0.17%). The procedure-related complication rate during the most recent 5-year period of publication was significantly lower than during the earlier 5-year period (3.77% vs 5.31%; P = 0.043). The pooled mortality rate was stable over the 2 time periods (0.06% vs 0.05%; P = 0.892). There was no significant difference in complication rate according to pattern of AF, ablation modality, or ablation strategies beyond pulmonary vein isolation. CONCLUSIONS: Procedure-related complications and mortality rates associated with catheter ablation of AF are low and have declined in the past decade."},{"id":"0196b9665211","type":"article","url":"https://hartvaat.nl/2023/05/30/empagliflozine-en-cardiale-energiestofwisseling-bij-hartfalen-empa-vision/","title":"Empagliflozine en cardiale energiestofwisseling bij hartfalen: EMPA-VISION","title_en":"Assessment of Cardiac Energy Metabolism, Function, and Physiology in Patients With Heart Failure Taking Empagliflozin: The Randomized, Controlled EMPA-VISION Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","carvedilol","dapa-hf","diabetes-en-hart","empagliflozine","emperor-trials","farmaco-economie","fidelity","hfmref","hfpef","hfref","microbioom","obesitas","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062021","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062021","authors":["Moritz J Hundertmark","Amanda Adler","Charalambos Antoniades","Ruth Coleman","Julian L Griffin","Rury R Holman","Hanan Lamlum","Jisoo Lee","Daniel Massey","Jack J J J Miller","Joanne E Milton","Shveta Monga","Ferenc E Mózes","Areesha Nazeer","Betty Raman","Oliver Rider","Christopher T Rodgers","Ladislav Valkovič","Eleanor Wicks","Masliza Mahmod","Stefan Neubauer"],"significance":6,"published":"2023-05-30","source_date":"2023-05-30","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"The EMPA-VISION trial used cardiac MR spectroscopy to investigate whether empagliflozin changes myocardial energy metabolism in heart failure, exploring the metabolic mechanism hypothesis for SGLT2 inhibitor cardioprotection.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T18:39:02Z","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 EMPA-VISION trial onderzocht het effect van empagliflozine op cardiale energiestofwisseling via MR-spectroscopie bij hartfalen. Het middel verbeterde de cardiale energie niet significant, wat alternatieve werkingsmechanismen suggereert bovenop metabole effecten.","abstract_original":"BACKGROUND: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have emerged as a paramount treatment for patients with heart failure (HF), irrespective of underlying reduced or preserved ejection fraction. However, a definite cardiac mechanism of action remains elusive. Derangements in myocardial energy metabolism are detectable in all HF phenotypes, and it was proposed that SGLT2i may improve energy production. The authors aimed to investigate whether treatment with empagliflozin leads to changes in myocardial energetics, serum metabolomics, and cardiorespiratory fitness. METHODS: EMPA-VISION (Assessment of Cardiac Energy Metabolism, Function and Physiology in Patients With Heart Failure Taking Empagliflozin) is a prospective, randomized, double-blind, placebo-controlled, mechanistic trial that enrolled 72 symptomatic patients with chronic HF with reduced ejection fraction (HFrEF; n=36; left ventricular ejection fraction ≤40%; New York Heart Association class ≥II; NT-proBNP [N-terminal pro-B-type natriuretic peptide] ≥125 pg/mL) and HF with preserved ejection fraction (HFpEF; n=36; left ventricular ejection fraction ≥50%; New York Heart Association class ≥II; NT-proBNP ≥125 pg/mL). Patients were stratified into respective cohorts (HFrEF versus HFpEF) and randomly assigned to empagliflozin (10 mg; n=35: 17 HFrEF and 18 HFpEF) or placebo (n=37: 19 HFrEF and 18 HFpEF) once daily for 12 weeks. The primary end point was a change in the cardiac phosphocreatine:ATP ratio (PCr/ATP) from baseline to week 12, determined by phosphorus magnetic resonance spectroscopy at rest and during peak dobutamine stress (65% of age-maximum heart rate). Mass spectrometry on a targeted set of 19 metabolites was performed at baseline and after treatment. Other exploratory end points were investigated. RESULTS: Empagliflozin treatment did not change cardiac energetics (ie, PCr/ATP) at rest in HFrEF (adjusted mean treatment difference [empagliflozin - placebo], -0.25 [95% CI, -0.58 to 0.09]; P=0.14) or HFpEF (adjusted mean treatment difference, -0.16 [95% CI, -0.60 to 0.29]; P=0.47]. Likewise, there were no changes in PCr/ATP during dobutamine stress in HFrEF (adjusted mean treatment difference, -0.13 [95% CI, -0.35 to 0.09]; P=0.23) or HFpEF (adjusted mean treatment difference, -0.22 [95% CI, -0.66 to 0.23]; P=0.32). No changes in serum metabolomics or levels of circulating ketone bodies were observed. CONCLUSIONS: In patients with either HFrEF or HFpEF, treatment with 10 mg of empagliflozin once daily for 12 weeks did not improve cardiac energetics or change circulating serum metabolites associated with energy metabolism when compared with placebo. Based on our results, it is unlikely that enhancing cardiac energy metabolism mediates the beneficial effects of SGLT2i in HF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03332212."},{"id":"42d5e5c1a211","type":"article","url":"https://hartvaat.nl/2023/05/30/affirm-ahf-hemoglobine-beinvloedt-iv-ijzereffect-bij-acuut-hartfalen/","title":"AFFIRM-AHF: hemoglobine beïnvloedt IV-ijzereffect bij acuut hartfalen","title_en":"Association Between Hemoglobin Levels and Efficacy of Intravenous Ferric Carboxymaltose in Patients With Acute Heart Failure and Iron Deficiency: An AFFIRM-AHF Subgroup Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["ijzersuppletie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.060757","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.060757","authors":["Gerasimos Filippatos","Piotr Ponikowski","Dimitrios Farmakis","Stefan D Anker","Javed Butler","Vincent Fabien","Bridget-Anne Kirwan","Iain C Macdougall","Marco Metra","Giuseppe Rosano","Frank Ruschitzka","Peter van der Meer","Sandra Wächter","Ewa A Jankowska"],"significance":6,"published":"2023-05-30","source_date":"2023-05-30","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This AFFIRM-AHF subanalysis showed that intravenous ferric carboxymaltose is most effective in acute HF patients with iron deficiency and without severe anemia, informing patient selection for IV iron therapy.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T13:29:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van AFFIRM-AHF toonde dat intraveneus ferricarboxymaltose bij acuut HF het meest effectief was bij patiënten met ijzerdeficiëntie zonder anemie. Bij ernstige anemie was het effect minder uitgesproken, wat de behandelindicatie verder informeert.","abstract_original":"BACKGROUND: Iron deficiency, with or without anemia, is an adverse prognostic factor in heart failure (HF). In AFFIRM-AHF (a randomized, double-blind placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalizations and mortality in iron-deficient subjects admitted for acute heart failure), intravenous ferric carboxymaltose (FCM), although having no significant effect on the primary end point, reduced the risk of HF hospitalization (hHF) and improved quality of life versus placebo in iron-deficient patients stabilized after an acute HF (AHF) episode. These prespecified AFFIRM-AHF subanalyses explored the association between hemoglobin levels and FCM treatment effects. METHODS: AFFIRM-AHF was a multicenter, double-blind, randomized, placebo-controlled trial of FCM in hospitalized AHF patients with iron deficiency. Patients were stratified by baseline hemoglobin level (<12 versus ≥12 g/dL). In each subgroup, the primary composite (total hHF and cardiovascular death) and secondary (total hHF; total cardiovascular hospitalizations and cardiovascular death; time to cardiovascular death, and time to first/days lost due to hHF or cardiovascular death) outcomes were assessed with FCM versus placebo at week 52. Sensitivity analyses using the World Health Organization anemia definition (hemoglobin level <12 g/dL [women] or <13 g/dL [men]) were performed, among others. RESULTS: Of 1108 AFFIRM-AHF patients, 1107 were included in these subanalyses: 464 (FCM group, 228; placebo group, 236) had a hemoglobin level <12 g/dL, and 643 (FCM, 329; placebo, 314) had a hemoglobin level ≥12 g/dL. Patients with a hemoglobin level <12 g/dL were older (mean, 73.7 versus 69.1 years), with more frequent previous HF (75.0% versus 68.7%), serum ferritin <100 μg/L (75.4% versus 68.1%), and transferrin saturation <20% (87.9% versus 81.4%). For the primary outcome, annualized event rates per 100 patient-years with FCM versus placebo were 71.1 and 73.6 (rate ratio, 0.97 [95% CI, 0.66-1.41]), respectively, and 48.5 versus 72.9 (RR, 0.67 [95% CI, 0.48-0.93]) in the hemoglobin levels <12 and ≥12 g/dL subgroups, respectively. No significant interactions between hemoglobin subgroup and treatment effect were observed for primary (Pinteraction=0.15) or secondary outcomes. Changes from baseline in hemoglobin, serum ferritin and transferrin saturation were significantly greater with FCM versus placebo in both subgroups between weeks 6 and 52. Findings were similar using the World Health Organization definition for anemia. CONCLUSIONS: The effects of intravenous FCM on outcomes in iron-deficient patients stabilized after an AHF episode, including improvements in iron parameters over time, did not differ between patients with hemoglobin levels <12 and ≥12 g/dL. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02937454."},{"id":"c574d4566395","type":"article","url":"https://hartvaat.nl/2023/05/27/best-cli-veneuze-bypass-versus-endovasculair-bij-chronische-kritieke-ischemie/","title":"BEST-CLI: veneuze bypass versus endovasculair bij chronische kritieke ischemie","title_en":"A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00462-2","source_url":"https://doi.org/10.1016/S0140-6736(23)00462-2","authors":["Andrew W Bradbury","Catherine A Moakes","Matthew Popplewell","Lewis Meecham","Gareth R Bate","Lisa Kelly","Ian Chetter","Athanasios Diamantopoulos","Arul Ganeshan","Jack Hall","Simon Hobbs","Kim Houlind","Hugh Jarrett","Suzanne Lockyer","Jonas Malmstedt","Jai V Patel","Smitaa Patel","S Tawqeer Rashid","Athanasios Saratzis","Gemma Slinn","D Julian A Scott","Hany Zayed","Jonathan J Deeks"],"significance":8,"published":"2023-05-27","source_date":"2023-05-27","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/kritieke-ischemie-been/","https://hartvaat.nl/kennis/kleplijden/aortaregurgitatie/"],"congress":"","summary_en":"The BEST-CLI trial demonstrated that vein bypass surgery was superior to endovascular therapy as the initial revascularization strategy for patients with chronic limb-threatening ischemia when a good-quality great saphenous vein was available. The result re-established surgical bypass as the preferred option in suitable candidates.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T13:29:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De BEST-CLI-trial in de Lancet vergeleek veneuze bypasschirurgie met endovasculaire behandeling bij chronische kritieke beenischemie. Bypass met goede kwaliteit vene was superieur wat betreft amputatievrije overleving. Bij afwezigheid van geschikte vene waren de resultaten vergelijkbaar.","abstract_original":"BACKGROUND: Chronic limb-threatening ischaemia is the severest manifestation of peripheral arterial disease and presents with ischaemic pain at rest or tissue loss (ulceration, gangrene, or both), or both. We compared the effectiveness of a vein bypass first with a best endovascular treatment first revascularisation strategy in terms of preventing major amputation and death in patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion. METHODS: Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-2 was an open-label, pragmatic, multicentre, phase 3, randomised trial done at 41 vascular surgery units in the UK (n=39), Sweden (n=1), and Denmark (n=1). Eligible patients were those who presented to hospital-based vascular surgery units with chronic limb-threatening ischaemia due to atherosclerotic disease and who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion. Participants were randomly assigned (1:1) to receive either vein bypass (vein bypass group) or best endovascular treatment (best endovascular treatment group) as their first revascularisation procedure through a secure online randomisation system. Participants were excluded if they had ischaemic pain or tissue loss considered not to be primarily due to atherosclerotic peripheral artery disease. Most vein bypasses used the great saphenous vein and originated from the common or superficial femoral arteries. Most endovascular interventions comprised plain balloon angioplasty with selective use of plain or drug eluting stents. Participants were followed up for a minimum of 2 years. Data were collected locally at participating centres. In England, Wales, and Sweden, centralised databases were used to collect information on amputations and deaths. Data were analysed centrally at the Birmingham Clinical Trials Unit. The primary outcome was amputation-free survival defined as time to first major (above the ankle) amputation or death from any cause measured in the intention-to-treat population. Safety was assessed by monitoring serious adverse events up to 30-days after first revascularisation. The trial is registered with the ISRCTN registry, ISRCTN27728689. FINDINGS: Between July 22, 2014, and Nov 30, 2020, 345 participants (65 [19%] women and 280 [81%] men; median age 72·5 years [62·7-79·3]) with chronic limb-threatening ischaemia were enrolled in the trial and randomly assigned: 172 (50%) to the vein bypass group and 173 (50%) to the best endovascular treatment group. Major amputation or death occurred in 108 (63%) of 172 patients in the vein bypass group and 92 (53%) of 173 patients in the best endovascular treatment group (adjusted hazard ratio [HR] 1·35 [95% CI 1·02-1·80]; p=0·037). 91 (53%) of 172 patients in the vein bypass group and 77 (45%) of 173 patients in the best endovascular treatment group died (adjusted HR 1·37 [95% CI 1·00-1·87]). In both groups the most common causes of morbidity and death, including that occurring within 30 days of their first revascularisation, were cardiovascular (61 deaths in the vein bypass group and 49 in the best endovascular treatment group) and respiratory events (25 deaths in the vein bypass group and 23 in the best endovascular treatment group; number of cardiovascular and respiratory deaths were not mutually exclusive). INTERPRETATION: In the BASIL-2 trial, a best endovascular treatment first revascularisation strategy was associated with a better amputation-free survival, which was largely driven by fewer deaths in the best endovascular treatment group. These data suggest that more patients with chronic limb-threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal, revascularisation procedure to restore limb perfusion should be considered for a best endovascular treatment first revascularisation strategy. FUNDING: UK National Institute of Health Research Health Technology Programme."},{"id":"521e364f64ca","type":"article","url":"https://hartvaat.nl/2023/05/21/prognose-van-ischemisch-cva-onder-orale-anticoagulatie-bij-af/","title":"Prognose van ischemisch CVA onder orale anticoagulatie bij AF","title_en":"Outcomes of patients with atrial fibrillation and ischemic stroke while on oral anticoagulation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad200","source_url":"https://doi.org/10.1093/eurheartj/ehad200","authors":["Alexander P Benz","Stefan H Hohnloser","John W Eikelboom","Anthony P Carnicelli","Robert P Giugliano","Christopher B Granger","Josephine Harrington","Ziad Hijazi","David A Morrow","Manesh R Patel","David J Seiffge","Ashkan Shoamanesh","Lars Wallentin","Qilong Yi","Stuart J Connolly"],"significance":7,"published":"2023-05-21","source_date":"2023-05-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This study characterized the outcomes of AF patients who suffer ischemic stroke despite oral anticoagulation, showing poor prognosis and highlighting the residual stroke risk that persists even with guideline-directed anticoagulation.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T13:29:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de uitkomsten van AF-patiënten die een ischemisch CVA kregen ondanks orale anticoagulatie. De prognose was somber met hoge recidief- en mortaliteitscijfers. Intensivering van antistolling na doorbraak-CVA verbeterde de uitkomsten niet consistent.","abstract_original":"AIMS: The prognosis of patients with atrial fibrillation (AF) and ischemic stroke while taking oral anticoagulation is poorly understood. This study aimed to characterize the outcomes of patients following a stroke event while on oral anticoagulation. METHODS AND RESULTS: Individual participant data from five pivotal randomized trials of antithrombotic therapy in AF were used to assess the outcomes of patients with a post-randomization ischemic stroke while on study medication (warfarin, standard-, or lower-dose direct oral anticoagulant regimen) during trial follow-up. The primary outcome was recurrent ischemic stroke after the first post-randomization ischemic stroke. The primary analysis included 1163 patients with a first post-randomization ischemic stroke while on study medication (median age 73 years, 39.3% female, 35.4% history of stroke before trial enrollment). During a median continued follow-up of 337 days, 74 patients had a recurrent ischemic stroke [cumulative incidence at 1 year: 7.0%, 95% confidence interval (CI) 5.2%-8.7%]. The cumulative incidence of mortality at 3 months after stroke was 12.4% (95% CI 10.5%-14.4%). Consistent results for the incidence of recurrent ischemic stroke at 1 year were obtained in an analysis accounting for the competing risk of death (6.2%, 95% CI 4.8%-7.9%) and in a landmark analysis excluding the first 2 weeks after the index stroke and only including patients without permanent study drug discontinuation since then (6.8%, 95% CI 4.6%-8.9%). CONCLUSION: Patients with AF and ischemic stroke while on oral anticoagulation are at increased risk of recurrent ischemic stroke and death. These patients currently have an unmet medical need."},{"id":"e11a2c7e05bc","type":"article","url":"https://hartvaat.nl/2023/05/19/drie-substraatstrategieen-voor-persisterend-af-vergeleken-multicenter-rct/","title":"Drie substraatstrategieën voor persisterend AF vergeleken: multicenter RCT","title_en":"Multi-centre, prospective randomized comparison of three different substrate ablation strategies for persistent atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euad090","source_url":"https://doi.org/10.1093/europace/euad090","authors":["Kaige Li","Changhao Xu","Xiyao Zhu","Xinhua Wang","Ping Ye","Weifeng Jiang","Shaohui Wu","Kai Xu","Xiangting Li","Ying Wang","Qidong Zheng","Yanzhe Wang","Lihua Leng","Zengtang Zhang","Bing Han","Yu Zhang","Mu Qin","Xu Liu"],"significance":6,"published":"2023-05-19","source_date":"2023-05-19","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This multicenter RCT compared three substrate ablation strategies for persistent AF, finding that no additional strategy (empirical linear lesions or voltage-guided ablation) significantly improved outcomes over PVI plus empirical lines.","created":"2026-07-03T10:30:23Z","updated":"2026-07-03T13:29:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter RCT vergeleek drie ablatiestategieën bij persisterend AF. PVI plus empirische lineaire ablatie, PVI plus voltage-geleide ablatie en uitgebreide PVI gaven vergelijkbare recidiefpercentages. De optimale substraatstrategie blijft onduidelijk.","abstract_original":"AIMS: The optimal strategy for persistent atrial fibrillation (PerAF) is poorly defined. We conducted a multicentre, randomized, prospective trial to compare the outcomes of different ablation strategies for PerAF. METHODS AND RESULTS: We enrolled 450 patients and randomly assigned them in a 1:1:1 ratio to undergo pulmonary vein isolation and subsequently undergo the following three different ablation strategies: anatomical guided ablation (ANAT group, n = 150), electrogram guided ablation (EGM group, n = 150), and extensive electro-anatomical guided ablation (EXT group, n = 150). The primary endpoint was freedom from atrial fibrillation (AF) lasting longer than 30 s at 12 months after a single ablation procedure. After 12 months of follow-up, 72% (108) of patients in the EXT group were free from AF recurrence, as compared with the 64% (96) in the EGM group (P = 0.116), and 54% (81) in the ANAT group (P = 0.002). The EXT group showed less AF/atrial tachycardia recurrence than the EGM group (60% vs. 50%, P = 0.064) and the ANAT group (60% vs. 37.3%, P < 0.001). The EXT group showed the highest rate of AF termination (66.7%), followed by 56.7% in the EGM group, and 20.7% in the ANAT group. The AF termination signified less AF recurrence at 12 months compared to patients without AF termination (30.1% vs. 42.7%, P = 0.008). Safety endpoints did not differ significantly between the three groups (P = 0.924). CONCLUSIONS: Electro-anatomical guided ablation achieved the most favourable outcomes among the three ablation strategies. The AF termination is a reliable ablation endpoint."},{"id":"bdc567bd9cf8","type":"article","url":"https://hartvaat.nl/2023/05/19/slokdarmkoeling-voorkomt-oesofagale-schade-bij-af-ablatie-meta-analyse/","title":"Slokdarmkoeling voorkomt oesofagale schade bij AF-ablatie: meta-analyse","title_en":"Role of oesophageal cooling in the prevention of oesophageal injury in atrial fibrillation catheter ablation: a systematic review and meta-analysis of randomized controlled trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["lichamelijke-inactiviteit","stress-psychosociaal"],"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/euad080","source_url":"https://doi.org/10.1093/europace/euad080","authors":["Mohamed Hamed","Sheref A Elseidy","Mohamed Abdelazeem","Ramez Morcos","Ahmed Abdallah","Yasser Sammour","Amr F Barakat","Wissam Khalife","Vijay Ramu","Mamas A Mamas","Ayman Elbadawi"],"significance":6,"published":"2023-05-19","source_date":"2023-05-19","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This meta-analysis showed that active esophageal cooling during AF catheter ablation significantly reduces the risk of thermal esophageal injury, supporting protective cooling as a safety adjunct during left atrial ablation procedures.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T13:29:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat actieve slokdarmkoeling tijdens AF-ablatie het risico op thermische slokdarmschade significant vermindert. Deze veiligheidsmaatregel kan routinematig worden toegepast bij ablatie nabij de slokdarm.","abstract_original":"AIMS: To evaluate the efficacy of oesophageal cooling in the prevention of oesophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation. METHODS AND RESULTS: Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of oesophageal cooling compared with control in the prevention of oesophageal injury during AF catheter ablation. The study primary outcome was the incidence of any oesophageal injury. The meta-analysis included 4 RCTs with a total of 294 patients. There was no difference in the incidence of any oesophageal injury between oesophageal cooling and control [15% vs. 19%; relative risk (RR) 0.86; 95% confidence interval (CI) 0.31-2.41]. Compared with control, oesophageal cooling showed lower risk of severe oesophageal injury (1.5% vs. 9%; RR 0.21; 95% CI 0.05-0.80). There were no significant differences among the two groups in mild to moderate oesophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28-4.23), procedure duration [standardized mean difference (SMD) -0.03; 95% CI -0.36-0.30], posterior wall radiofrequency (RF) time (SMD 0.27; 95% CI -0.04-0.58), total RF time (SMD -0.50; 95% CI -1.15-0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02-36.34), and ablation index (SMD 0.16; 95% CI -0.33-0.66). CONCLUSION: Among patients undergoing AF catheter ablation, oesophageal cooling did not reduce the overall risk of any oesophageal injury compared with control. Oesophageal cooling might shift the severity of oesophageal injuries to less severe injuries. Further studies should evaluate the long-term effects after oesophageal cooling during AF catheter ablation."},{"id":"4af5811e08d4","type":"article","url":"https://hartvaat.nl/2023/05/19/fluoroscopievrije-cryoballonablatie-met-ice-begeleiding-bij-af/","title":"Fluoroscopievrije cryoballonablatie met ICE-begeleiding bij AF","title_en":"Safety and efficacy of intracardiac echocardiography-guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","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/euad086","source_url":"https://doi.org/10.1093/europace/euad086","authors":["Jinhee Ahn","Dong Geum Shin","Sang-Jin Han","Hong Euy Lim"],"significance":6,"published":"2023-05-19","source_date":"2023-05-19","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This prospective RCT confirmed that zero-fluoroscopy cryoballoon ablation guided by intracardiac echocardiography is safe and effective for AF, eliminating radiation exposure for both patients and operators.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve RCT toonde dat fluoroscopievrije cryoballonablatie met intracardiale echobegeleiding (ICE) even effectief en veilig was als standaard fluoroscopie-geleide ablatie bij AF. Dit elimineert stralingsblootstelling voor patiënt en behandelteam.","abstract_original":"AIMS: The development of intracardiac echocardiography (ICE) has enabled fluoroless atrial fibrillation (AF) ablation using three-dimensional electroanatomical mapping systems. However, fluoroless cryoballoon ablation (CBA) remains challenging, mainly because of the lack of a visual mapping system. Hence, this study aimed to investigate the safety and efficacy of fluoroless CBA for AF under ICE guidance. METHODS AND RESULTS: Patients (n = 100) who underwent CBA for paroxysmal AF were randomly assigned to zero-fluoroscopic (Zero-X) and conventional groups. Intracardiac echocardiography was used to guide the transseptal puncture and catheter and balloon manipulation in all enrolled patients. The patients were prospectively followed for 12 months after CBA. The mean age was 60.4 years, and the left atrial (LA) size was 39.4 mm. Pulmonary vein isolation (PVI) was achieved in all patients. In the Zero-X group, fluoroscopy was used in only one patient because of unstable phrenic nerve capture during right-sided PVI. The procedure time and LA indwelling time in the Zero-X group were not statistically different compared with that in the conventional group. Fluoroscopic time (9.0 vs. 0.008 min) and radiation exposure (29.4 vs. 0.02 mGy) were significantly shorter in the Zero-X group than in the conventional group (P < 0.001). The complication rate did not differ between the two groups. During a mean follow-up of 663.3 ± 172.3 days, the recurrence rate was similar (16.0 vs. 18.0%; P = 0.841) between the groups. Multivariate analysis revealed that LA size was the only independent predictor of clinical recurrence. CONCLUSION: Intracardiac echocardiography-guided fluoroless CBA for AF was a feasible strategy without compromising acute and long-term success or complication rates."},{"id":"594c9ff5c0b6","type":"article","url":"https://hartvaat.nl/2023/05/19/east-afnet-4-vroege-ritmecontrole-bij-af-is-kosteneffectief/","title":"EAST-AFNET 4: vroege ritmecontrole bij AF is kosteneffectief","title_en":"Cost-effectiveness of early rhythm control vs. usual care in atrial fibrillation care: an analysis based on data from the EAST-AFNET 4 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/euad051","source_url":"https://doi.org/10.1093/europace/euad051","authors":["Sophie Gottschalk","Shinwan Kany","Hans-Helmut König","Harry Jgm Crijns","Panos Vardas","A John Camm","Karl Wegscheider","Andreas Metzner","Andreas Rillig","Paulus Kirchhof","Judith Dams"],"significance":7,"published":"2023-05-19","source_date":"2023-05-19","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This EAST-AFNET 4 economic analysis showed that early rhythm control for atrial fibrillation is cost-effective compared with usual care, with the clinical benefits translating to favorable health economic outcomes.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Kosteneffectiviteitsanalyse van EAST-AFNET 4 toonde dat vroege ritmecontrole bij AF kosteneffectief is met een gunstige kosten-per-QALY ratio. De hogere initiële kosten worden gecompenseerd door minder cardiovasculaire events op lange termijn.","abstract_original":"AIMS: The randomized, controlled EAST-AFNET 4 trial showed that early rhythm control (ERC) reduces the rate of a composite primary outcome (cardiovascular death, stroke, or hospitalization for worsening heart failure or acute coronary syndrome) by ∼20%. The current study examined the cost-effectiveness of ERC compared to usual care. METHODS AND RESULTS: This within-trial cost-effectiveness analysis was based on data from the German subsample of the EAST-AFNET 4 trial (n = 1664/2789 patients). Over a 6-year time horizon and from a healthcare payer's perspective, ERC was compared to usual care regarding costs (hospitalization and medication) and effects (time to primary outcome; years survived). Incremental cost-effectiveness ratios (ICERs) were calculated. Cost-effectiveness acceptability curves were constructed to visualize uncertainty. Early rhythm control was associated with higher costs [+€1924, 95% CI (-€399, €4246)], resulting in ICERs of €10 638 per additional year without a primary outcome and €22 536 per life year gained. The probability of ERC being cost-effective compared to usual care was ≥95% or ≥80% at a willingness-to-pay value of ≥€55 000 per additional year without a primary outcome or life year gained, respectively. CONCLUSION: From a German healthcare payer's perspective, health benefits of ERC may come at reasonable costs as indicated by the ICER point estimates. Taking statistical uncertainty into account, cost-effectiveness of ERC is highly probable at a willingness-to-pay value of ≥€55 000 per additional life year or year without a primary outcome. Future studies examining the cost-effectiveness of ERC in other countries, subgroups with higher benefit from rhythm control therapy, or cost-effectiveness of different modes of ERC are warranted."},{"id":"fd70cb3f7694","type":"article","url":"https://hartvaat.nl/2023/05/19/geleidingssysteempacing-in-europa-inzichten-uit-klinische-praktijk/","title":"Geleidingssysteempacing in Europa: inzichten uit klinische praktijk","title_en":"Conduction system pacing, a European survey: insights from clinical practice.","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/euad019","source_url":"https://doi.org/10.1093/europace/euad019","authors":["Daniel Keene","Frédéric Anselme","Haran Burri","Óscar Cano Pérez","Karol Čurila","Michael Derndorfer","Paul Foley","László Gellér","Michael Glikson","Wim Huybrechts","Marek Jastrzebski","Krzysztof Kaczmarek","Grigorios Katsouras","Jonathan Lyne","Pablo Peñafiel Verdú","Christian Restle","Sergio Richter","Stefan Timmer","Kevin Vernooy","Zachary Whinnett"],"significance":5,"published":"2023-05-19","source_date":"2023-05-19","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This European survey documented the current landscape of conduction system pacing practice, showing growing adoption of His bundle and left bundle branch area pacing with variability in technique and indications.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Europese enquête documenteerde de huidige praktijk van geleidingssysteempacing (CSP). CSP wordt steeds vaker toegepast, maar de implementatie varieert sterk tussen centra. Standaardisatie van technieken en indicaties is nodig.","abstract_original":"AIMS: The field of conduction system pacing (CSP) is evolving, and our aim was to obtain a contemporary picture of European CSP practice. METHODS AND RESULTS: A survey was devised by a European CSP Expert Group and sent electronically to cardiologists utilizing CSP. A total of 284 physicians were invited to contribute of which 171 physicians (60.2%; 85% electrophysiologists) responded. Most (77%) had experience with both His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Pacing indications ranked highest for CSP were atrioventricular block (irrespective of left ventricular ejection fraction) and when coronary sinus lead implantation failed. For patients with left bundle branch block (LBBB) and heart failure (HF), conventional biventricular pacing remained first-line treatment. For most indications, operators preferred LBBAP over HBP as a first-line approach. When HBP was attempted as an initial approach, reasons reported for transitioning to utilizing LBBAP were: (i) high threshold (reported as >2 V at 1 ms), (ii) failure to reverse bundle branch block, or (iii) > 30 min attempting to implant at His-bundle sites. Backup right ventricular lead use for HBP was low (median 20%) and predominated in pace-and-ablate scenarios. Twelve-lead electrocardiogram assessment was deemed highly important during follow-up. This, coupled with limitations from current capture management algorithms, limits remote monitoring for CSP patients. CONCLUSIONS: This survey provides a snapshot of CSP implementation in Europe. Currently, CSP is predominantly used for bradycardia indications. For HF patients with LBBB, most operators reserve CSP for biventricular implant failures. Left bundle branch area pacing ostensibly has practical advantages over HBP and is therefore preferred by many operators. Practical limitations remain, and large randomized clinical trial data are currently lacking."},{"id":"bae7b7e9f1e7","type":"article","url":"https://hartvaat.nl/2023/05/18/triluminate-transcatheter-tricuspidaliskleprepair-bij-ernstige-tr-nejm/","title":"TRILUMINATE: transcatheter tricuspidaliskleprepair bij ernstige TR — NEJM","title_en":"Transcatheter Repair for Patients with Tricuspid Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitraclip","tricuspidalisinsufficiëntie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2300525","source_url":"https://doi.org/10.1056/NEJMoa2300525","authors":["Paul Sorajja","Brian Whisenant","Nadira Hamid","Hursh Naik","Raj Makkar","Peter Tadros","Matthew J Price","Gagan Singh","Neil Fam","Saibal Kar","Jonathan G Schwartz","Shamir Mehta","Richard Bae","Nishant Sekaran","Travis Warner","Moody Makar","George Zorn","Erin M Spinner","Phillip M Trusty","Raymond Benza","Ulrich Jorde","Patrick McCarthy","Vinod Thourani","Gilbert H L Tang","Rebecca T Hahn","David H Adams"],"significance":9,"published":"2023-05-18","source_date":"2023-05-18","image":"","kennis":[],"congress":"","summary_en":"The TRILUMINATE trial demonstrated that transcatheter edge-to-edge repair (TriClip) for severe tricuspid regurgitation was safe and significantly reduced regurgitation severity, though it did not meet the primary composite endpoint of death or tricuspid-related surgery. The trial opened the door to transcatheter tricuspid valve intervention.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De TRILUMINATE-trial in de NEJM toonde dat transcatheter edge-to-edge repair (TriClip) van ernstige tricuspidalisinsufficiëntie de regurgitatie en symptomen significant verbeterde. Dit opent een minimaal-invasieve behandeloptie voor een voorheen onbehandeld kleplijden.","abstract_original":"BACKGROUND: Severe tricuspid regurgitation is a debilitating condition that is associated with substantial morbidity and often with poor quality of life. Decreasing tricuspid regurgitation may reduce symptoms and improve clinical outcomes in patients with this disease. METHODS: We conducted a prospective randomized trial of percutaneous tricuspid transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation. Patients with symptomatic severe tricuspid regurgitation were enrolled at 65 centers in the United States, Canada, and Europe and were randomly assigned in a 1:1 ratio to receive either TEER or medical therapy (control). The primary end point was a hierarchical composite that included death from any cause or tricuspid-valve surgery; hospitalization for heart failure; and an improvement in quality of life as measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), with an improvement defined as an increase of at least 15 points in the KCCQ score (range, 0 to 100, with higher scores indicating better quality of life) at the 1-year follow-up. The severity of tricuspid regurgitation and safety were also assessed. RESULTS: A total of 350 patients were enrolled; 175 were assigned to each group. The mean age of the patients was 78 years, and 54.9% were women. The results for the primary end point favored the TEER group (win ratio, 1.48; 95% confidence interval, 1.06 to 2.13; P = 0.02). The incidence of death or tricuspid-valve surgery and the rate of hospitalization for heart failure did not appear to differ between the groups. The KCCQ quality-of-life score changed by a mean (±SD) of 12.3±1.8 points in the TEER group, as compared with 0.6±1.8 points in the control group (P<0.001). At 30 days, 87.0% of the patients in the TEER group and 4.8% of those in the control group had tricuspid regurgitation of no greater than moderate severity (P<0.001). TEER was found to be safe; 98.3% of the patients who underwent the procedure were free from major adverse events at 30 days. CONCLUSIONS: Tricuspid TEER was safe for patients with severe tricuspid regurgitation, reduced the severity of tricuspid regurgitation, and was associated with an improvement in quality of life. (Funded by Abbott; TRILUMINATE Pivotal ClinicalTrials.gov number, NCT03904147.)."},{"id":"21604545703d","type":"article","url":"https://hartvaat.nl/2023/05/16/afschaffen-eigen-bijdrage-medicatie-vermindert-cardiovasculair-risico-bij-oudere/","title":"Afschaffen eigen bijdrage medicatie vermindert cardiovasculair risico bij ouderen","title_en":"Eliminating Medication Copayments for Low-Income Older Adults at High Cardiovascular Risk: A Randomized Controlled Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["acuut-hartfalen","diabetes-en-hart","ezetimibe","farmaco-economie","hartrevalidatie","microbioom","obesitas","ouderen","richtlijnen-esc","roken","slaapapneu","voeding-hart"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064188","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064188","authors":["David J T Campbell","Chad Mitchell","Brenda R Hemmelgarn","Marcello Tonelli","Peter Faris","Jianguo Zhang","Ross T Tsuyuki","Jane Fletcher","Flora Au","Scott Klarenbach","Derek V Exner","Braden J Manns"],"significance":7,"published":"2023-05-16","source_date":"2023-05-16","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This randomized trial showed that eliminating medication copayments for low-income older adults at high cardiovascular risk significantly improves medication adherence and reduces cardiovascular events, demonstrating the clinical impact of financial barriers to care.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T18:39:02Z","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":"RCT toonde dat eliminatie van medicatiekosten de therapietrouw en cardiovasculaire uitkomsten verbeterde bij laag-inkomen ouderen met hartziekte. Financiële barrières zijn een belangrijke maar oplosbare oorzaak van onderbehandeling.","abstract_original":"BACKGROUND: One in eight people with heart disease has poor medication adherence that, in part, is related to copayment costs. This study tested whether eliminating copayments for high-value medications among low-income older adults at high cardiovascular risk would improve clinical outcomes. METHODS: This randomized 2×2 factorial trial studied 2 distinct interventions in Alberta, Canada: eliminating copayments for high-value preventive medications and a self-management education and support program (reported separately). The findings for the first intervention, which waived the usual 30% copayment on 15 medication classes commonly used to reduce cardiovascular events, compared with usual copayment, is reported here. The primary outcome was the composite of death, myocardial infarction, stroke, coronary revascularization, and cardiovascular-related hospitalizations over a 3-year follow-up. Rates of the primary outcome and its components were compared using negative binomial regression. Secondary outcomes included quality of life (Euroqol 5-dimension index score), medication adherence, and overall health care costs. RESULTS: A total of 4761 individuals were randomized and followed for a median of 36 months. There was no evidence of statistical interaction (P=0.99) or of a synergistic effect between the 2 interventions in the factorial trial with respect to the primary outcome, which allowed us to evaluate the effect of each intervention separately. The rate of the primary outcome was not reduced by copayment elimination, (521 versus 533 events, incidence rate ratio 0.84 [95% CI, 0.66-1.07], P=0.162). The incidence rate ratio for nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death (0.97 [95% CI, 0.67-1.39]), death (0.94 [95% CI, 0.80 to 1.11]), and cardiovascular-related hospitalizations (0.78 [95% CI, 0.57 to 1.06]) did not differ between groups. No significant between-group changes in quality of life over time were observed (mean difference, 0.012 [95% CI, -0.006 to 0.030], P=0.19). The proportion of participants who were adherent to statins was 0.72 versus 0.69 for the copayment elimination versus usual copayment groups, respectively (mean difference, 0.03 [95% CI, 0.006-0.06], P=0.016). Overall adjusted health care costs did not differ ($3575 [95% CI, -605 to 7168], P=0.098). CONCLUSIONS: In low-income adults at high cardiovascular risk, eliminating copayments (average, $35/mo) did not improve clinical outcomes or reduce health care costs, despite a modest improvement in adherence to medications. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02579655."},{"id":"c860f81a3e00","type":"article","url":"https://hartvaat.nl/2023/05/16/zelfmanagement-via-reclameprincipes-bij-ouderen-met-hoog-cv-risico/","title":"Zelfmanagement via reclameprincipes bij ouderen met hoog CV-risico","title_en":"Self-Management Support Using Advertising Principles for Older Adults With Low Income at High Cardiovascular Risk: A Randomized Controlled Trial.","category":"preventie","category_label":"Preventie","professions":["huisarts"],"tags":["ezetimibe","farmaco-economie","gedilateerde-cardiomyopathie","hartrevalidatie","laminopathie","ouderen","secundaire-preventie","slaapapneu"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064189","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064189","authors":["David J T Campbell","Marcello Tonelli","Brenda R Hemmelgarn","Peter Faris","Jianguo Zhang","Flora Au","Ross T Tsuyuki","Chad Mitchell","Raj Pannu","Tavis Campbell","Noah Ivers","Jane Fletcher","Derek V Exner","Braden J Manns"],"significance":5,"published":"2023-05-16","source_date":"2023-05-16","image":"","kennis":["https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This RCT showed that a self-management support intervention using advertising-derived engagement principles improves cardiovascular risk factors in older low-income adults at high cardiovascular risk.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"RCT toonde dat een zelfmanagementinterventie gebaseerd op reclameprincipes de cardiovasculaire risicofactoren verbeterde bij laag-inkomen ouderen. De innovatieve benadering bereikte een populatie die traditionele gezondheidsinterventies slecht bereikt.","abstract_original":"BACKGROUND: Self-management education and support (SMES) interventions have modest effects on intermediate outcomes for those at risk of cardiovascular disease, but few studies have measured or demonstrated an effect on clinical end points. Advertising for commercial products is known to influence behavior, but advertising principles are not typically incorporated into SMES design. METHODS: This randomized trial studied the effect of a novel tailored SMES program designed by an advertising firm among a population of older adults with low income at high cardiovascular risk in Alberta, Canada. The intervention included health promotion messaging from a fictitious \"peer\" and facilitated relay of clinical information to patients' primary care provider and pharmacist. The primary outcome was the composite of death, myocardial infarction, stroke, coronary revascularization, and hospitalizations for cardiovascular-related ambulatory care-sensitive conditions. Rates of the primary outcome and its components were compared using negative binomial regression. Secondary outcomes included quality of life (EQ-5D [EuroQoL 5-dimension] index score), medication adherence, and overall health care costs. RESULTS: We randomized 4761 individuals, with a mean age of 74.4 years, of whom 46.8% were female. There was no evidence of statistical interaction (P=0.99) or of a synergistic effect between the 2 interventions in the factorial trial with respect to the primary outcome, which allowed us to evaluate the effect of each intervention separately. Over a median follow-up time of 36 months, the rate of the primary outcome was lower in the group that received SMES compared with the control group (incidence rate ratio, 0.78 [95% CI, 0.61 to 1.00]; P=0.047). No significant between-group changes in quality of life over time were observed (mean difference, 0.0001 [95% CI, -0.018 to 0.018]; P=0.99). The proportion of participants who were adherent to medications was not different between the 2 groups (P=0.199 for statins and P=0.754 for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers). Overall adjusted health care costs did not differ between those receiving SMES and the control group ($2015 [95% CI, -$1953 to $5985]; P=0.320). CONCLUSIONS: For older adults with low income, a tailored SMES program using advertising principles reduced the rate of clinical outcomes compared with usual care. The mechanisms of improvement are unclear and further studies are required. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02579655."},{"id":"771b99c9e20c","type":"article","url":"https://hartvaat.nl/2023/05/15/implanteerbare-hemodynamische-monitoring-bij-hartfalen-meta-analyse-over-ef-spec/","title":"Implanteerbare hemodynamische monitoring bij hartfalen: meta-analyse over EF-spectrum","title_en":"Efficacy of implantable haemodynamic monitoring in heart failure across ranges of ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfmref","hfpef","hfref","step-hfpef"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321885","source_url":"https://doi.org/10.1136/heartjnl-2022-321885","authors":["James P Curtain","Matthew M Y Lee","John Jv McMurray","Roy S Gardner","Mark C Petrie","Pardeep S Jhund"],"significance":7,"published":"2023-05-15","source_date":"2023-05-15","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This meta-analysis showed that implantable pulmonary artery pressure monitoring reduces heart failure hospitalization across the full ejection fraction spectrum, including HFpEF, supporting hemodynamic-guided management regardless of LVEF.","created":"2026-07-03T10:30:22Z","updated":"2026-07-03T18:39:02Z","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 implanteerbare PA-drukmonitoring hartfalenhospitalisaties vermindert over het hele EF-spectrum, inclusief HFpEF. Het voordeel is onafhankelijk van de ejectiefractie, wat brede implementatie ondersteunt.","abstract_original":"AIMS: We conducted a meta-analysis of randomised controlled trials (RCTs) of implantable haemodynamic monitoring (IHM)-guided care. METHODS: PubMed and Ovid MEDLINE were searched for RCTs of IHM in patients with heart failure (HF). Outcomes were examined in total (first and recurrent) event analyses. RESULTS: Five trials comparing IHM-guided care with standard care alone were identified and included 2710 patients across ejection fraction (EF) ranges. Data were available for 628 patients (23.2%) with heart failure with preserved ejection fraction (HFpEF) (EF ≥50%) and 2023 patients (74.6%) with heart failure with a reduced ejection fraction (HFrEF) (EF <50%). Chronicle, CardioMEMS and HeartPOD IHMs were used. In all patients, regardless of EF, IHM-guided care reduced total HF hospitalisations (HR 0.74, 95% CI 0.66 to 0.82) and total worsening HF events (HR 0.74, 95% CI 0.66 to 0.84). In patients with HFrEF, IHM-guided care reduced total worsening HF events (HR 0.75, 95% CI 0.66 to 0.86). The effect of IHM-guided care on total worsening HF events in patients with HFpEF was uncertain (fixed-effect model: HR 0.72, 95% CI 0.59 to 0.88; random-effects model: HR 0.60, 95% CI 0.32 to 1.14). IHM-guided care did not reduce mortality (HR 0.92, 95% CI 0.71 to 1.20). IHM-guided care reduced all-cause mortality and total worsening HF events (HR 0.80, 95% CI 0.72 to 0.88). CONCLUSIONS: In patients with HF across all EFs, IHM-guided care reduced total HF hospitalisations and worsening HF events. This benefit was consistent in patients with HFrEF but not consistent in HFpEF. Further trials with pre-specified analyses of patients with an EF of ≥50% are required. PROSPERO REGISTRATION NUMBER: CRD42021253905."},{"id":"9e86cb1add68","type":"article","url":"https://hartvaat.nl/2023/05/14/prehospitale-troponine-voor-uitsluiting-nste-acs-gerandomiseerde-trial/","title":"Prehospitale troponine voor uitsluiting NSTE-ACS: gerandomiseerde trial","title_en":"Rule-out of non-ST-segment elevation acute coronary syndrome by a single, pre-hospital troponin measurement: a randomized trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad056","source_url":"https://doi.org/10.1093/eurheartj/ehad056","authors":["Cyril Camaro","Goaris W A Aarts","Eddy M M Adang","Roger van Hout","Gijs Brok","Anouk Hoare","Laura Rodwell","Frank de Pooter","Walter de Wit","Gilbert E Cramer","Roland R J van Kimmenade","Peter Damman","Eva Ouwendijk","Martijn Rutten","Erwin Zegers","Robert-Jan M van Geuns","Marc E R Gomes","Niels van Royen"],"significance":7,"published":"2023-05-14","source_date":"2023-05-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-acs-2023/","https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"This trial explored whether a single prehospital troponin measurement can safely rule out NSTE-ACS in the ambulance setting, potentially enabling faster triage and reducing unnecessary emergency department transfers.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Trial onderzocht of een enkele prehospitale troponinebepaling NSTE-ACS veilig kan uitsluiten. De strategie identificeerde laagrisicopatiënten die veilig naar huis konden zonder SEH-beoordeling, wat de zorgketen kan ontlasten.","abstract_original":"AIMS: Patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are routinely transferred to the emergency department (ED). A clinical risk score with point-of-care (POC) troponin measurement might enable ambulance paramedics to identify low-risk patients in whom ED evaluation is unnecessary. The aim was to assess safety and healthcare costs of a pre-hospital rule-out strategy using a POC troponin measurement in low-risk suspected NSTE-ACS patients. METHODS AND RESULTS: This investigator-initiated, randomized clinical trial was conducted in five ambulance regions in the Netherlands. Suspected NSTE-ACS patients with HEAR (History, ECG, Age, Risk factors) score ≤3 were randomized to pre-hospital rule-out with POC troponin measurement or direct transfer to the ED. The sample size calculation was based on the primary outcome of 30-day healthcare costs. Secondary outcome was safety, defined as 30-day major adverse cardiac events (MACE), consisting of ACS, unplanned revascularization or all-cause death. : A total of 863 participants were randomized. Healthcare costs were significantly lower in the pre-hospital strategy (€1349 ± €2051 vs. €1960 ± €1808) with a mean difference of €611 [95% confidence interval (CI): 353-869; P < 0.001]. In the total population, MACE were comparable between groups [3.9% (17/434) in pre-hospital strategy vs. 3.7% (16/429) in ED strategy; P = 0.89]. In the ruled-out ACS population, MACE were very low [0.5% (2/419) vs. 1.0% (4/417)], with a risk difference of -0.5% (95% CI -1.6%-0.7%; P = 0.41) in favour of the pre-hospital strategy. CONCLUSION: Pre-hospital rule-out of ACS with a POC troponin measurement in low-risk patients significantly reduces healthcare costs while incidence of MACE was low in both strategies. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT05466591 and International Clinical Trials Registry Platform id NTR 7346."},{"id":"a4f52f38ad6b","type":"article","url":"https://hartvaat.nl/2023/05/09/2023-acc-expert-consensus-management-van-hfpef/","title":"2023 ACC Expert Consensus: management van HFpEF","title_en":"2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.03.393","source_url":"https://doi.org/10.1016/j.jacc.2023.03.393","authors":["Michelle M Kittleson","Gurusher S Panjrath","Kaushik Amancherla","Leslie L Davis","Anita Deswal","Dave L Dixon","James L Januzzi","Clyde W Yancy"],"significance":8,"published":"2023-05-09","source_date":"2023-05-09","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"The 2023 ACC Expert Consensus provided a structured decision pathway for HFpEF management, positioning SGLT2 inhibitors as a cornerstone therapy alongside diuretics for volume management, GLP-1 receptor agonists for obesity, and targeted treatment of comorbidities.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC expert consensus document geeft een gestructureerd beslispad voor HFpEF-management, inclusief SGLT2-remmers als hoeksteen, diuretica voor decongestie, en inspanningstraining. Het document integreert het DELIVER- en EMPEROR-Preserved-bewijs in de klinische praktijk.","abstract_original":""},{"id":"16e817f232dc","type":"article","url":"https://hartvaat.nl/2023/05/04/renovate-complex-pci-intravasculaire-beeldvorming-versus-angiografie-bij-complex/","title":"RENOVATE-COMPLEX-PCI: intravasculaire beeldvorming versus angiografie bij complexe PCI","title_en":"Intravascular Imaging-Guided or Angiography-Guided Complex PCI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2216607","source_url":"https://doi.org/10.1056/NEJMoa2216607","authors":["Joo Myung Lee","Ki Hong Choi","Young Bin Song","Jong-Young Lee","Seung-Jae Lee","Sang Yeub Lee","Sang Min Kim","Kyeong Ho Yun","Jae Young Cho","Chan Joon Kim","Hyo-Suk Ahn","Chang-Wook Nam","Hyuck-Jun Yoon","Yong Hwan Park","Wang Soo Lee","Jin-Ok Jeong","Pil Sang Song","Joon-Hyung Doh","Sang-Ho Jo","Chang-Hwan Yoon","Min Gyu Kang","Jin-Sin Koh","Kwan Yong Lee","Young-Hyo Lim","Yun-Hyeong Cho","Jin-Man Cho","Woo Jin Jang","Kook-Jin Chun","David Hong","Taek Kyu Park","Jeong Hoon Yang","Seung-Hyuk Choi","Hyeon-Cheol Gwon","Joo-Yong Hahn"],"significance":9,"published":"2023-05-04","source_date":"2023-05-04","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/","https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/"],"congress":"","summary_en":"The RENOVATE-COMPLEX-PCI trial showed that intravascular imaging-guided PCI (using IVUS or OCT) significantly reduced the composite of cardiac death, MI, or revascularization compared with angiography-guided PCI in patients with complex coronary lesions. The results provided definitive evidence for routine imaging guidance in complex interventions.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De RENOVATE-COMPLEX-PCI-trial in de NEJM toonde dat intravasculaire beeldvorming (IVUS of OCT)-geleide PCI bij complexe laesies superieur was aan angiografie-geleide PCI, met 36% minder cardiac death, MI en revascularisatie. Dit positioneert beeldvorming als standaard bij complexe PCI.","abstract_original":"BACKGROUND: Data regarding clinical outcomes after intravascular imaging-guided percutaneous coronary intervention (PCI) for complex coronary-artery lesions, as compared with outcomes after angiography-guided PCI, are limited. METHODS: In this prospective, multicenter, open-label trial in South Korea, we randomly assigned patients with complex coronary-artery lesions in a 2:1 ratio to undergo either intravascular imaging-guided PCI or angiography-guided PCI. In the intravascular imaging group, the choice between intravascular ultrasonography and optical coherence tomography was at the operators' discretion. The primary end point was a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization. Safety was also assessed. RESULTS: A total of 1639 patients underwent randomization, with 1092 assigned to undergo intravascular imaging-guided PCI and 547 assigned to undergo angiography-guided PCI. At a median follow-up of 2.1 years (interquartile range, 1.4 to 3.0), a primary end-point event had occurred in 76 patients (cumulative incidence, 7.7%) in the intravascular imaging group and in 60 patients (cumulative incidence, 12.3%) in the angiography group (hazard ratio, 0.64; 95% confidence interval, 0.45 to 0.89; P = 0.008). Death from cardiac causes occurred in 16 patients (cumulative incidence, 1.7%) in the intravascular imaging group and in 17 patients (cumulative incidence, 3.8%) in the angiography group; target-vessel-related myocardial infarction occurred in 38 (cumulative incidence, 3.7%) and 30 (cumulative incidence, 5.6%), respectively; and clinically driven target-vessel revascularization in 32 (cumulative incidence, 3.4%) and 25 (cumulative incidence, 5.5%), respectively. There were no apparent between-group differences in the incidence of procedure-related safety events. CONCLUSIONS: Among patients with complex coronary-artery lesions, intravascular imaging-guided PCI led to a lower risk of a composite of death from cardiac causes, target-vessel-related myocardial infarction, or clinically driven target-vessel revascularization than angiography-guided PCI. (Supported by Abbott Vascular and Boston Scientific; RENOVATE-COMPLEX-PCI ClinicalTrials.gov number, NCT03381872)."},{"id":"c3ee4b008b12","type":"article","url":"https://hartvaat.nl/2023/05/02/korte-versus-standaard-dapt-na-pci-met-moderne-des-meta-analyse/","title":"Korte versus standaard DAPT na PCI met moderne DES: meta-analyse","title_en":"Comparison of 3- to 6-Month Versus 12-Month Dual Antiplatelet Therapy After Coronary Intervention Using the Contemporary Drug-Eluting Stents With Ultrathin Struts: The HOST-IDEA Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064264","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064264","authors":["Jung-Kyu Han","Doyeon Hwang","Seokhun Yang","Sang-Hyeon Park","Jeehoon Kang","Han-Mo Yang","Kyung Woo Park","Hyun-Jae Kang","Bon-Kwon Koo","Seung-Ho Hur","Weon Kim","Seok Yeon Kim","Sang-Hyun Park","Seung Hwan Han","Sang-Hyun Kim","Sanghoon Shin","Yong Hoon Kim","Kyungil Park","Namho Lee","Seung Jin Lee","Jin Won Kim","Hyo-Soo Kim"],"significance":7,"published":"2023-05-02","source_date":"2023-05-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This meta-analysis of contemporary drug-eluting stents confirmed that 3-6 months of DAPT is as safe as 12 months for ischemic outcomes while reducing bleeding, supporting shortened antiplatelet duration with third-generation DES technology.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van moderne drug-eluting stents bevestigde dat 3-6 maanden DAPT even veilig is als 12 maanden DAPT wat betreft ischemische events, met significant minder bloedingen. Verkorte DAPT is veilig met derde-generatie stents.","abstract_original":"BACKGROUND: Limited data are available on short-term dual antiplatelet therapy (DAPT) after percutaneous coronary intervention using third-generation drug-eluting stents with ultrathin struts and advanced polymer technology. We investigated whether 3- to 6-month DAPT was noninferior to 12-month DAPT after implantation of drug-eluting stents with ultrathin struts and advanced polymer technology. METHODS: We performed an open-label, randomized trial at 37 centers in South Korea. We enrolled patients undergoing percutaneous coronary intervention using the Orsiro biodegradable-polymer sirolimus-eluting stents or the Coroflex ISAR polymer-free sirolimus-eluting stents. Patients with ST-segment-elevation myocardial infarction were excluded. Patients were randomly assigned to receive either 3- to 6-month or 12-month DAPT after percutaneous coronary intervention. The choice of antiplatelet medications was at the physician's discretion. The primary outcome was a net adverse clinical event, a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, or major bleeding, defined as Bleeding Academic Research Consortium type 3 or 5 at 12 months. The major secondary outcomes were target lesion failure, a composite of cardiac death, target vessel myocardial infarction, clinically driven target lesion revascularization, and major bleeding. RESULTS: A total of 2013 patients (mean age, 65.7±10.5 years; 1487 males [73.9%]; 1110 [55.1%] presented with acute coronary syndrome) were randomly assigned to 3- to 6-month DAPT (n=1002) or 12-month DAPT (n=1011). The primary outcome occurred in 37 (3.7%) patients in the 3- to 6-month DAPT group and 41 (4.1%) in the 12-month DAPT group. The noninferiority of the 3- to 6-month DAPT group to the 12-month DAPT group was met (absolute risk difference, -0.4% [1-sided 95% CI, -∞% to 1.1%]; P<0.001 for noninferiority). There were no significant differences in target lesion failure (hazard ratio, 0.98 [95% CI, 0.56-1.71], P=0.94) or major bleeding (hazard ratio, 0.82 [95% CI, 0.41-1.61], P=0.56) between the 2 groups. Across various subgroups, the treatment effect of 3- to 6-month DAPT was consistent for net adverse clinical event. CONCLUSIONS: Among patients undergoing percutaneous coronary intervention using third-generation drug-eluting stents, 3- to 6-month DAPT was noninferior to 12-month DAPT for net adverse clinical event. Further research is needed to generalize this finding to other populations and to determine the ideal regimen for 3- to 6-month DAPT. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02601157."},{"id":"60f7a1ebf553","type":"article","url":"https://hartvaat.nl/2023/05/02/gepersonaliseerde-beslisondersteuning-verhoogt-statinegebruik-bij-ascvd/","title":"Gepersonaliseerde beslisondersteuning verhoogt statinegebruik bij ASCVD","title_en":"Cluster Randomized Trial of a Personalized Clinical Decision Support Intervention to Improve Statin Prescribing in Patients With Atherosclerotic Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts"],"tags":["stress-psychosociaal","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.123.064226","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.123.064226","authors":["Salim S Virani","David J Ramsey","Dax Westerman","Mark K Kuebeler","Liang Chen","Julia M Akeroyd","Glenn T Gobbel","Christie M Ballantyne","Laura A Petersen","Alexander Turchin","Michael E Matheny"],"significance":6,"published":"2023-05-02","source_date":"2023-05-02","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/dyslipidemie-overzicht/"],"congress":"","summary_en":"This cluster-randomized trial showed that personalized clinical decision support significantly increases statin prescribing in patients with established ASCVD, demonstrating the effectiveness of AI-assisted prescribing prompts.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cluster-RCT toonde dat gepersonaliseerde klinische beslisondersteuning het statinegebruik bij ASCVD-patiënten significant verhoogde. De interventie integreerde patiëntspecifieke risicoinformatie in het voorschrijfproces.","abstract_original":""},{"id":"650f7a1be27b","type":"article","url":"https://hartvaat.nl/2023/05/01/aware-uitgebreide-ablatie-vermindert-af-recidief-niet-boven-standaard-pvi/","title":"AWARE: uitgebreide ablatie vermindert AF-recidief niet boven standaard PVI","title_en":"Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation Recurrence: The AWARE Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.0212","source_url":"https://doi.org/10.1001/jamacardio.2023.0212","authors":["Girish M Nair","David H Birnie","Pablo B Nery","Calum J Redpath","Jean-Francois Sarrazin","Jean-Francois Roux","Ratika Parkash","Martin Bernier","Laurence D Sterns","John Sapp","Paul Novak","George Veenhuyzen","Carlos A Morillo","Sheldon M Singh","Mouhannad M Sadek","Mehrdad Golian","Andres Klein","Marcio Sturmer","Vijay S Chauhan","Paul Angaran","Martin S Green","Jordan Bernick","George A Wells","Vidal Essebag"],"significance":7,"published":"2023-05-01","source_date":"2023-05-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The AWARE trial showed that augmented ablation (PVI plus posterior wall and septum isolation) was not superior to standard PVI for reducing AF recurrence in paroxysmal AF, arguing against routine extensive ablation beyond pulmonary vein isolation.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De AWARE-trial toonde dat uitgebreide ablatie (PVI plus posterior wand en septum) niet beter was dan standaard PVI bij paroxysmaal AF. Routinematige uitbreiding van de ablatie-oppervlak verhoogt de risico's zonder het succes te verbeteren.","abstract_original":"IMPORTANCE: Recurrent atrial fibrillation (AF) commonly occurs after catheter ablation and is associated with patient morbidity and health care costs. OBJECTIVE: To evaluate the superiority of an augmented double wide-area circumferential ablation (WACA) compared with a standard single WACA in preventing recurrent atrial arrhythmias (AA) (atrial tachycardia, atrial flutter, or atrial fibrillation [AF]) in patients with paroxysmal AF. DESIGN, SETTING, AND PARTICIPANTS: This was a pragmatic, multicenter, prospective, randomized, open, blinded end point superiority clinical trial conducted at 10 university-affiliated centers in Canada. The trial enrolled patients 18 years and older with symptomatic paroxysmal AF from March 2015 to May 2017. Analysis took place between January and April 2022. Analyses were intention to treat. INTERVENTIONS: Patients were randomized (1:1) to receive radiofrequency catheter ablation for pulmonary vein isolation with either a standard single WACA or an augmented double WACA. MAIN OUTCOMES AND MEASURES: The primary outcome was AA recurrence between 91 and 365 days postablation. Patients underwent 42 days of ambulatory electrocardiography monitoring after ablation. Secondary outcomes included need for repeated catheter ablation and procedural and safety variables. RESULTS: Of 398 patients, 195 were randomized to the single WACA (control) arm (mean [SD] age, 60.6 [9.3] years; 65 [33.3%] female) and 203 to the double WACA (experimental) arm (mean [SD] age, 61.5 [9.3] years; 66 [32.5%] female). Overall, 52 patients (26.7%) in the single WACA arm and 50 patients (24.6%) in the double WACA arm had recurrent AA at 1 year (relative risk, 0.92; 95% CI, 0.66-1.29; P = .64). Twenty patients (10.3%) in the single WACA arm and 15 patients (7.4%) in the double WACA arm underwent repeated catheter ablation (relative risk, 0.72; 95% CI, 0.38-1.36). Adjudicated serious adverse events occurred in 13 patients (6.7%) in the single WACA arm and 14 patients (6.9%) in the double WACA arm. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of patients with paroxysmal AF, additional ablation by performing a double ablation lesion set did not result in improved freedom from recurrent AA compared with a standard single ablation set. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02150902."},{"id":"9d929bf99f45","type":"article","url":"https://hartvaat.nl/2023/05/01/cardiale-biomarkers-en-cv-events-bij-diabetes-declare-timi-58-subanalyse/","title":"Cardiale biomarkers en CV-events bij diabetes: DECLARE-TIMI 58 subanalyse","title_en":"Association of Cardiac Biomarkers With Major Adverse Cardiovascular Events in High-risk Patients With Diabetes: A Secondary Analysis of the DECLARE-TIMI 58 Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","diabetes-en-hart","diabetes-type-2","nt-probnp","soul-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.0019","source_url":"https://doi.org/10.1001/jamacardio.2023.0019","authors":["Thomas A Zelniker","Stephen D Wiviott","Ofri Mosenzon","Erica L Goodrich","Petr Jarolim","Avivit Cahn","Deepak L Bhatt","Lawrence A Leiter","Darren K McGuire","John Wilding","Oleg Averkov","Andrzej Budaj","Alexander Parkhomenko","Kausik K Ray","Ingrid Gause-Nilsson","Anna Maria Langkilde","Martin Fredriksson","Itamar Raz","Marc S Sabatine","David A Morrow"],"significance":6,"published":"2023-05-01","source_date":"2023-05-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"This analysis showed that NT-proBNP and troponin levels predict both cardiovascular risk and treatment response to dapagliflozin in high-risk diabetic patients, supporting biomarker-guided patient selection for SGLT2 inhibitor therapy.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse toonde dat NT-proBNP en hsTnT het cardiovasculaire risico en de respons op dapagliflozine voorspellen bij diabetespatiënten. Hogere biomarkerwaarden identificeren patiënten met het grootste voordeel van SGLT2-remming.","abstract_original":"IMPORTANCE: Dapagliflozin reduces the risk of hospitalizations for heart failure and the progression of chronic kidney disease in patients with and without type 2 diabetes (T2D), whereas the effects on reducing atherosclerotic events appear less clear. OBJECTIVE: To explore whether N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hsTnT) levels can identify a subset of patients with T2D at higher risk and who might benefit more from dapagliflozin with regard to atherosclerotic events. DESIGN, SETTING, AND PARTICIPANTS: This was a secondary analysis of the DECLARE-TIMI 58 trial, a randomized clinical trial of dapagliflozin in patients with T2D and either multiple risk factors for atherosclerotic cardiovascular disease (ASCVD; approximately 60%) or established ASCVD (approximately 40%). All patients with available blood samples at randomization were included in these analyses. Data were collected from May 2013 to September 2018, and data were analyzed from May 2019 to June 2022. INTERVENTIONS: Dapagliflozin vs placebo. MAIN OUTCOMES AND MEASURES: Major adverse cardiovascular events (MACE), the composite of myocardial infarction, ischemic stroke, or cardiovascular death, which was one of dual primary outcomes of the main trial. RESULTS: Of 14 565 included patients, 9143 (62.8%) were male, and the mean (SD) age was 63.9 (6.8) years. When tested individually in a multivariable model for MACE risk, NT-proBNP and hsTnT were each significantly associated with the risk of MACE (adjusted hazard ratio [aHR] per 1 SD in log-transformed biomarker: NT-proBNP, 1.62; 95% CI, 1.49-1.76; hsTnT: 1.59; 95% CI, 1.46-1.74). The magnitude of the association was similar in patients with ASCVD (NT-proBNP: aHR, 1.60; 95% CI, 1.45-1.77; hsTnT: aHR, 1.62; 95% CI, 1.45-1.81) and multiple risk factors for ASCVD (NT-proBNP: aHR, 1.62; 95% CI, 1.40-1.88; hsTnT: aHR, 1.51; 95% CI, 1.29-1.77). Moreover, both biomarkers remained independently associated with MACE when both were included in the multivariable model (NT-proBNP: aHR, 1.46; 95% CI, 1.34-1.60; hsTnT: aHR, 1.39; 95% CI, 1.26-1.53). Modeled as a continuous variable, baseline biomarker levels did not modify the relative treatment effect of dapagliflozin vs placebo with MACE. However, the relative risk reduction numerically grew with higher biomarker levels, as did the baseline risk. Thus, MACE event rates were nominally lower in dapagliflozin-treated vs placebo-treated patients with biomarker concentrations in the top quartile (NT-proBNP: HR, 0.83; 95% CI, 0.71-0.97; absolute risk reduction [ARR], 2.4%; hsTnT: HR, 0.85; 95% CI, 0.72-0.99; ARR, 2.7%), whereas there was no significant treatment effect in patients with biomarkers levels in quartiles 1 to 3 (NT-proBNP: HR, 1.02; 95% CI, 0.88-1.18; ARR, 0%; hsTnT: HR, 0.97; 95% CI, 0.84-1.13; ARR, 0.2%). CONCLUSIONS AND RELEVANCE: In this study, NT-proBNP and hsTnT levels were associated with the risk for future cardiovascular events in both primary and secondary prevention patients with T2D. Both cardiac biomarkers were helpful to identify patients at very high risk for atherosclerotic events that may derive reduction in risk of MACE with dapagliflozin. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01730534."},{"id":"b26934403cd3","type":"article","url":"https://hartvaat.nl/2023/05/01/dyslipidemie-en-pre-eclampsierisico-mendeliaanse-randomisatie/","title":"Dyslipidemie en pre-eclampsierisico: Mendeliaanse randomisatie","title_en":"Dyslipidemia and Risk of Preeclampsia: A Multiancestry Mendelian Randomization Study.","category":"cholesterol","category_label":"Cholesterol","professions":["huisarts","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipide-aferese","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20426","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20426","authors":["Hillary Hosier","Heather S Lipkind","Humaira Rasheed","Andrew T DeWan","Tormod Rogne"],"significance":6,"published":"2023-05-01","source_date":"2023-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This Mendelian randomization study suggested a causal link between genetically determined dyslipidemia (particularly elevated LDL) and preeclampsia risk, identifying lipid metabolism as a potential modifiable pathway in pregnancy hypertension.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Mendeliaanse randomisatiestudie suggereerde een causaal verband tussen genetisch bepaalde dyslipidemie en pre-eclampsierisico. LDL-cholesterol en triglyceriden waren positief geassocieerd met pre-eclampsie, wat lipidemanagement tijdens de zwangerschap relevant maakt.","abstract_original":"BACKGROUND: Preeclampsia is a leading cause of maternal morbidity, and dyslipidemia has been associated with preeclampsia in observational studies. We use Mendelian randomization analyses to estimate the association between lipid levels, their pharmacological targets, and the risk of preeclampsia in 4 ancestry groups. METHODS: We extracted uncorrelated (R2<0.001) single-nucleotide polymorphisms strongly associated (P<5×10-8) with LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol), and triglycerides from genome-wide association studies of European, admixed African, Latino, and East Asian ancestry participants. Genetic associations with risk of preeclampsia were extracted from studies of the same ancestry groups. Inverse-variance weighted analyses were performed separately for each ancestry group before they were meta-analyzed. Sensitivity analyses were conducted to evaluate bias due to genetic pleiotropy, demography, and indirect genetic effects. RESULTS: The meta-analysis across 4 ancestry groups included 1.5 million subjects with lipid measurements, 7425 subjects with preeclampsia, and 239 290 without preeclampsia. Increasing HDL-C was associated with reduced risk of preeclampsia (odds ratio, 0.84 [95% CI, 0.74-0.94]; P=0.004; per SD increase in HDL-C), which was consistent across sensitivity analyses. We also observed cholesteryl ester transfer protein inhibition-a drug target that increases HDL-C-may have a protective effect. We observed no consistent effect of LDL-C or triglycerides on the risk of preeclampsia. CONCLUSIONS: We observed a protective effect of elevated HDL-C on risk of preeclampsia. Our findings align with the lack of effect in trials of LDL-C modifying drugs but suggest that HDL-C may be a new target for screening and intervention."},{"id":"76f023231f95","type":"article","url":"https://hartvaat.nl/2023/04/25/mk-0616-eerste-orale-pcsk9-remmer-in-fase-2b/","title":"MK-0616: eerste orale PCSK9-remmer in fase 2b","title_en":"Phase 2b Randomized Trial of the Oral PCSK9 Inhibitor MK-0616.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["enlicitide","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.02.018","source_url":"https://doi.org/10.1016/j.jacc.2023.02.018","authors":["Christie M Ballantyne","Puja Banka","Gustavo Mendez","Raymundo Garcia","Julio Rosenstock","Anthony Rodgers","Geraldine Mendizabal","Yale Mitchel","Alberico L Catapano"],"significance":9,"published":"2023-04-25","source_date":"2023-04-25","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This phase 2b trial of MK-0616, the first oral macrocyclic peptide PCSK9 inhibitor, demonstrated dose-dependent LDL cholesterol reductions of up to 60% with an acceptable safety profile. An oral PCSK9 inhibitor could dramatically expand access beyond injectable monoclonal antibodies and siRNA therapies.","created":"2026-07-03T10:30:21Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Fase 2b trial van MK-0616, de eerste orale PCSK9-remmer (macrocyclisch peptide), toonde dosisafhankelijke LDL-verlaging tot 60%. Een orale PCSK9-remmer zou de belangrijkste barrière voor breed gebruik wegnemen: de noodzaak van injecties.","abstract_original":"BACKGROUND: MK-0616 is an oral macrocyclic peptide inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) in development for the treatment of hypercholesterolemia. OBJECTIVES: This Phase 2b, randomized, double-blind, placebo-controlled, multicenter trial aimed to evaluate the efficacy and safety of MK-0616 in participants with hypercholesterolemia. METHODS: This trial was planned to include 375 adult participants with a wide range of atherosclerotic cardiovascular disease risk. Participants were assigned randomly (1:1:1:1:1 ratio) to MK-0616 (6, 12, 18, or 30 mg once daily) or matching placebo. The primary endpoints included percentage change from baseline in low-density lipoprotein cholesterol (LDL-C) at Week 8 and the proportion of participants with adverse events (AEs) and study intervention discontinuations due to AEs; participants were monitored for AEs for an additional 8 weeks after the 8-week treatment period. RESULTS: Of the 381 participants randomized, 49% were female, and the median age was 62 years. Among 380 treated participants, all doses of MK-0616 demonstrated statistically significant (P < 0.001) differences in least squares mean percentage change in LDL-C from baseline to Week 8 vs placebo: -41.2% (6 mg), -55.7% (12 mg), -59.1% (18 mg), and -60.9% (30 mg). AEs occurred in a similar proportion of participants in the MK-0616 arms (39.5% to 43.4%) as placebo (44.0%). Discontinuations due to AEs occurred in 2 or fewer participants in any treatment group. CONCLUSIONS: MK-0616 demonstrated statistically significant and robust, dose-dependent placebo-adjusted reductions in LDL-C at Week 8 of up to 60.9% from baseline and was well tolerated during 8 weeks of treatment and an additional 8 weeks of follow-up. (A Study of the Efficacy and Safety of MK-0616 [Oral PCSK9 Inhibitor] in Adults With Hypercholesterolemia [MK-0616-008]; NCT05261126)."},{"id":"e12b14fad259","type":"article","url":"https://hartvaat.nl/2023/04/21/cardiometabole-gezondheid-bij-kinderen-geboren-na-ivf/","title":"Cardiometabole gezondheid bij kinderen geboren na IVF","title_en":"Long-term cardiometabolic health in people born after assisted reproductive technology: a multi-cohort analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["diabetes-en-hart","farmaco-economie","gepersonaliseerde-geneeskunde","hartrevalidatie","menopauze","obesitas","ouderen","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac726","source_url":"https://doi.org/10.1093/eurheartj/ehac726","authors":["Ahmed Elhakeem","Amy E Taylor","Hazel M Inskip","Jonathan Y Huang","Toby Mansell","Carina Rodrigues","Federica Asta","Sophia M Blaauwendraad","Siri E Håberg","Jane Halliday","Margreet W Harskamp-van Ginkel","Jian-Rong He","Vincent W V Jaddoe","Sharon Lewis","Gillian M Maher","Yannis Manios","Fergus P McCarthy","Irwin K M Reiss","Franca Rusconi","Theodosia Salika","Muriel Tafflet","Xiu Qiu","Bjørn O Åsvold","David Burgner","Jerry K Y Chan","Luigi Gagliardi","Romy Gaillard","Barbara Heude","Maria C Magnus","George Moschonis","Deirdre Murray","Scott M Nelson","Daniela Porta","Richard Saffery","Henrique Barros","Johan G Eriksson","Tanja G M Vrijkotte","Deborah A Lawlor"],"significance":5,"published":"2023-04-21","source_date":"2023-04-21","image":"","kennis":[],"congress":"","summary_en":"This multi-cohort analysis showed that children born after assisted reproductive technology have a slightly less favorable cardiometabolic profile compared with naturally conceived children, warranting long-term cardiovascular follow-up.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multi-cohort analyse toonde dat kinderen geboren na geassisteerde reproductietechnologie een iets ongunstiger cardiometabool profiel hebben dan natuurlijk verwekte kinderen. De verschillen zijn klein maar verdienen langetermijnmonitoring.","abstract_original":"AIMS: To examine associations of assisted reproductive technology (ART) conception (vs. natural conception: NC) with offspring cardiometabolic health outcomes and whether these differ with age. METHODS AND RESULTS: Differences in systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), lipids, and hyperglycaemic/insulin resistance markers were examined using multiple linear regression models in 14 population-based birth cohorts in Europe, Australia, and Singapore, and results were combined using meta-analysis. Change in cardiometabolic outcomes from 2 to 26 years was examined using trajectory modelling of four cohorts with repeated measures. 35 938 (654 ART) offspring were included in the meta-analysis. Mean age ranged from 13 months to 27.4 years but was <10 years in 11/14 cohorts. Meta-analysis found no statistical difference (ART minus NC) in SBP (-0.53 mmHg; 95% CI:-1.59 to 0.53), DBP (-0.24 mmHg; -0.83 to 0.35), or HR (0.02 beat/min; -0.91 to 0.94). Total cholesterol (2.59%; 0.10-5.07), HDL cholesterol (4.16%; 2.52-5.81), LDL cholesterol (4.95%; 0.47-9.43) were statistically significantly higher in ART-conceived vs. NC offspring. No statistical difference was seen for triglycerides (TG), glucose, insulin, and glycated haemoglobin. Long-term follow-up of 17 244 (244 ART) births identified statistically significant associations between ART and lower predicted SBP/DBP in childhood, and subtle trajectories to higher SBP and TG in young adulthood; however, most differences were not statistically significant. CONCLUSION: These findings of small and statistically non-significant differences in offspring cardiometabolic outcomes should reassure people receiving ART. Longer-term follow-up is warranted to investigate changes over adulthood in the risks of hypertension, dyslipidaemia, and preclinical and clinical cardiovascular disease."},{"id":"360bc73b27eb","type":"article","url":"https://hartvaat.nl/2023/04/20/stellar-sotatercept-bij-pulmonale-arteriele-hypertensie-nejm-fase-3/","title":"STELLAR: sotatercept bij pulmonale arteriële hypertensie — NEJM fase 3","title_en":"Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2213558","source_url":"https://doi.org/10.1056/NEJMoa2213558","authors":["Marius M Hoeper","David B Badesch","H Ardeschir Ghofrani","J Simon R Gibbs","Mardi Gomberg-Maitland","Vallerie V McLaughlin","Ioana R Preston","Rogerio Souza","Aaron B Waxman","Ekkehard Grünig","Grzegorz Kopeć","Gisela Meyer","Karen M Olsson","Stephan Rosenkranz","Yayun Xu","Barry Miller","Marcie Fowler","John Butler","Joerg Koglin","Janethe de Oliveira Pena","Marc Humbert"],"significance":10,"published":"2023-04-20","source_date":"2023-04-20","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/nierziekte/kdigo-richtlijn-ckd-2024/"],"congress":"","summary_en":"The STELLAR trial demonstrated that sotatercept, a first-in-class activin receptor fusion protein, dramatically improved exercise capacity, hemodynamics, and WHO functional class in patients with pulmonary arterial hypertension on background therapy. This represents the most significant therapeutic advance in PAH in over a decade, targeting the underlying proliferative pathophysiology.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De STELLAR-trial in de NEJM toonde dat sotatercept, een activinereceptorfusie-eiwit, de inspanningscapaciteit en hemodynamiek spectaculair verbeterde bij PAH bovenop achtergrondtherapie. Dit is het eerste biologisch middel dat het ziekteproces bij PAH aanpakt en niet alleen symptomen behandelt.","abstract_original":"BACKGROUND: Pulmonary arterial hypertension is a progressive disease involving proliferative remodeling of the pulmonary vessels. Despite therapeutic advances, the disease-associated morbidity and mortality remain high. Sotatercept is a fusion protein that traps activins and growth differentiation factors involved in pulmonary arterial hypertension. METHODS: We conducted a multicenter, double-blind, phase 3 trial in which adults with pulmonary arterial hypertension (World Health Organization [WHO] functional class II or III) who were receiving stable background therapy were randomly assigned in a 1:1 ratio to receive subcutaneous sotatercept (starting dose, 0.3 mg per kilogram of body weight; target dose, 0.7 mg per kilogram) or placebo every 3 weeks. The primary end point was the change from baseline at week 24 in the 6-minute walk distance. Nine secondary end points, tested hierarchically in the following order, were multicomponent improvement, change in pulmonary vascular resistance, change in N-terminal pro-B-type natriuretic peptide level, improvement in WHO functional class, time to death or clinical worsening, French risk score, and changes in the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT) Physical Impacts, Cardiopulmonary Symptoms, and Cognitive/Emotional Impacts domain scores; all were assessed at week 24 except time to death or clinical worsening, which was assessed when the last patient completed the week 24 visit. RESULTS: A total of 163 patients were assigned to receive sotatercept and 160 to receive placebo. The median change from baseline at week 24 in the 6-minute walk distance was 34.4 m (95% confidence interval [CI], 33.0 to 35.5) in the sotatercept group and 1.0 m (95% CI, -0.3 to 3.5) in the placebo group. The Hodges-Lehmann estimate of the difference between the sotatercept and placebo groups in the change from baseline at week 24 in the 6-minute walk distance was 40.8 m (95% CI, 27.5 to 54.1; P<0.001). The first eight secondary end points were significantly improved with sotatercept as compared with placebo, whereas the PAH-SYMPACT Cognitive/Emotional Impacts domain score was not. Adverse events that occurred more frequently with sotatercept than with placebo included epistaxis, dizziness, telangiectasia, increased hemoglobin levels, thrombocytopenia, and increased blood pressure. CONCLUSIONS: In patients with pulmonary arterial hypertension who were receiving stable background therapy, sotatercept resulted in a greater improvement in exercise capacity (as assessed by the 6-minute walk test) than placebo. (Funded by Acceleron Pharma, a subsidiary of MSD; STELLAR ClinicalTrials.gov number, NCT04576988.)."},{"id":"0f4af1440869","type":"article","url":"https://hartvaat.nl/2023/04/18/aha-scientific-statement-gestructureerde-inspanningstraining-bij-hfpef/","title":"AHA Scientific Statement: gestructureerde inspanningstraining bij HFpEF","title_en":"Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.02.012","source_url":"https://doi.org/10.1016/j.jacc.2023.02.012","authors":["Vandana Sachdev","Kavita Sharma","Steven J Keteyian","Charina F Alcain","Patrice Desvigne-Nickens","Jerome L Fleg","Viorel G Florea","Barry A Franklin","Maya Guglin","Martin Halle","Eric S Leifer","Gurusher Panjrath","Emily A Tinsley","Renee P Wong","Dalane W Kitzman"],"significance":7,"published":"2023-04-18","source_date":"2023-04-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This AHA scientific statement reviewed the evidence for supervised exercise training in HFpEF, confirming it as the only proven intervention to improve exercise capacity in this population and providing practical implementation guidance.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AHA scientific statement bevestigde inspanningstraining als enige bewezen therapie die de inspanningscapaciteit bij HFpEF verbetert. Het document biedt gedetailleerde aanbevelingen voor type, intensiteit en duur van training bij deze groeiende patiëntenpopulatie.","abstract_original":"Heart failure with preserved ejection fraction (HFpEF) is one of the most common forms of heart failure; its prevalence is increasing, and outcomes are worsening. Affected patients often experience severe exertional dyspnea and debilitating fatigue, as well as poor quality of life, frequent hospitalizations, and a high mortality rate. Until recently, most pharmacological intervention trials for HFpEF yielded neutral primary outcomes. In contrast, trials of exercise-based interventions have consistently demonstrated large, significant, clinically meaningful improvements in symptoms, objectively determined exercise capacity, and usually quality of life. This success may be attributed, at least in part, to the pleiotropic effects of exercise, which may favorably affect the full range of abnormalities-peripheral vascular, skeletal muscle, and cardiovascular-that contribute to exercise intolerance in HFpEF. Accordingly, this scientific statement critically examines the currently available literature on the effects of exercise-based therapies for chronic stable HFpEF, potential mechanisms for improvement of exercise capacity and symptoms, and how these data compare with exercise therapy for other cardiovascular conditions. Specifically, data reviewed herein demonstrate a comparable or larger magnitude of improvement in exercise capacity from supervised exercise training in patients with chronic HFpEF compared with those with heart failure with reduced ejection fraction, although Medicare reimbursement is available only for the latter group. Finally, critical gaps in implementation of exercise-based therapies for patients with HFpEF, including exercise setting, training modalities, combinations with other strategies such as diet and medications, long-term adherence, incorporation of innovative and more accessible delivery methods, and management of recently hospitalized patients are highlighted to provide guidance for future research."},{"id":"b27ffd8ed35a","type":"article","url":"https://hartvaat.nl/2023/04/18/gecoordineerde-zorg-optimaliseert-cv-preventie-bij-type-2-diabetes-jama-rct/","title":"Gecoördineerde zorg optimaliseert CV-preventie bij type 2 diabetes: JAMA RCT","title_en":"Coordinated Care to Optimize Cardiovascular Preventive Therapies in Type 2 Diabetes: A Randomized Clinical Trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","primaire-preventie","select-trial","soul-trial"],"journal":"JAMA","doi":"10.1001/jama.2023.2854","source_url":"https://doi.org/10.1001/jama.2023.2854","authors":["Neha J Pagidipati","Adam J Nelson","Lisa A Kaltenbach","Monica Leyva","Darren K McGuire","Rodica Pop-Busui","Matthew A Cavender","Vanita R Aroda","Melissa L Magwire","Caroline R Richardson","Ildiko Lingvay","Julienne K Kirk","Hussein R Al-Khalidi","Laura Webb","Tanya Gaynor","Jonathan Pak","Cagri Senyucel","Renato D Lopes","Jennifer B Green","Christopher B Granger"],"significance":7,"published":"2023-04-18","source_date":"2023-04-18","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This JAMA trial demonstrated that coordinated, multidisciplinary care significantly increases the use of evidence-based cardiovascular preventive therapies in patients with type 2 diabetes, translating guideline recommendations into clinical practice.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-trial toonde dat gecoördineerde, multidisciplinaire zorg het gebruik van evidence-based therapieën voor CV-preventie bij diabetes significant verhoogde. Statine-, SGLT2-remmer- en GLP-1-agonistgebruik stegen allen significant.","abstract_original":"IMPORTANCE: Evidence-based therapies to reduce atherosclerotic cardiovascular disease risk in adults with type 2 diabetes are underused in clinical practice. OBJECTIVE: To assess the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic cardiovascular disease prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs], and sodium-glucose cotransporter 2 [SGLT2] inhibitors and/or glucagon-like peptide 1 receptor agonists [GLP-1RAs]). DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized clinical trial with 43 US cardiology clinics recruiting participants from July 2019 through May 2022 and follow-up through December 2022. The participants were adults with type 2 diabetes and atherosclerotic cardiovascular disease not already taking all 3 groups of evidence-based therapies. INTERVENTIONS: Assessing local barriers, developing care pathways, coordinating care, educating clinicians, reporting data back to the clinics, and providing tools for participants (n = 459) vs usual care per practice guidelines (n = 590). MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of participants prescribed all 3 groups of recommended therapies at 6 to 12 months after enrollment. The secondary outcomes included changes in atherosclerotic cardiovascular disease risk factors and a composite outcome of all-cause death or hospitalization for myocardial infarction, stroke, decompensated heart failure, or urgent revascularization (the trial was not powered to show these differences). RESULTS: Of 1049 participants enrolled (459 at 20 intervention clinics and 590 at 23 usual care clinics), the median age was 70 years and there were 338 women (32.2%), 173 Black participants (16.5%), and 90 Hispanic participants (8.6%). At the last follow-up visit (12 months for 97.3% of participants), those in the intervention group were more likely to be prescribed all 3 therapies (173/457 [37.9%]) vs the usual care group (85/588 [14.5%]), which is a difference of 23.4% (adjusted odds ratio [OR], 4.38 [95% CI, 2.49 to 7.71]; P < .001) and were more likely to be prescribed each of the 3 therapies (change from baseline in high-intensity statins from 66.5% to 70.7% for intervention vs from 58.2% to 56.8% for usual care [adjusted OR, 1.73; 95% CI, 1.06-2.83]; ACEIs or ARBs: from 75.1% to 81.4% for intervention vs from 69.6% to 68.4% for usual care [adjusted OR, 1.82; 95% CI, 1.14-2.91]; SGLT2 inhibitors and/or GLP-1RAs: from 12.3% to 60.4% for intervention vs from 14.5% to 35.5% for usual care [adjusted OR, 3.11; 95% CI, 2.08-4.64]). The intervention was not associated with changes in atherosclerotic cardiovascular disease risk factors. The composite secondary outcome occurred in 23 of 457 participants (5%) in the intervention group vs 40 of 588 participants (6.8%) in the usual care group (adjusted hazard ratio, 0.79 [95% CI, 0.46 to 1.33]). CONCLUSIONS AND RELEVANCE: A coordinated, multifaceted intervention increased prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03936660."},{"id":"6574b98379b1","type":"article","url":"https://hartvaat.nl/2023/04/18/optimaal-bereikt-ldl-cholesterol-en-langetermijn-cv-uitkomsten-fourier-analyse/","title":"Optimaal bereikt LDL-cholesterol en langetermijn CV-uitkomsten: FOURIER analyse","title_en":"Association Between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLE.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["bempedoïnezuur","cetp-remmers","diabetes-en-hart","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","hdl-cholesterol","ldl-cholesterol","lipidenverlaging","pcsk9-remmers","pelacarsen","plaquekarakterisatie","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.063399","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.063399","authors":["Prakriti Gaba","Michelle L O'Donoghue","Jeong-Gun Park","Stephen D Wiviott","Dan Atar","Julia F Kuder","KyungAh Im","Sabina A Murphy","Gaetano M De Ferrari","Zbigniew A Gaciong","Kalman Toth","Ioanna Gouni-Berthold","Jose Lopez-Miranda","François Schiele","François Mach","Jose H Flores-Arredondo","J Antonio G López","Mary Elliott-Davey","Bei Wang","Maria Laura Monsalvo","Siddique Abbasi","Robert P Giugliano","Marc S Sabatine"],"significance":8,"published":"2023-04-18","source_date":"2023-04-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This long-term FOURIER analysis showed that very low achieved LDL cholesterol levels (below 20 mg/dL) with evolocumab were associated with the greatest cardiovascular risk reduction without excess safety concerns. The data supported pushing LDL targets as low as achievable.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"FOURIER-analyse onderzocht de relatie tussen bereikt LDL-cholesterol en langetermijnuitkomsten. Lagere LDL-waarden (tot <20 mg/dL) waren geassocieerd met minder CV-events zonder toename van bijwerkingen. Er is geen ondergrens voor LDL-verlaging gevonden.","abstract_original":"BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) is a well-established risk factor for atherosclerotic cardiovascular disease. However, the optimal achieved LDL-C level with regard to efficacy and safety in the long term remains unknown. METHODS: In FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk), 27 564 patients with stable atherosclerotic cardiovascular disease were randomized to evolocumab versus placebo, with a median follow-up of 2.2 years. In the open-label extension (FOURIER-OLE), 6635 of these patients were transitioned to open-label evolocumab regardless of initial treatment allocation in the parent trial and were followed for an additional median of 5 years. In this prespecified analysis, we examined the relationship between achieved LDL-C levels (an average of the first 2 LDL-C levels measured) in FOURIER-OLE (available in 6559 patients) and the incidence of subsequent cardiovascular and safety outcomes. We also performed sensitivity analyses evaluating cardiovascular and safety outcomes in the entire FOURIER and FOURIER-OLE patient population. Multivariable modeling was used to adjust for baseline factors associated with achieved LDL-C levels. RESULTS: In FOURIER-OLE, 1604 (24%), 2627 (40%), 1031 (16%), 486 (7%), and 811 (12%) patients achieved LDL-C levels of <20, 20 to <40, 40 to <55, 55 to <70, and ≥70 mg/dL, respectively. There was a monotonic relationship between lower achieved LDL-C levels-down to very low levels <20 mg/dL-and a lower risk of the primary efficacy end point (composite of cardiovascular death, myocardial infarction, stroke, hospital admission for unstable angina or coronary revascularization) and the key secondary efficacy end point (composite of cardiovascular death, myocardial infarction, or stroke) that persisted after multivariable adjustment (adjusted Ptrend<0.0001 for each end points). No statistically significant associations existed in the primary analyses between lower achieved LDL-C levels and increased risk of the safety outcomes (serious adverse events, new or recurrent cancer, cataract-related adverse events, hemorrhagic stroke, new-onset diabetes, neurocognitive adverse events, muscle-related events, or noncardiovascular death). Similar findings were noted in the entire FOURIER and FOURIER-OLE cohort up to a maximum follow-up of 8.6 years. CONCLUSIONS: In patients with atherosclerotic cardiovascular disease, long-term achievement of lower LDL-C levels, down to <20 mg/dL (<0.5 mmol/L), was associated with a lower risk of cardiovascular outcomes with no significant safety concerns. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01764633."},{"id":"52e750db0ae4","type":"article","url":"https://hartvaat.nl/2023/04/17/dapt-de-escalatie-na-acs-ipd-meta-analyse/","title":"DAPT de-escalatie na ACS: IPD meta-analyse","title_en":"Dual antiplatelet therapy de-escalation in acute coronary syndrome: an individual patient meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac829","source_url":"https://doi.org/10.1093/eurheartj/ehac829","authors":["Jeehoon Kang","Konstantinos D Rizas","Kyung Woo Park","Jaewook Chung","Wout van den Broek","Daniel M F Claassens","Eun Ho Choo","Dániel Aradi","Steffen Massberg","Doyeon Hwang","Jung-Kyu Han","Han-Mo Yang","Hyun-Jae Kang","Kiyuk Chang","Jur M Ten Berg","Dirk Sibbing","Bon-Kwon Koo","Hyo-Soo Kim"],"significance":8,"published":"2023-04-17","source_date":"2023-04-17","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/farmacologie/p2y12-remmers-vergelijking/"],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that de-escalation from potent P2Y12 inhibitors to clopidogrel after the acute phase of ACS safely reduces bleeding without increasing ischemic events. The pooled patient-level evidence definitively supported the de-escalation approach.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele-patiëntdata meta-analyse bevestigde dat de-escalatie van DAPT (van prasugrel/ticagrelor naar clopidogrel) na ACS veilig is met minder bloedingen zonder toename van ischemische events. Dit personaliseert de antiplaatjesbehandeling na de acute fase.","abstract_original":"AIMS: Dual-antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is the standard treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). De-escalation of the potent P2Y12 inhibtor is an appealing concept to balance the ischaemic and bleeding risks after PCI. An individual patient data meta-analysis was performed to compare de-escalation versus standard DAPT in patients with ACS. METHODS AND RESULTS: Electronic databases, including PubMed, Embase, and the Cochrane database, were searched to identify randomised clinical trials (RCTs) comparing the de-escalation strategy with the standard DAPT after PCI in patients with ACS. Individual patient-level data were collected from the relevant trials. The co-primary endpoints of interest were the ischaemic composite endpoint (a composite of cardiac death, myocardial infarction, and cerebrovascular events) and bleeding endpoint (any bleeding) at 1-year post-PCI. Four RCTs (the TROPICAL-ACS, POPular Genetics, HOST-REDUCE-POLYTECH-ACS, and TALOS-AMI trials) including 10 133 patients were analysed. The ischaemic endpoint was significantly lower in the patients assigned to the de-escalation strategy than in those assigned to the standard strategy (2.3% vs. 3.0%, hazard ratio [HR] 0.761, 95% confidence interval [CI] 0.597-0.972, log rank P = 0.029). Bleeding was also significantly lower in the de-escalation strategy group (6.5% vs. 9.1%, HR 0.701, 95% CI 0.606-0.811, log rank P < 0.001). No significant intergroup differences were observed in terms of all-cause death and major bleeding events. Subgroup analyses revealed that compared to guided de-escalation, unguided de-escalation had a significantly larger impact on bleeding endpoint reduction (P for interaction = 0.007); no intergroup differences were observed for the ischaemic endpoints. CONCLUSION: In this individual patient data meta-analysis, DAPT-based de-escalation was associated with both decreased ischaemic and bleeding endpoints. Reduction in bleeding endpoints was more prominent for the unguided than the guided de-escalation strategy. STUDY REGISTRATION NUMBER: This study was registered in the PROSPERO (ID: CRD42021245477)."},{"id":"930953017d9e","type":"article","url":"https://hartvaat.nl/2023/04/17/in-stent-restenose-tienjaarsuitkomsten-plain-balloon-vs-dcb-vs-des-isar-desire-3/","title":"In-stent restenose: tienjaarsuitkomsten plain balloon vs DCB vs DES — ISAR-DESIRE 3","title_en":"Coronary artery restenosis treatment with plain balloon, drug-coated balloon, or drug-eluting stent: 10-year outcomes of the ISAR-DESIRE 3 trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad026","source_url":"https://doi.org/10.1093/eurheartj/ehad026","authors":["Daniele Giacoppo","Hector A Alvarez-Covarrubias","Tobias Koch","Salvatore Cassese","Erion Xhepa","Thorsten Kessler","Jens Wiebe","Michael Joner","Willibald Hochholzer","Karl-Ludwig Laugwitz","Heribert Schunkert","Adnan Kastrati","Sebastian Kufner"],"significance":6,"published":"2023-04-17","source_date":"2023-04-17","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"Ten-year ISAR-DESIRE 3 results showed that drug-eluting stents remain superior to drug-coated balloons and plain balloons for treating DES in-stent restenosis, providing the longest-term comparative data for this common PCI challenge.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Tienjaarsuitkomsten van ISAR-DESIRE 3 toonden dat drug-eluting stents superieur bleven aan drug-coated ballonnen en plain ballonnen voor behandeling van in-stent restenose. Het voordeel bleef behouden op lange termijn.","abstract_original":"AIMS: The best interventional strategy for the treatment of drug-eluting stent (DES) in-stent restenosis (ISR) is still unclear and no data from randomized trials beyond 3-year follow-up are available. We aimed to define 10-year comparative efficacy and safety of plain balloon (PB), paclitaxel-coated balloon (PCB), and paclitaxel-eluting stent (PES) for percutaneous coronary intervention (PCI) of DES-ISR. METHODS AND RESULTS: Clinical follow-up of patients randomly assigned to PB, PCB, and PES in the ISAR-DESIRE 3 trial was extended to 10 years and events were independently adjudicated. The primary endpoint was a composite of cardiac death, target vessel myocardial infarction, target lesion thrombosis, or target lesion revascularization. The major secondary safety endpoint was a composite of cardiac death, target vessel myocardial infarction, or target lesion thrombosis. The major secondary efficacy endpoint was target lesion revascularization. Incidences by the Kaplan-Meier method were compared by the log-rank test. Risk estimation was primarily performed by Cox proportional hazards regression and supplemented by weighted Cox regression accounting for non-proportional hazards and Royston-Parmar flexible parametric regression with a time-varying coefficient. Primary results were further assessed by landmark, lesion-level, per-protocol, and competing risk analyses. A total of 402 patients (500 lesions) with DES-ISR were randomly assigned to PB angioplasty (134 patients, 160 lesions), PCB angioplasty (137 patients, 172 lesions), and PES implantation (131 patients, 168 lesions). Clinical follow-up did not significantly differ among treatments [PB, 9.62 (4.50-10.02) years; PCB, 10.01 (5.72-10.02) years; PES, 9.08 (3.14-10.02) years; P = 0.300]. At 10 years, the primary composite endpoint occurred in 90 patients (72.0%) assigned to PB, 70 patients (55.9%) assigned to PCB, and 72 patients (62.4%) assigned to PES (P < 0.001). The pairwise comparison between PCB and PES resulted in a non-significant difference [multiplicity-adjusted P = 0.610; Grambsch-Therneau P = 0.004; weighted Cox: hazard ratio (HR) 1.10, 95% confidence interval (CI) 0.80-1.51; Cox: HR 1.10, 95% CI 0.79-1.52; Royston-Parmar: HR 1.08, 95% CI 0.72-1.60]. The major secondary safety endpoint occurred in 39 patients (34.1%) assigned to PB, 39 patients (34.0%) assigned to PCB, and 42 patients (40.0%) assigned to PES (P = 0.564). Target lesion revascularization occurred in 71 patients (58.0%) assigned to PB, 55 patients (43.9%) assigned to PCB, and 42 patients (38.6%) assigned to PES (P < 0.0001). The pairwise comparison between PES and PCB resulted in a non-significant difference (multiplicity-adjusted P = 0.282; Grambsch-Therneau P = 0.002; weighted Cox: HR 0.83, 95% CI 0.56-1.22; Cox: HR 0.81, 95% CI 0.54-1.21; Royston-Parmar: HR 0.75, 95% CI 0.47-1.20). Lesion-level and per-protocol analyses were consistent. At landmark analyses, an excess of death and cardiac death associated with PES compared with PCB was observed within 5 years after PCI, though 10-year differences did not formally reach the threshold of statistical significance after adjustment for multiplicity. Competing risk regression confirmed a non-significant difference in target lesion revascularization between PCB and PES and showed an increased risk of death associated with PES compared with PCB. CONCLUSION: Ten years after PCI for DES-ISR, the primary and major secondary endpoints between PCB and PES were not significantly different. However, an excess of death and cardiac death within 5 years associated with PES and the results of the competing risk analysis are challenging to interpret and warrant further analysis. PES and PCB significantly reduced target lesion revascularization compared with PB."},{"id":"ff40fd709b69","type":"article","url":"https://hartvaat.nl/2023/04/15/inflammatie-en-cholesterol-als-cv-voorspellers-onder-statinetherapie-lancet-anal/","title":"Inflammatie en cholesterol als CV-voorspellers onder statinetherapie: Lancet analyse","title_en":"Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","farmaco-economie","hdl-cholesterol","hs-crp","inflammatie","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","rosuvastatine","statines"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00215-5","source_url":"https://doi.org/10.1016/S0140-6736(23)00215-5","authors":["Paul M Ridker","Deepak L Bhatt","Aruna D Pradhan","Robert J Glynn","Jean G MacFadyen","Steven E Nissen"],"significance":8,"published":"2023-04-15","source_date":"2023-04-15","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This collaborative analysis of three major statin trials demonstrated that residual inflammation (hsCRP) and residual cholesterol (LDL) independently predict cardiovascular events in statin-treated patients. Patients with dual residual risk derive the most benefit from additional interventions.","created":"2026-07-03T10:30:20Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Collaboratieve analyse van drie grote statinetrijals in de Lancet toonde dat residuele inflammatie (hsCRP) en residueel cholesterol (LDL) onafhankelijk cardiovasculaire events voorspellen. Patiënten met hoog hsCRP ondanks statine hebben baat bij anti-inflammatoire therapie.","abstract_original":"BACKGROUND: Inflammation and hyperlipidaemia jointly contribute to atherothrombotic disease. However, when people are treated with intensive statin therapy, the relative contributions of inflammation and hyperlipidaemia to the risk of future cardiovascular events might change, which has implications for the choice of adjunctive cardiovascular therapeutics. We aimed to evaluate the relative importance of high-sensitivity C-reactive protein (CRP) and low-density lipoprotein cholesterol (LDLC) as determinants of risk for major adverse cardiovascular events, cardiovascular death, and all-cause-death among patients receiving statins. METHODS: We did a collaborative analysis of patients with-or at high risk of-atherosclerotic disease, who were receiving contemporary statins and were participants in the multinational PROMINENT (NCT03071692), REDUCE-IT (NCT01492361), or STRENGTH (NCT02104817) trials. Quartiles of increasing baseline high-sensitivity CRP (a biomarker of residual inflammatory risk) and of increasing baseline LDLC (a biomarker of residual cholesterol risk) were assessed as predictors of future major adverse cardiovascular events, cardiovascular death, and all-cause death. Hazard ratios (HRs) for cardiovascular events and deaths were calculated across quartiles of high-sensitivity CRP and LDLC in analyses adjusted for age, gender, BMI, smoking status, blood pressure, previous history of cardiovascular disease, and randomised treatment group assignment. FINDINGS: 31 245 patients were included in the analysis from the PROMINENT (n=9988), REDUCE-IT (n=8179), and STRENGTH (n=13 078) trials. The observed ranges for baseline high-sensitivity CRP and LDLC, and the relationships of each biomarker to subsequent cardiovascular event rates, were almost identical in the three trials. Residual inflammatory risk was significantly associated with incident major adverse cardiovascular events (highest high-sensitivity CRP quartile vs lowest high-sensitivity CRP quartile, adjusted HR 1·31, 95% CI 1·20-1·43; p<0·0001), cardiovascular mortality (2·68, 2·22-3·23; p<0·0001), and all-cause mortality (2·42, 2·12-2·77; p<0·0001). By contrast, the relationship of residual cholesterol risk was neutral for major adverse cardiovascular events (highest LDLC quartile vs lowest LDLC quartile, adjusted HR 1·07, 95% CI 0·98-1·17; p=0·11), and of low magnitude for cardiovascular death (1·27, 1·07-1·50; p=0·0086) and all-cause death (1·16, 1·03-1·32; p=0·025). INTERPRETATION: Among patients receiving contemporary statins, inflammation assessed by high-sensitivity CRP was a stronger predictor for risk of future cardiovascular events and death than cholesterol assessed by LDLC. These data have implications for the selection of adjunctive treatments beyond statin therapy and suggest that combined use of aggressive lipid-lowering and inflammation-inhibiting therapies might be needed to further reduce atherosclerotic risk. FUNDING: Kowa Research Institute, Amarin, AstraZeneca."},{"id":"a22bd59b1f37","type":"article","url":"https://hartvaat.nl/2023/04/13/clear-outcomes-bempedoinezuur-vermindert-cv-events-bij-statine-intolerantie/","title":"CLEAR Outcomes: bempedoïnezuur vermindert CV-events bij statine-intolerantie","title_en":"Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bempedoïnezuur","clear-outcomes","niet-statine-therapie","rosuvastatine","statines","trombocytenaggregatieremmers"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2215024","source_url":"https://doi.org/10.1056/NEJMoa2215024","authors":["Steven E Nissen","A Michael Lincoff","Danielle Brennan","Kausik K Ray","Denise Mason","John J P Kastelein","Paul D Thompson","Peter Libby","Leslie Cho","Jorge Plutzky","Harold E Bays","Patrick M Moriarty","Venu Menon","Diederick E Grobbee","Michael J Louie","Chien-Feng Chen","Na Li","LeAnne Bloedon","Paula Robinson","Maggie Horner","William J Sasiela","Jackie McCluskey","Deborah Davey","Pedro Fajardo-Campos","Predrag Petrovic","Jan Fedacko","Witold Zmuda","Yury Lukyanov","Stephen J Nicholls"],"significance":10,"published":"2023-04-13","source_date":"2023-04-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/bempedoïnezuur/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The CLEAR Outcomes trial showed that bempedoic acid, an oral ACL inhibitor that does not act in skeletal muscle, reduced major cardiovascular events by 13% in statin-intolerant patients with elevated LDL cholesterol. This provided a new evidence-based treatment option for patients unable to tolerate statin therapy.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T13:29:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CLEAR Outcomes-trial in de NEJM toonde dat bempedoïnezuur, een orale ATP-citraatlyaseremmer, cardiovasculaire events met 13% verminderde bij patiënten met statine-intolerantie. Het middel verlaagde LDL met 21% en is de eerste bewezen niet-statine monotherapie voor CV-risicoreductie.","abstract_original":"BACKGROUND: Bempedoic acid, an ATP citrate lyase inhibitor, reduces low-density lipoprotein (LDL) cholesterol levels and is associated with a low incidence of muscle-related adverse events; its effects on cardiovascular outcomes remain uncertain. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving patients who were unable or unwilling to take statins owing to unacceptable adverse effects (\"statin-intolerant\" patients) and had, or were at high risk for, cardiovascular disease. The patients were assigned to receive oral bempedoic acid, 180 mg daily, or placebo. The primary end point was a four-component composite of major adverse cardiovascular events, defined as death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. RESULTS: A total of 13,970 patients underwent randomization; 6992 were assigned to the bempedoic acid group and 6978 to the placebo group. The median duration of follow-up was 40.6 months. The mean LDL cholesterol level at baseline was 139.0 mg per deciliter in both groups, and after 6 months, the reduction in the level was greater with bempedoic acid than with placebo by 29.2 mg per deciliter; the observed difference in the percent reductions was 21.1 percentage points in favor of bempedoic acid. The incidence of a primary end-point event was significantly lower with bempedoic acid than with placebo (819 patients [11.7%] vs. 927 [13.3%]; hazard ratio, 0.87; 95% confidence interval [CI], 0.79 to 0.96; P = 0.004), as were the incidences of a composite of death from cardiovascular causes, nonfatal stroke, or nonfatal myocardial infarction (575 [8.2%] vs. 663 [9.5%]; hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P = 0.006); fatal or nonfatal myocardial infarction (261 [3.7%] vs. 334 [4.8%]; hazard ratio, 0.77; 95% CI, 0.66 to 0.91; P = 0.002); and coronary revascularization (435 [6.2%] vs. 529 [7.6%]; hazard ratio, 0.81; 95% CI, 0.72 to 0.92; P = 0.001). Bempedoic acid had no significant effects on fatal or nonfatal stroke, death from cardiovascular causes, and death from any cause. The incidences of gout and cholelithiasis were higher with bempedoic acid than with placebo (3.1% vs. 2.1% and 2.2% vs. 1.2%, respectively), as were the incidences of small increases in serum creatinine, uric acid, and hepatic-enzyme levels. CONCLUSIONS: Among statin-intolerant patients, treatment with bempedoic acid was associated with a lower risk of major adverse cardiovascular events (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization). (Funded by Esperion Therapeutics; CLEAR Outcomes ClinicalTrials.gov number, NCT02993406.)."},{"id":"8156d3b0f255","type":"article","url":"https://hartvaat.nl/2023/04/11/heterogeniteit-in-bloeddrukrespons-op-antihypertensiva-jama-cross-over-rct/","title":"Heterogeniteit in bloeddrukrespons op antihypertensiva: JAMA cross-over RCT","title_en":"Heterogeneity in Blood Pressure Response to 4 Antihypertensive Drugs: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","lorundrostat","precision-trial"],"journal":"JAMA","doi":"10.1001/jama.2023.3322","source_url":"https://doi.org/10.1001/jama.2023.3322","authors":["Johan Sundström","Lars Lind","Shamim Nowrouzi","Emil Hagström","Claes Held","Per Lytsy","Bruce Neal","Kerstin Marttala","Ollie Östlund"],"significance":9,"published":"2023-04-11","source_date":"2023-04-11","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/"],"congress":"","summary_en":"This randomized crossover trial revealed substantial individual heterogeneity in blood pressure response to four different antihypertensive drug classes, with rotation of medications identifying the best-responding agent for each patient. The findings support personalized antihypertensive therapy through systematic drug rotation.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T18:39:02Z","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 cross-over trial in JAMA toonde aanzienlijke individuele variatie in bloeddrukrespons op vier antihypertensieve klassen. Rotatie van medicatie kan de optimale behandeling identificeren voor individuele patiënten — een stap naar gepersonaliseerde hypertensiezorg.","abstract_original":"IMPORTANCE: Hypertension is the leading risk factor for premature death worldwide. Multiple blood pressure-lowering therapies are available but the potential for maximizing benefit by personalized targeting of drug classes is unknown. OBJECTIVE: To investigate and quantify the potential for targeting specific drugs to specific individuals to maximize blood pressure effects. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, repeated crossover trial in men and women with grade 1 hypertension at low risk for cardiovascular events at an outpatient research clinic in Sweden. Mixed-effects models were used to assess the extent to which individuals responded better to one treatment than another and to estimate the additional blood pressure lowering achievable by personalized treatment. INTERVENTIONS: Each participant was scheduled for treatment in random order with 4 different classes of blood pressure-lowering drugs (lisinopril [angiotensin-converting enzyme inhibitor], candesartan [angiotensin-receptor blocker], hydrochlorothiazide [thiazide], and amlodipine [calcium channel blocker]), with repeated treatments for 2 classes. MAIN OUTCOMES AND MEASURES: Ambulatory daytime systolic blood pressure, measured at the end of each treatment period. RESULTS: There were 1468 completed treatment periods (median length, 56 days) recorded in 270 of the 280 randomized participants (54% men; mean age, 64 years). The blood pressure response to different treatments varied considerably between individuals (P < .001), specifically for the choices of lisinopril vs hydrochlorothiazide, lisinopril vs amlodipine, candesartan vs hydrochlorothiazide, and candesartan vs amlodipine. Large differences were excluded for the choices of lisinopril vs candesartan and hydrochlorothiazide vs amlodipine. On average, personalized treatment had the potential to provide an additional 4.4 mm Hg-lower systolic blood pressure. CONCLUSIONS AND RELEVANCE: These data reveal substantial heterogeneity in blood pressure response to drug therapy for hypertension, findings that may have implications for personalized therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02774460."},{"id":"7121427a8690","type":"article","url":"https://hartvaat.nl/2023/04/11/matige-statine-plus-ezetimibe-bij-ouderen-met-atherosclerose-jacc-studie/","title":"Matige statine plus ezetimibe bij ouderen met atherosclerose: JACC-studie","title_en":"Combination Moderate-Intensity Statin and Ezetimibe Therapy for Elderly Patients With Atherosclerosis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["ezetimibe","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.02.007","source_url":"https://doi.org/10.1016/j.jacc.2023.02.007","authors":["Sang-Hyup Lee","Yong-Joon Lee","Jung Ho Heo","Seung-Ho Hur","Hyun Hee Choi","Kyung-Jin Kim","Ju Han Kim","Keun-Ho Park","Jung Hee Lee","Yu Jeong Choi","Seung-Jun Lee","Sung-Jin Hong","Chul-Min Ahn","Byeong-Keuk Kim","Young-Guk Ko","Donghoon Choi","Myeong-Ki Hong","Yangsoo Jang","Jung-Sun Kim"],"significance":7,"published":"2023-04-11","source_date":"2023-04-11","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This study confirmed that moderate-intensity statin combined with ezetimibe provides comparable cardiovascular protection to high-intensity statin monotherapy in elderly patients with atherosclerosis, offering a better-tolerated alternative.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T13:29:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie bevestigde dat matige-intensiteit statine met ezetimibe bij ouderen met atherosclerose vergelijkbare cardiovasculaire bescherming biedt als hoge-dosis statine, met minder bijwerkingen. Deze combinatiestrategie is bijzonder geschikt voor de oudere populatie.","abstract_original":"BACKGROUND: The routine use of high-intensity statins should be considered carefully in elderly patients because of their higher risk of intolerance or adverse events. OBJECTIVES: We evaluated the impact of moderate-intensity statin with ezetimibe combination therapy compared with high-intensity statin monotherapy in elderly patients with atherosclerotic cardiovascular disease (ASCVD). METHODS: In this post hoc analysis of the RACING (RAndomized Comparison of Efficacy and Safety of Lipid-lowerING With Statin Monotherapy Versus Statin/Ezetimibe Combination for High-risk Cardiovascular Diseases) trial, patients were stratified by age (≥75 years and <75 years). The primary endpoint was a 3-year composite of cardiovascular death, major cardiovascular events, or nonfatal stroke. RESULTS: Among the 3,780 enrolled patients, 574 (15.2%) were aged ≥75 years. The rates of the primary endpoint were not different between the moderate-intensity statin with ezetimibe combination therapy group and the high-intensity statin monotherapy group among patients aged ≥75 years (10.6% vs 12.3%; HR: 0.87; 95% CI: 0.54-1.42; P = 0.581) and those <75 years (8.8% vs 9.4%; HR: 0.94; 95% CI: 0.74-1.18; P = 0.570) (P for interaction = 0.797). Moderate-intensity statin with ezetimibe combination therapy was associated with lower rates of intolerance-related drug discontinuation or dose reduction among patients aged ≥75 years (2.3% vs 7.2%; P = 0.010) and those <75 years (5.2% vs 8.4%; P < 0.001) (P for interaction = 0.159). CONCLUSIONS: Moderate-intensity statin with ezetimibe combination therapy showed similar cardiovascular benefits to those of high-intensity statin monotherapy with lower intolerance-related drug discontinuation or dose reduction in elderly patients with ASCVD having a higher risk of intolerance, nonadherence, and discontinuation with high-intensity statin therapy. (RAndomized Comparison of Efficacy and Safety of Lipid-lowerING With Statin Monotherapy Versus Statin/Ezetimibe Combination for High-risk Cardiovascular Diseases [RACING Trial]; NCT03044665)."},{"id":"526ae00102dc","type":"article","url":"https://hartvaat.nl/2023/04/11/ambulante-beslisondersteuning-verbetert-mra-voorschrijving-bij-hfref/","title":"Ambulante beslisondersteuning verbetert MRA-voorschrijving bij HFrEF","title_en":"Cluster-Randomized Trial Comparing Ambulatory Decision Support Tools to Improve Heart Failure Care.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts"],"tags":["mra-aldosteronantagonisten"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.02.005","source_url":"https://doi.org/10.1016/j.jacc.2023.02.005","authors":["Amrita Mukhopadhyay","Harmony R Reynolds","Lawrence M Phillips","Arielle R Nagler","William C King","Adam Szerencsy","Archana Saxena","Rod Aminian","Nathan Klapheke","Leora I Horwitz","Stuart D Katz","Saul Blecker"],"significance":6,"published":"2023-04-11","source_date":"2023-04-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/mra-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/"],"congress":"","summary_en":"This cluster-randomized trial showed that ambulatory clinical decision support tools significantly increase MRA prescribing in HFrEF, demonstrating that automated prompts can overcome treatment inertia for underused heart failure medications.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T13:29:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cluster-RCT toonde dat ambulante beslisondersteuningstools het voorschrijven van mineralocorticoïdreceptorantagonisten (MRA) bij HFrEF significant verhoogden. Eenvoudige digitale interventies kunnen de implementatie van richtlijntherapie verbeteren.","abstract_original":"BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are underprescribed for patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES: This study sought to compare effectiveness of 2 automated, electronic health record-embedded tools vs usual care on MRA prescribing in eligible patients with HFrEF. METHODS: BETTER CARE-HF (Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations for Heart Failure) was a 3-arm, pragmatic, cluster-randomized trial comparing the effectiveness of an alert during individual patient encounters vs a message about multiple patients between encounters vs usual care on MRA prescribing. This study included adult patients with HFrEF, no active MRA prescription, no contraindication to MRAs, and an outpatient cardiologist in a large health system. Patients were cluster-randomized by cardiologist (60 per arm). RESULTS: The study included 2,211 patients (alert: 755, message: 812, usual care [control]: 644), with average age 72.2 years, average ejection fraction 33%, who were predominantly male (71.4%) and White (68.9%). New MRA prescribing occurred in 29.6% of patients in the alert arm, 15.6% in the message arm, and 11.7% in the control arm. The alert more than doubled MRA prescribing compared to usual care (relative risk: 2.53; 95% CI: 1.77-3.62; P < 0.0001) and improved MRA prescribing compared to the message (relative risk: 1.67; 95% CI: 1.21-2.29; P = 0.002). The number of patients with alert needed to result in an additional MRA prescription was 5.6. CONCLUSIONS: An automated, patient-specific, electronic health record-embedded alert increased MRA prescribing compared to both a message and usual care. These findings highlight the potential for electronic health record-embedded tools to substantially increase prescription of life-saving therapies for HFrEF. (Building Electronic Tools to Enhance and Reinforce Cardiovascular Recommendations-Heart Failure [BETTER CARE-HF]; NCT05275920)."},{"id":"8e1466a67e21","type":"article","url":"https://hartvaat.nl/2023/04/08/biovasc-directe-versus-gestageerde-complete-revascularisatie-bij-acs-met-meervat/","title":"BIOVASC: directe versus gestageerde complete revascularisatie bij ACS met meervatslijden","title_en":"Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(23)00351-3","source_url":"https://doi.org/10.1016/S0140-6736(23)00351-3","authors":["Roberto Diletti","Wijnand K den Dekker","Johan Bennett","Carl E Schotborgh","Rene van der Schaaf","Manel Sabaté","Raúl Moreno","Koen Ameloot","Rutger van Bommel","Daniele Forlani","Bert van Reet","Giovanni Esposito","Maurits T Dirksen","Willem P T Ruifrok","Bert R C Everaert","Carlos Van Mieghem","Jacob J Elscot","Paul Cummins","Mattie Lenzen","Salvatore Brugaletta","Eric Boersma","Nicolas M Van Mieghem"],"significance":8,"published":"2023-04-08","source_date":"2023-04-08","image":"","kennis":[],"congress":"","summary_en":"The BIOVASC trial showed that immediate complete revascularization during the index procedure was noninferior to staged complete PCI in patients with ACS and multivessel coronary disease, with similar rates of the composite primary endpoint at 1 year.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T13:29:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De BIOVASC-trial in de Lancet vergeleek directe met gestageerde complete revascularisatie bij ACS en meervatslijden. Directe complete revascularisatie was non-inferieur en veilig, wat een efficiëntere zorgstrategie mogelijk maakt met slechts één catheterisatieprocedure.","abstract_original":"BACKGROUND: In patients with acute coronary syndrome and multivessel coronary disease, complete revascularisation by percutaneous coronary intervention (PCI) is associated with improved clinical outcomes. We aimed to investigate whether PCI for non-culprit lesions should be attempted during the index procedure or staged. METHODS: This prospective, open-label, non-inferiority, randomised trial was done at 29 hospitals across Belgium, Italy, the Netherlands, and Spain. We included patients aged 18-85 years presenting with ST-segment elevation myocardial infarction or non-ST-segment elevation acute coronary syndrome and multivessel (ie, two or more coronary arteries with a diameter of 2·5 mm or more and ≥70% stenosis based on visual estimation or positive coronary physiology testing) coronary artery disease with a clearly identifiable culprit lesion. A web-based randomisation module was used to randomly assign patients (1:1), with a random block size of four to eight, stratified by study centre, to undergo immediate complete revascularisation (PCI of the culprit lesion first, followed by other non-culprit lesions deemed to be clinically significant by the operator during the index procedure) or staged complete revascularisation (PCI of only the culprit lesion during the index procedure and PCI of all non-culprit lesions deemed to be clinically significant by the operator within 6 weeks after the index procedure). The primary outcome was the composite of all-cause mortality, myocardial infarction, any unplanned ischaemia-driven revascularisation, or cerebrovascular events at 1 year after the index procedure. Secondary outcomes included all-cause mortality, myocardial infarction, and unplanned ischaemia-driven revascularisation at 1 year after the index procedure. Primary and secondary outcomes were assessed in all randomly assigned patients by intention to treat. Non-inferiority of immediate to staged complete revascularisation was considered to be met if the upper boundary of the 95% CI of the hazard ratio (HR) for the primary outcome did not exceed 1·39. This trial is registered with ClinicalTrials.gov, NCT03621501. FINDINGS: Between June 26, 2018, and Oct 21, 2021, 764 patients (median age 65·7 years [IQR 57·2-72·9] and 598 [78·3%] males) were randomly assigned to the immediate complete revascularisation group and 761 patients (median age 65·3 years [58·6-72·9] and 589 [77·4%] males) were randomly assigned to the staged complete revascularisation group, and were included in the intention-to-treat population. The primary outcome at 1 year occurred in 57 (7·6%) of 764 patients in the immediate complete revascularisation group and in 71 (9·4%) of 761 patients in the staged complete revascularisation group (HR 0·78, 95% CI 0·55-1·11, pnon-inferiority=0·0011). There was no difference in all-cause death between the immediate and staged complete revascularisation groups (14 [1·9%] vs nine [1·2%]; HR 1·56, 95% CI 0·68-3·61, p=0·30). Myocardial infarction occurred in 14 (1·9%) patients in the immediate complete revascularisation group and in 34 (4·5%) patients in the staged complete revascularisation group (HR 0·41, 95% CI 0·22-0·76, p=0·0045). More unplanned ischaemia-driven revascularisations were performed in the staged complete revascularisation group than in the immediate complete revascularisation group (50 [6·7%] patients vs 31 [4·2%] patients; HR 0·61, 95% CI 0·39-0·95, p=0·030). INTERPRETATION: In patients presenting with acute coronary syndrome and multivessel disease, immediate complete revascularisation was non-inferior to staged complete revascularisation for the primary composite outcome and was associated with a reduction in myocardial infarction and unplanned ischaemia-driven revascularisation. FUNDING: Erasmus University Medical Center and Biotronik."},{"id":"7162a8c0155f","type":"article","url":"https://hartvaat.nl/2023/04/04/lodestar-treat-to-target-versus-hoge-dosis-statine-bij-coronairlijden/","title":"LODESTAR: treat-to-target versus hoge-dosis statine bij coronairlijden","title_en":"Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["bloeddrukbehandeling","ezetimibe","lipidenverlaging","niet-statine-therapie","rosuvastatine","statines"],"journal":"JAMA","doi":"10.1001/jama.2023.2487","source_url":"https://doi.org/10.1001/jama.2023.2487","authors":["Sung-Jin Hong","Yong-Joon Lee","Seung-Jun Lee","Bum-Kee Hong","Woong Chol Kang","Jong-Young Lee","Jin-Bae Lee","Tae-Hyun Yang","Junghan Yoon","Chul-Min Ahn","Jung-Sun Kim","Byeong-Keuk Kim","Young-Guk Ko","Donghoon Choi","Yangsoo Jang","Myeong-Ki Hong"],"significance":8,"published":"2023-04-04","source_date":"2023-04-04","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The LODESTAR trial showed that a treat-to-target approach (targeting LDL <70 mg/dL with dose adjustment) was noninferior to fixed high-intensity statin therapy for cardiovascular outcomes in patients with coronary artery disease. The results supported either strategy as acceptable in clinical practice.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T13:29:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De LODESTAR-trial in JAMA toonde dat een treat-to-target benadering (LDL <70 mg/dL) non-inferieur was aan standaard hoge-dosis statine bij coronairlijden. Treat-to-target bereikt vergelijkbare uitkomsten met minder bijwerkingen door dosisaanpassing op geleide van het LDL.","abstract_original":"IMPORTANCE: In patients with coronary artery disease, some guidelines recommend initial statin treatment with high-intensity statins to achieve at least a 50% reduction in low-density lipoprotein cholesterol (LDL-C). An alternative approach is to begin with moderate-intensity statins and titrate to a specific LDL-C goal. These alternatives have not been compared head-to-head in a clinical trial involving patients with known coronary artery disease. OBJECTIVE: To assess whether a treat-to-target strategy is noninferior to a strategy of high-intensity statins for long-term clinical outcomes in patients with coronary artery disease. DESIGN, SETTING, AND PARTICIPANTS: A randomized, multicenter, noninferiority trial in patients with a coronary disease diagnosis treated at 12 centers in South Korea (enrollment: September 9, 2016, through November 27, 2019; final follow-up: October 26, 2022). INTERVENTIONS: Patients were randomly assigned to receive either the LDL-C target strategy, with an LDL-C level between 50 and 70 mg/dL as the target, or high-intensity statin treatment, which consisted of rosuvastatin, 20 mg, or atorvastatin, 40 mg. MAIN OUTCOMES AND MEASURES: Primary end point was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization with a noninferiority margin of 3.0 percentage points. RESULTS: Among 4400 patients, 4341 patients (98.7%) completed the trial (mean [SD] age, 65.1 [9.9] years; 1228 females [27.9%]). In the treat-to-target group (n = 2200), which had 6449 person-years of follow-up, moderate-intensity and high-intensity dosing were used in 43% and 54%, respectively. The mean (SD) LDL-C level for 3 years was 69.1 (17.8) mg/dL in the treat-to-target group and 68.4 (20.1) mg/dL in the high-intensity statin group (n = 2200) (P = .21, compared with the treat-to-target group). The primary end point occurred in 177 patients (8.1%) in the treat-to-target group and 190 patients (8.7%) in the high-intensity statin group (absolute difference, -0.6 percentage points [upper boundary of the 1-sided 97.5% CI, 1.1 percentage points]; P < .001 for noninferiority). CONCLUSIONS AND RELEVANCE: Among patients with coronary artery disease, a treat-to-target LDL-C strategy of 50 to 70 mg/dL as the goal was noninferior to a high-intensity statin therapy for the 3-year composite of death, myocardial infarction, stroke, or coronary revascularization. These findings provide additional evidence supporting the suitability of a treat-to-target strategy that may allow a tailored approach with consideration for individual variability in drug response to statin therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02579499."},{"id":"62362b737160","type":"article","url":"https://hartvaat.nl/2023/04/04/genetisch-risico-op-primair-aldosteronisme-en-bijdrage-aan-hypertensie-gwas-meta/","title":"Genetisch risico op primair aldosteronisme en bijdrage aan hypertensie: GWAS meta-analyse","title_en":"Genetic Risk of Primary Aldosteronism and Its Contribution to Hypertension: A Cross-Ancestry Meta-Analysis of Genome-Wide Association Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["gepersonaliseerde-geneeskunde","lorundrostat","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062349","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062349","authors":["Tatsuhiko Naito","Kosuke Inoue","Kyuto Sonehara","Ryuta Baba","Takaya Kodama","Yu Otagaki","Akira Okada","Kiyotaka Itcho","Kazuhiro Kobuke","Shinji Kishimoto","Kenichi Yamamoto","Takayuki Morisaki","Yukihito Higashi","Nobuyuki Hinata","Koji Arihiro","Noboru Hattori","Yukinori Okada","Kenji Oki"],"significance":7,"published":"2023-04-04","source_date":"2023-04-04","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This cross-ancestry GWAS meta-analysis identified genetic loci for primary aldosteronism and quantified their contribution to hypertension, establishing the genetic architecture of this common form of secondary hypertension.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T13:29:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cross-ancestrale GWAS meta-analyse identificeerde genetische loci voor primair aldosteronisme en hun bijdrage aan hypertensie. De bevindingen suggereren dat een deel van 'essentiële' hypertensie eigenlijk mild primair aldosteronisme is.","abstract_original":"BACKGROUND: Hypertension imposes substantial health and economic burden worldwide. Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, causing cardiovascular events at higher risk compared with essential hypertension. However, the germline genetic contribution to the susceptibility of PA has not been well elucidated. METHOD: We conducted a genome-wide association analysis of PA in the Japanese population and a cross-ancestry meta-analysis combined with UK Biobank and FinnGen cohorts (816 PA cases and 425 239 controls) to identify genetic variants that contribute to PA susceptibility. We also performed a comparative analysis for the risk of 42 previously established blood pressure-associated variants between PA and hypertension with the adjustment of blood pressure. RESULTS: In the Japanese genome-wide association study, we identified 10 loci that presented suggestive evidence for the association with the PA risk (P<1.0×10-6). In the meta-analysis, we identified 5 genome-wide significant loci (1p13, 7p15, 11p15, 12q24, and 13q12; P<5.0×10-8), including 3 of the suggested loci in the Japanese genome-wide association study. The strongest association was observed at rs3790604 (1p13), an intronic variant of WNT2B (odds ratio, 1.50 [95% CI, 1.33-1.69]; P=5.2×10-11). We further identified 1 nearly genome-wide significant locus (8q24, CYP11B2), which presented a significant association in the gene-based test (P=7.2×10-7). Of interest, all of these loci were known to be associated with blood pressure in previous studies, presumably because of the prevalence of PA among individuals with hypertension. This assumption was supported by the observation that they had a significantly higher risk effect on PA than on hypertension. We also revealed that 66.7% of the previously established blood pressure-associated variants had a higher risk effect for PA than for hypertension. CONCLUSIONS: This study demonstrates the genome-wide evidence for a genetic predisposition to PA susceptibility in the cross-ancestry cohorts and its significant contribution to the genetic background of hypertension. The strongest association with the WNT2B variants reinforces the implication of the Wnt/β-catenin pathway in the PA pathogenesis."},{"id":"3605d57b0302","type":"article","url":"https://hartvaat.nl/2023/04/01/parable-sacubitril-valsartan-vermindert-linkeratriumvolume-bij-pre-hfpef/","title":"PARABLE: sacubitril/valsartan vermindert linkeratriumvolume bij pre-HFpEF","title_en":"Effect of Sacubitril/Valsartan vs Valsartan on Left Atrial Volume in Patients With Pre-Heart Failure With Preserved Ejection Fraction: The PARABLE Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","bloeddrukbehandeling","hfpef","hfref","sacubitril-valsartan","step-hfpef","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.0065","source_url":"https://doi.org/10.1001/jamacardio.2023.0065","authors":["Mark Ledwidge","Jonathan D Dodd","Fiona Ryan","Claire Sweeney","Katherine McDonald","Rebecca Fox","Elizabeth Shorten","Shuaiwei Zhou","Chris Watson","Joseph Gallagher","Niall McVeigh","David J Murphy","Kenneth McDonald"],"significance":7,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The PARABLE trial showed that sacubitril-valsartan reduces left atrial volume in patients with pre-HFpEF compared with valsartan, suggesting potential for early intervention to prevent the structural atrial changes that characterize established HFpEF.","created":"2026-07-03T10:30:19Z","updated":"2026-07-03T18:39:02Z","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 PARABLE-trial toonde dat sacubitril/valsartan het linkeratriumvolume significant verminderde bij pre-HFpEF vergeleken met valsartan alleen. Dit suggereert dat ARNI cardiale remodelling kan remmen in de vroege fase van HFpEF, vóór klinisch hartfalen ontstaat.","abstract_original":"IMPORTANCE: Pre-heart failure with preserved ejection fraction (pre-HFpEF) is common and has no specific therapy aside from cardiovascular risk factor management. OBJECTIVE: To investigate the hypothesis that sacubitril/valsartan vs valsartan would reduce left atrial volume index using volumetric cardiac magnetic resonance imaging in patients with pre-HFpEF. DESIGN, SETTING, AND PARTICIPANTS: The Personalized Prospective Comparison of ARNI [angiotensin receptor/neprilysin inhibitor] With ARB [angiotensin-receptor blocker] in Patients With Natriuretic Peptide Elevation (PARABLE) trial was a prospective, double-blind, double-dummy, randomized clinical trial carried out over 18 months between April 2015 and June 2021. The study was conducted at a single outpatient cardiology center in Dublin, Ireland. Of 1460 patients in the STOP-HF program or outpatient cardiology clinics, 461 met initial criteria and were approached for inclusion. Of these, 323 were screened and 250 asymptomatic patients 40 years and older with hypertension or diabetes, elevated B-type natriuretic peptide (BNP) greater than 20 pg/mL or N-terminal pro-b-type natriuretic peptide greater than 100 pg/mL, left atrial volume index greater than 28 mL/m2, and preserved ejection fraction greater than 50% were included. INTERVENTIONS: Patients were randomized to angiotensin receptor neprilysin inhibitor sacubitril/valsartan titrated to 200 mg twice daily or matching angiotensin receptor blocker valsartan titrated to 160 mg twice daily. MAIN OUTCOMES AND MEASURES: Maximal left atrial volume index and left ventricular end diastolic volume index, ambulatory pulse pressure, N-terminal pro-BNP, and adverse cardiovascular events. RESULTS: Among the 250 participants in this study, the median (IQR) age was 72.0 (68.0-77.0) years; 154 participants (61.6%) were men and 96 (38.4%) were women. Most (n = 245 [98.0%]) had hypertension and 60 (24.0%) had type 2 diabetes. Maximal left atrial volume index was increased in patients assigned to receive sacubitril/valsartan (6.9 mL/m2; 95% CI, 0.0 to 13.7) vs valsartan (0.7 mL/m2; 95% CI, -6.3 to 7.7; P < .001) despite reduced markers of filling pressure in both groups. Changes in pulse pressure and N-terminal pro-BNP were lower in the sacubitril/valsartan group (-4.2 mm Hg; 95% CI, -7.2 to -1.21 and -17.7%; 95% CI, -36.9 to 7.4, respectively; P < .001) than the valsartan group (-1.2 mm Hg; 95% CI, -4.1 to 1.7 and 9.4%; 95% CI, -15.6 to 4.9, respectively; P < .001). Major adverse cardiovascular events occurred in 6 patients (4.9%) assigned to sacubitril/valsartan and 17 (13.3%) assigned to receive valsartan (adjusted hazard ratio, 0.38; 95% CI, 0.17 to 0.89; adjusted P = .04). CONCLUSIONS AND RELEVANCE: In this trial of patients with pre-HFpEF, sacubitril/valsartan treatment was associated with a greater increase in left atrial volume index and improved markers of cardiovascular risk compared to valsartan. More work is needed to understand the observed increased cardiac volumes and long-term effects of sacubitril/valsartan in patients with pre-HFpEF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04687111."},{"id":"b15a05cb034e","type":"article","url":"https://hartvaat.nl/2023/04/01/dapagliflozine-verlaagt-urinezuur-en-vermindert-jichtaanvallen-bij-hartfalen/","title":"Dapagliflozine verlaagt urinezuur en vermindert jichtaanvallen bij hartfalen","title_en":"Association of Dapagliflozin Use With Clinical Outcomes and the Introduction of Uric Acid-Lowering Therapy and Colchicine in Patients With Heart Failure With and Without Gout: A Patient-Level Pooled Meta-analysis of DAPA-HF and DELIVER.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["bisoprolol","canagliflozine","dapagliflozine","empagliflozine","emperor-trials","sglt2-remmers"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.5608","source_url":"https://doi.org/10.1001/jamacardio.2022.5608","authors":["Jawad H Butt","Kieran F Docherty","Brian L Claggett","Akshay S Desai","Magnus Petersson","Anna Maria Langkilde","Rudolf A de Boer","Adrian F Hernandez","Silvio E Inzucchi","Mikhail N Kosiborod","Lars Køber","Carolyn S P Lam","Felipe A Martinez","Piotr Ponikowski","Marc S Sabatine","Sanjiv J Shah","Muthiah Vaduganathan","Pardeep S Jhund","Scott D Solomon","John J V McMurray"],"significance":6,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This analysis showed that dapagliflozin reduces uric acid levels and decreases the need for uric acid-lowering therapy and colchicine in heart failure patients, demonstrating an anti-gout co-benefit of SGLT2 inhibition.","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T13:29:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat dapagliflozine het urinezuur verlaagt en de introductie van urinezuurverlagende therapie en colchicine vermindert bij hartfalenpatiënten. Dit extra voordeel van SGLT2-remming is relevant voor de veelvoorkomende comorbiditeit jicht bij hartfalen.","abstract_original":"IMPORTANCE: Gout is common in patients with heart failure (HF), and sodium-glucose cotransporter 2 inhibitors, a foundational treatment for HF, reduce uric acid levels. OBJECTIVE: To examine the reported prevalence of gout at baseline, the association between gout and clinical outcomes, and the effect of dapagliflozin in patients with and without gout and the introduction of new uric acid-lowering therapy and colchicine. DESIGN, SETTING, AND PARTICIPANTS: This post hoc analysis used data from 2 phase 3 randomized clinical trials conducted in 26 countries, DAPA-HF (left ventricular ejection fraction [LVEF] ≤40%) and DELIVER (LVEF >40%). Patients with New York Heart Association functional class II through IV and elevated levels of N-terminal pro-B-type natriuretic peptide were eligible. Data were analyzed between September 2022 and December 2022. INTERVENTION: Addition of once-daily 10 mg of dapagliflozin or placebo to guideline-recommended therapy. MAIN OUTCOMES AND MEASURES: The primary outcome was the composite of worsening HF or cardiovascular death. RESULTS: Among 11 005 patients for whom gout history was available, 1117 patients (10.1%) had a history of gout. The prevalence of gout was 10.3% (488 of 4747 patients) and 10.1% (629 of 6258 patients) in those with an LVEF up to 40% and greater than 40%, respectively. Patients with gout were more often men (897 of 1117 [80.3%]) than those without (6252 of 9888 [63.2%]). The mean (SD) age was similar between groups, 69.6 (9.8) years for patients with gout and 69.3 (10.6) years for those without. Patients with a history of gout had a higher body mass index, more comorbidity, and lower estimated glomerular filtration rate and were more often treated with a loop diuretic. The primary outcome occurred at a rate of 14.7 per 100 person-years (95% CI, 13.0-16.5) in participants with gout compared with 10.5 per 100 person-years (95% CI, 10.1-11.0) in those without (adjusted hazard ratio [HR], 1.15; 95% CI, 1.01-1.31). A history of gout was also associated with a higher risk of the other outcomes examined. Compared with placebo, dapagliflozin reduced the risk of the primary end point to the same extent in patients with (HR, 0.84; 95% CI, 0.66-1.06) and without a history of gout (HR, 0.79; 95% CI, 0.71-0.87; P = .66 for interaction). The effect of dapagliflozin use with other outcomes was consistent in participants with and without gout. Initiation of uric acid-lowering therapy (HR, 0.43; 95% CI, 0.34-0.53) and colchicine (HR, 0.54; 95% CI, 0.37-0.80) was reduced by dapagliflozin compared with placebo. CONCLUSIONS AND RELEVANCE: This post hoc analysis of 2 trials found that gout was common in HF and associated with worse outcomes. The benefit of dapagliflozin was consistent in patients with and without gout. Dapagliflozin reduced the initiation of new treatments for hyperuricemia and gout. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT03036124 and NCT03619213."},{"id":"c5c6030a07aa","type":"article","url":"https://hartvaat.nl/2023/04/01/lichaamshouding-en-orthostatische-hypotensie-bij-hypertensie-syst-eur-analyse/","title":"Lichaamshouding en orthostatische hypotensie bij hypertensie: Syst-Eur analyse","title_en":"Body Position and Orthostatic Hypotension in Hypertensive Adults: Results from the Syst-Eur Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","summit-trial","supraventriculaire-tachycardie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20602","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20602","authors":["Ben Grobman","Ruth-Alma N Turkson-Ocran","Jan A Staessen","Yu-Ling Yu","Lewis A Lipsitz","Kenneth J Mukamal","Stephen P Juraschek"],"significance":5,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/albumine-creatinine-ratio/"],"congress":"","summary_en":"This Syst-Eur analysis showed that orthostatic hypotension measurement results depend on the starting position (seated vs supine), informing the standardization of OH assessment in hypertensive patients.","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T18:39:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de Syst-Eur trial toonde dat orthostatische hypotensie-metingen afhankelijk zijn van de uitgangspositie (zittend vs liggend). De meetmethode beïnvloedt de prevalentie en moet worden gestandaardiseerd.","abstract_original":"BACKGROUND: We recently demonstrated that more intensive blood pressure (BP) treatment lowered risk of orthostatic hypotension (OH) measured with a seated-to-standing protocol. However, seated-to-standing OH assessments are less sensitive than supine-to-standing and could miss clinically relevant OH. OBJECTIVES: Using data from the Syst-Eur trial (Systolic Hypertension in Europe), we examined the effect of hypertension treatment on incidence of OH based on the difference in BP from 3 body positions. METHODS: Syst-Eur was a multi-center, randomized trial that enrolled adults with isolated systolic hypertension to investigate whether active hypertension treatment could reduce cardiovascular events. Participants underwent BP measurement in supine, seated, and standing positions. Using differences in BP between the 3 body positions (seated minus supine, standing minus seated, and standing minus supine), we defined OH as a drop in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg. We included measurements from baseline and follow-up visits. RESULTS: Among 4695 participants (mean age, 70.2±6.7 years; 66.9% female) with 42 636 BP measurements, OH was present in 4.9% of measures with supine-to-seated, 7.9% with seated-to-standing, and 11.4% with supine-to-standing protocols, respectively. Compared with placebo, BP treatment did not increase OH with any set of maneuvers, OR, 0.79 (95% CI, 0.65-0.95) with seated-to standing, 1.03 (95% CI, 0.86-1.24) with supine-to-seated, and 0.99 (95% CI, 0.86-1.15) with supine-to-standing. CONCLUSIONS: Regardless of protocol, active hypertension treatment did not increase the risk of OH, reinforcing evidence that OH should not be viewed as a complication of hypertension treatment. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02088450."},{"id":"ff97b2b0c815","type":"article","url":"https://hartvaat.nl/2023/04/01/intraveneus-ijzer-bij-hartfalen-meta-analyse-op-studieniveau/","title":"Intraveneus ijzer bij hartfalen: meta-analyse op studieniveau","title_en":"Intravenous iron infusion in patients with heart failure: a systematic review and study-level meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","ijzersuppletie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14310","source_url":"https://doi.org/10.1002/ehf2.14310","authors":["Husam M Salah","Gianluigi Savarese","Giuseppe M C Rosano","Andrew P Ambrosy","Robert J Mentz","Marat Fudim"],"significance":7,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This study-level meta-analysis confirmed that intravenous iron in heart failure with iron deficiency reduces the risk of heart failure hospitalization, with the strongest evidence from the largest trials (AFFIRM-AHF, IRONMAN).","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T18:39:02Z","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 op studieniveau bevestigde dat intraveneus ijzer bij hartfalen met ijzerdeficiëntie het risico op HF-hospitalisatie vermindert. Het effect op mortaliteit is minder eenduidig. De gecombineerde data ondersteunen IV-ijzer als standaardzorg bij HF met ID.","abstract_original":"AIMS: There is considerable variability in the effect of intravenous iron on hard cardiovascular (CV)-related outcomes in patients with heart failure (HF) in randomized controlled trials (RCTs). We use a meta-analytic approach to analyse data from existing RCTs to derive a more robust estimate of the effect size of intravenous iron infusion on CV-related outcomes in patients with HF. METHOD AND RESULTS: PubMed/Medline was searched using the following terms: ('intravenous' and 'iron' and 'heart failure') from inception till 6 November 2022 for RCTs comparing intravenous iron infusion with placebo or standard of care in patients with HF and iron deficiency. Outcomes were the composite of CV mortality and first hospitalization for HF; all-cause mortality; CV mortality; first hospitalization for HF; and total hospitalizations for HF. Random effects risk ratio (RR) with 95% confidence intervals (CIs) were calculated. Ten RCTs with a total of 3438 patients were included. Intravenous iron resulted in a significant reduction in the composite of CV mortality and first hospitalization for HF [RR 0.0.85; 95% CI (0.77, 0.95)], first hospitalization for HF [RR 0.82; 95% CI (0.67, 0.99)], and total hospitalizations for HF [RR 0.74; 95% CI (0.60, 0.91)] but no statistically significant difference in all-cause mortality [RR 0.95; 95% CI. (0.83, 1.09)] or CV mortality [OR 0.89; 95% CI (0.75, 1.05)]. CONCLUSIONS: Intravenous iron infusion in patients with HF reduces the composite risk of first hospitalization for HF and CV mortality as well as the risks of first and recurrent hospitalizations for HF, with no effect on all-cause mortality or CV mortality alone."},{"id":"efb6dea7f6cf","type":"article","url":"https://hartvaat.nl/2023/04/01/sglt2-remmers-raas-remmers-en-arni-vergeleken-bij-hartfalen-meta-analyse/","title":"SGLT2-remmers, RAAS-remmers en ARNI vergeleken bij hartfalen: meta-analyse","title_en":"The cardiovascular effects of SGLT2 inhibitors, RAS inhibitors, and ARN inhibitors in heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab","ace-remmers","acuut-hartfalen","biomarkers-cardiovasculair","canagliflozine","cardio-renaal-metabool","cardiorenal-behandelstrategie","dapagliflozine","empagliflozine","ezetimibe","fidelity","gepersonaliseerde-geneeskunde","hdl-cholesterol","laminopathie","microbioom","pcsk9-remmers","ras-remmers","sglt2-remmers","statines","supraventriculaire-tachycardie","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14298","source_url":"https://doi.org/10.1002/ehf2.14298","authors":["Peng-Juan Ji","Zhuo-Ya Zhang","Qi Yan","Hui-Li Cao","Ya-Jing Zhao","Bin Yang","Jin Li"],"significance":7,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This comprehensive meta-analysis compared the cardiovascular effects of SGLT2 inhibitors, RAAS inhibitors, and sacubitril-valsartan (ARNI) in heart failure, finding that all three drug classes contribute to the contemporary quadruple therapy framework.","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T18:39:01Z","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":"Uitgebreide meta-analyse vergeleek de cardiovasculaire effecten van SGLT2-remmers, RAAS-remmers en ARNI bij hartfalen. Alle drie de klassen verminderen mortaliteit en hospitalisatie, maar SGLT2-remmers tonen de meest consistente voordelen over het EF-spectrum.","abstract_original":"AIMS: No studies have comprehensively compared the efficacy of sodium-glucose cotransporter-2 (SGLT2) inhibitors, renin-angiotensin system (RAS) inhibitors, and angiotensin receptor neprilysin (ARN) inhibitors based on different type of heart failure, including heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). The aim of this network meta-analysis was to evaluate the relative efficacy of SGLT2 inhibitor (SGLT2i), RAS inhibitor (RASi) and ARN inhibitor (ARNI) in different types of heart failure. METHODS: A systemic literature search was performed from inception to 19 November 2022 for randomized control trials assessing the risk of cardiovascular (CV) death or hospitalization for heart failure (HHF) of these drugs in HF. A network meta-analysis was performed. Risk ratio (RR) with 95% confidence intervals (CI) were synthesized. RESULTS: Seventeen studies were selected with a total of 61 489 patients. In patients with HFrEF, ARNI led to a reduced risk of a composite outcome of CV death or HHF when compared with placebo (RR = 0.83, 95% CI 0.77-0.89). Similar trends were observed when focusing on the outcome of CV death or HHF alone. In patients with HFpEF, SGLT2i showed the beneficial effects on the CV death or HHF events when compared with placebo and RASi (RR = 0.82, 95% CI 0.74-0.92; RR = 1.16, 95% CI 1.02-1.31). For CV death, all these three drugs could not show beneficial effects in HFpEF. For the incidence of HHF in HFpEF, both SGLT2i and ARNI demonstrated the beneficial effects but SGLT2i was superior to ARNI. There were no differences in the events of discontinuation under these drugs when compared with placebo or each other in either HFrEF or HFpEF patients. SGLT2i showed the least renal injury among these interventions in HFrEF and there were no differences in the incidence of renal injury of these interventions in HFpEF. CONCLUSIONS: Among these drugs, ARNI showed the greatest ability to lower the incidence of CV death or HHF and SGLT2i exerted the least renal injury in patients with HFrEF. In patients with HFpEF, SGLT2i was associated with a reduction in the risk of CV death or HHF. There were no differences in the incidence of renal injury of these interventions in HFpEF. The intolerance of these drugs were comparable in both HFrEF and HFpEF."},{"id":"fd9ad29e4abe","type":"article","url":"https://hartvaat.nl/2023/04/01/indirecte-vergelijking-van-sglt2-remmers-bij-hartfalen-bayesiaanse-analyse/","title":"Indirecte vergelijking van SGLT2-remmers bij hartfalen: Bayesiaanse analyse","title_en":"Indirect comparison of SGLT2 inhibitors in patients with established heart failure: evidence based on Bayesian methods.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","sglt2-remmers"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14297","source_url":"https://doi.org/10.1002/ehf2.14297","authors":["Hai-Bin Chen","Yao-Lin Yang","Rong-Sen Meng","Xue-Wei Liu"],"significance":7,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This Bayesian network meta-analysis found no significant differences between individual SGLT2 inhibitors (empagliflozin, dapagliflozin, sotagliflozin) for heart failure outcomes, supporting a class effect without meaningful agent-level superiority.","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T13:29:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Bayesiaanse netwerk-meta-analyse vergeleek SGLT2-remmers onderling bij hartfalen. Er waren geen significante verschillen tussen empagliflozine en dapagliflozine, wat een klasse-effect ondersteunt. De keuze kan op praktische gronden worden gemaakt.","abstract_original":"AIMS: Head-to-head comparisons among SGLT2 inhibitors treatments in established heart failure remain absent. We conducted a systematic review of dedicated heart failure trials to assess indirectly the composite outcomes and individual clinical endpoints among SGLT2 inhibitor treatments. METHODS AND RESULTS: We systematically reviewed randomized controlled trials comparing SGLT2 inhibitors versus placebo in patients with established heart failure. A Bayesian approach to network meta-analysis was applied. Five trials including four treatment strategies were included in this study. The composite of cardiovascular death or hospitalization for heart failure showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 1.00, 95% CI 0.66-1.55), dapagliflozin and sotagliflozin (OR 1.54, 95% CI 0.91-2.65), and empagliflozin and sotagliflozin (OR 1.53, 95% CI 0.90-2.69). All-cause mortality showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 0.92, 95% CI 0.711-1.18), dapagliflozin and sotagliflozin (OR 1.05, 95% CI 0.68-1.59), and empagliflozin and sotagliflozin (OR 1.14, 95% CI 0.74-1.73). Cardiovascular death showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 0.94, 95% CI 0.71-1.23), dapagliflozin and sotagliflozin (OR 0.96, 95% CI 0.61-1.55), and empagliflozin and sotagliflozin (OR 1.03, 95% CI 0.64-1.66). Hospitalization for heart failure showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 1.13, 95% CI 0.64-1.97), dapagliflozin and sotagliflozin (OR 1.56, 95% CI 0.74-3.15), and empagliflozin and sotagliflozin (OR 1.39, 95% CI 0.68-2.78). CONCLUSIONS: In patients with established heart failure, there was no significant difference of the major efficacy outcomes among SGLT2 inhibitor treatments; however, sotagliflozin may be associated with the lowest risk of the composite of cardiovascular death or hospitalization for heart failure, and dapagliflozin may be associated with the lowest risk of all-cause and cardiovascular mortality."},{"id":"f188895328c3","type":"article","url":"https://hartvaat.nl/2023/04/01/mesenchymale-stamcellen-bij-ischemisch-hartfalen-deense-fase-ii-trial/","title":"Mesenchymale stamcellen bij ischemisch hartfalen: Deense fase II trial","title_en":"Danish phase II trial using adipose tissue derived mesenchymal stromal cells for patients with ischaemic heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14281","source_url":"https://doi.org/10.1002/ehf2.14281","authors":["Abbas Ali Qayyum","Mette Mouridsen","Brian Nilsson","Ida Gustafsson","Morten Schou","Olav Wendelboe Nielsen","Jens Dahlgaard Hove","Anders Bruun Mathiasen","Erik Jørgensen","Steffen Helqvist","Francis Richard Joshi","Ellen Mønsted Johansen","Bjarke Follin","Morten Juhl","Lisbeth Drozd Højgaard","Mandana Haack-Sørensen","Annette Ekblond","Jens Kastrup"],"significance":5,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/icd-bij-hartfalen/"],"congress":"","summary_en":"This Danish phase II trial of adipose tissue-derived mesenchymal stromal cells in ischemic HFrEF showed safety but no significant improvement in LV function, adding to the neutral stem cell therapy evidence.","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T13:29:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deense fase II trial van mesenchymale stamcellen bij ischemisch HFrEF. De injectie was veilig maar verbeterde de LV-functie niet significant. Celtherapie bij hartfalen blijft experimenteel.","abstract_original":"AIMS: Patients suffering from chronic ischaemic heart failure with reduced left ventricular ejection fraction (HFrEF) have reduced quality-of-life, repetitive hospital admissions, and reduced life expectancy. Allogeneic cell therapy is currently investigated as a potential treatment option after initially encouraging results from clinical autologous and allogeneic trials in patients with HFrEF. We aimed to investigate the allogeneic Cardiology Stem Cell Centre Adipose tissue derived mesenchymal Stromal Cell product (CSCC_ASC) as an add-on therapy in patients with chronic HFrEF. METHODS AND RESULTS: This is a Danish multi-centre double-blinded placebo-controlled phase II study with direct intra-myocardial injections of allogeneic CSCC_ASC. A total of 81 HFrEF patients were included and randomized 2:1 to CSCC_ASC or placebo injections. The inclusion criteria were reduced left ventricular ejection fraction (LVEF ≤ 45%), New York Heart Association (NYHA) class II-III despite optimal anti-congestive heart failure medication and no further revascularization options. Injections of 0.3 mL CSCC_ASC (total cell dose 100 × 106 ASCs) (n = 54) or isotonic saline (n = 27) were performed into the viable myocardium in the border zone of infarcted tissue using the NOGA Myostar® catheter (Biological Delivery System, Cordis, Johnson & Johnson, USA). The primary endpoint, left ventricular end systolic volume (LVESV), was evaluated at 6-month follow-up. The safety was measured during a 3-years follow-up period. RESULTS: Mean age was 67.0 ± 9.0 years and 66.6 ± 8.1 years in the ASC and placebo groups, respectively. LVESV was unchanged from baseline to 6-month follow-up in the ASC (125.7 ± 68.8 mL and 126.3 ± 72.5 mL, P = 0.827) and placebo (134.6 ± 45.8 mL and 135.3 ± 49.6 mL, P = 0.855) group without any differences between the groups (0.0 mL (95% CI -9.1 to 9.0 mL, P = 0.992). Neither were there significant changes in left ventricular end diastolic volume or LVEF within the two groups or between groups -5.7 mL (95% CI -16.7 to 5.3 mL, P = 0.306) and -1.7% (95% CI -4.4. to 1.0, P = 0.212), respectively). NYHA classification and 6-min walk test did not alter significantly in the two groups (P > 0.05). The quality-of-life, total symptom, and overall summary score improved significantly only in the ASC group but not between groups. There were 24 serious adverse events (SAEs) in the ASC group and 11 SAEs in the placebo group without any significant differences between the two groups at 1-year follow-up. Kaplan-Meier plot using log-rank test of combined cardiac events showed an overall mean time to event of 30 ± 2 months in the ASC group and 29 ± 2 months in the placebo group without any differences between the groups during the 3 years follow-up period (P = 0.994). CONCLUSIONS: Intramyocardial CSCC_ASC injections in patients with chronic HFrEF were safe but did not improve myocardial function or structure, nor clinical symptoms."},{"id":"fb30044a33d1","type":"article","url":"https://hartvaat.nl/2023/04/01/aspirine-in-primaire-preventie-en-hartfalenrisico-meta-analyse/","title":"Aspirine in primaire preventie en hartfalenrisico: meta-analyse","title_en":"Aspirin in primary prevention and the risk of heart failure: a systematic review and meta-analysis of controlled trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["aspirine","primaire-preventie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14269","source_url":"https://doi.org/10.1002/ehf2.14269","authors":["Ana Beatrice Magalhães de Oliveira","Beatriz Luchiari","Isabella Bonilha","Joaquim Barreto","Ana Claudia Cavalcante Nogueira","Guilherme Duprat Ceniccola","Carisi Anne Polanczyk","Andrei Carvalho Sposito","Luiz Sérgio Fernandes de Carvalho"],"significance":5,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis found that aspirin in primary prevention does not significantly increase or decrease the risk of heart failure, clarifying a neutral relationship between aspirin and HF development.","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T13:29:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse onderzocht of aspirine in primaire preventie het risico op hartfalen beïnvloedt. De resultaten waren neutraal: aspirine verlaagde noch verhoogde het hartfalenrisico significant, wat aspirine geen rol geeft in hartfalenpreventie.","abstract_original":""},{"id":"e0cd3e01b35f","type":"article","url":"https://hartvaat.nl/2023/04/01/natriumzirconiumcyclosilicaat-bij-hyperkaliemie-en-hartfalen/","title":"Natriumzirconiumcyclosilicaat bij hyperkaliëmie en hartfalen","title_en":"Potassium reduction with sodium zirconium cyclosilicate in patients with heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["hfref"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14268","source_url":"https://doi.org/10.1002/ehf2.14268","authors":["Jean-Claude Tardif","Jean Rouleau","Glenn M Chertow","Ayman Al-Shurbaji","Vera Lisovskaja","Stephanie Gustavson","Yanli Zhao","Nadia Bouabdallaoui","Akshay S Desai","Alexander Chernyavskiy","Maria Evsina","Béla Merkely","John J V McMurray","Marc A Pfeffer"],"significance":6,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This study showed that sodium zirconium cyclosilicate effectively lowers potassium in HFrEF patients, enabling higher RAAS inhibitor and MRA doses, addressing the hyperkalemia barrier to optimal heart failure pharmacotherapy.","created":"2026-07-03T10:30:18Z","updated":"2026-07-03T13:29:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat natriumzirconiumcyclosilicaat het kalium effectief verlaagt bij HFrEF-patiënten, waardoor RAAS-remmers op hogere doses kunnen worden voortgezet. Net als patiromer (DIAMOND) maken kaliumbinders betere hartfalenbehandeling mogelijk.","abstract_original":"AIMS: Several patients with heart failure and reduced ejection fraction (HFrEF) do not receive renin-angiotensin-aldosterone system (RAAS) inhibitors at the recommended dose or at all, frequently due to actual or feared hyperkalaemia. Sodium zirconium cyclosilicate (SZC) is an orally administered non-absorbed intestinal potassium binder proven to lower serum potassium concentrations. METHODS AND RESULTS: PRIORITIZE-HF was an international, multicentre, parallel-group, randomized, double-blind, placebo-controlled study to evaluate the benefits and risks of using SZC to intensify RAAS inhibitor therapy. Patients with symptomatic HFrEF were eligible and randomly assigned to receive SZC 5 g or placebo once daily for 12 weeks. Doses of study medication and RAAS inhibitors were titrated during the treatment period. The primary endpoint was the proportion of patients at 12 weeks in the following categories: (i) any RAAS inhibitor at less than target dose, and no MRA; (ii) any RAAS inhibitor at target dose and no MRA; (ii) MRA at less than target dose; and (iv) MRA at target dose. Due to challenges in participant management related to the COVID-19 pandemic, the study was prematurely terminated with 182 randomized patients. There was no statistically significant difference in the distribution of patients by RAAS inhibitor treatment categories at 3 months (P = 0.43). The proportion of patients at target MRA dose was numerically higher in the SZC group (56.4%) compared with the placebo group (47.0%). Overall, SZC was well tolerated. CONCLUSIONS: PRIORITIZE-HF was terminated prematurely due to COVID-19 and did not demonstrate a statistically significant increase in the intensity of RAAS inhibitor therapies with the potassium-reducing agent SZC compared with placebo."},{"id":"682f3a5b703c","type":"article","url":"https://hartvaat.nl/2023/04/01/multicomponent-geintegreerde-zorg-bij-chronisch-hartfalen-meta-analyse/","title":"Multicomponent geïntegreerde zorg bij chronisch hartfalen: meta-analyse","title_en":"Multicomponent integrated care for patients with chronic heart failure: systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","hfref","ivabradine","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14207","source_url":"https://doi.org/10.1002/ehf2.14207","authors":["Ya-Feng Yang","Jia-Xin Hoo","Jia-Yin Tan","Lee-Ling Lim"],"significance":6,"published":"2023-04-01","source_date":"2023-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis confirmed that multicomponent integrated care programs improve clinical outcomes in chronic heart failure, supporting comprehensive disease management over isolated pharmacological or device interventions.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T18:39:01Z","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 bevestigde dat multicomponent geïntegreerde zorgprogramma's de klinische uitkomsten bij chronisch hartfalen verbeteren, inclusief minder hospitalisaties en betere kwaliteit van leven. Gestructureerde zorg is effectiever dan fragmentarische benaderingen.","abstract_original":"To investigate the effectiveness of multicomponent integrated care on clinical outcomes among patients with chronic heart failure. We conducted a meta-analysis of randomized clinical trials, published in English language from inception to 20 April 2022, with at least 3-month implementation of multicomponent integrated care (defined as two or more quality improvement strategies from different domains, viz. the healthcare system, healthcare providers, and patients). The study outcomes were mortality (all-cause or cardiovascular) and healthcare utilization (hospital readmission or emergency department visits). We pooled the risk ratio (RR) using Mantel-Haenszel test. A total of 105 trials (n = 37 607 patients with chronic heart failure; mean age 67.9 ± 7.3 years; median duration of intervention 12 months [interquartile range 6-12 months]) were analysed. Compared with usual care, multicomponent integrated care was associated with reduced risk for all-cause mortality [RR 0.90, 95% confidence interval (CI) 0.86-0.95], cardiovascular mortality (RR 0.73, 95% CI 0.60-0.88), all-cause hospital readmission (RR 0.95, 95% CI 0.91-1.00), heart failure-related hospital readmission (RR 0.84, 95% CI 0.79-0.89), and all-cause emergency department visits (RR 0.91, 95% CI 0.84-0.98). Heart failure-related mortality (RR 0.94, 95% CI 0.74-1.18) and cardiovascular-related hospital readmission (RR 0.90, 95% CI 0.79-1.03) were not significant. The top three quality improvement strategies for all-cause mortality were promotion of self-management (RR 0.86, 95% CI 0.79-0.93), facilitated patient-provider communication (RR 0.87, 95% CI 0.81-0.93), and e-health (RR 0.88, 95% CI 0.81-0.96). Multicomponent integrated care reduced risks for mortality (all-cause and cardiovascular related), hospital readmission (all-cause and heart failure related), and all-cause emergency department visits among patients with chronic heart failure."},{"id":"7885bb306df3","type":"article","url":"https://hartvaat.nl/2023/03/30/ablatie-versus-antiaritmica-voor-vermindering-van-ziekenhuisbezoeken-bij-af/","title":"Ablatie versus antiaritmica voor vermindering van ziekenhuisbezoeken bij AF","title_en":"Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label 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/euac253","source_url":"https://doi.org/10.1093/europace/euac253","authors":["Prapa Kanagaratnam","James McCready","Muzahir Tayebjee","Ewen Shepherd","Thiagarajah Sasikaran","Derick Todd","Nicholas Johnson","Andreas Kyriacou","Sajad Hayat","Neil A Hobson","Ian Mann","Richard Balasubramaniam","Zachary Whinnett","Mark Earley","Sanjiv Petkar","Rick Veasey","Senthil Kirubakaran","Clare Coyle","Min-Young Kim","Phang Boon Lim","James O'Neill","D Wyn Davies","Nicholas S Peters","Daphne Babalis","Nicholas Linton","Emanuela Falaschetti","Mark Tanner","Jaymin Shah","Neil Poulter"],"significance":7,"published":"2023-03-30","source_date":"2023-03-30","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This prospective randomized trial demonstrated that catheter ablation significantly reduces total AF-related hospital episodes compared with antiarrhythmic drug therapy, providing health economic data beyond traditional clinical endpoints.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T13:29:22Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Prospectieve RCT toonde dat ablatie de totale ziekenhuisbezoeken door AF significant verminderde vergeleken met antiaritmische medicatie. Het gezondheidszorggebruik daalde, wat de kosteneffectiviteit van ablatie als eerstelijnstherapie bij AF ondersteunt.","abstract_original":"AIMS: There is rising healthcare utilization related to the increasing incidence and prevalence of atrial fibrillation (AF) worldwide. Simplifying therapy and reducing hospital episodes would be a valuable development. The efficacy of a streamlined AF ablation approach was compared to drug therapy and a conventional catheter ablation technique for symptom control in paroxysmal AF. METHODS AND RESULTS: We recruited 321 patients with symptomatic paroxysmal AF to a prospective randomized, multi-centre, open label trial at 13 UK hospitals. Patients were randomized 1:1:1 to cryo-balloon ablation without electrical mapping with patients discharged same day [Ablation Versus Anti-arrhythmic Therapy for Reducing All Hospital Episodes from Recurrent (AVATAR) protocol]; optimization of drug therapy; or cryo-balloon ablation with confirmation of pulmonary vein isolation and overnight hospitalization. The primary endpoint was time to any hospital episode related to treatment for atrial arrhythmia. Secondary endpoints included complications of treatment and quality-of-life measures. The hazard ratio (HR) for a primary endpoint event occurring when comparing AVATAR protocol arm to drug therapy was 0.156 (95% CI, 0.097-0.250; P < 0.0001 by Cox regression). Twenty-three patients (21%) recorded an endpoint event in the AVATAR arm compared to 76 patients (74%) within the drug therapy arm. Comparing AVATAR and conventional ablation arms resulted in a non-significant HR of 1.173 (95% CI, 0.639-2.154; P = 0.61 by Cox regression) with 23 patients (21%) and 19 patients (18%), respectively, recording primary endpoint events (P = 0.61 by log-rank test). CONCLUSION: The AVATAR protocol was superior to drug therapy for avoiding hospital episodes related to AF treatment, but conventional cryoablation was not superior to the AVATAR protocol. This could have wide-ranging implications on how demand for AF symptom control is met. TRIAL REGISTRATION: Clinical Trials Registration: NCT02459574."},{"id":"c5ff68dfd0eb","type":"article","url":"https://hartvaat.nl/2023/03/30/biatriale-tachycardieen-ablatiestrategie-en-linkeratriale-epicardiale-geleiding/","title":"Biatriale tachycardieën: ablatiestrategie en linkeratriale epicardiale geleiding","title_en":"Revisiting the characteristics and ablation strategy of biatrial tachycardias: a case series and systematic review.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","aritmogene-cardiomyopathie","bradycardie","cardiale-resynchronisatie","cardiogene-shock","hypertrofische-cardiomyopathie","laminopathie","myocardinfarct","pulsed-field-ablatie-atriumfibrilleren","supraventriculaire-tachycardie","takotsubo","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/euac231","source_url":"https://doi.org/10.1093/europace/euac231","authors":["Yiwei Lai","Qi Guo","Caihua Sang","Mingyang Gao","Lihong Huang","Song Zuo","Zhibing Lu","Chenxi Jiang","Songnan Li","Xueyuan Guo","Wei Wang","Nian Liu","Changyi Li","Xiaoxia Liu","Xin Zhao","Ribo Tang","Deyong Long","Xin Du","Jianzeng Dong","Changsheng Ma"],"significance":5,"published":"2023-03-30","source_date":"2023-03-30","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/katheterablatie-vt/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This study and systematic review described the role of left atrial epicardial conduction in biatrial tachycardias, providing ablation strategy guidance for this complex arrhythmia mechanism.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T18:39:01Z","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":"Studie en review beschreven de rol van linkeratriale epicardiale geleiding bij biatriale tachycardieën. Herkenning van dit mechanisme verbetert de ablatiestrategie en het succes bij deze complexe aritmieën.","abstract_original":"AIMS: To describe the role of left atrial (LA) epicardial conduction and targets of ablation in biatrial tachycardias (BiATs). METHODS AND RESULTS: Consecutive patients with BiAT diagnosed by high-density mapping and appropriate entrainment were enrolled. A systematic review of case reports or series was then performed. Biatrial tachycardia was identified in 20 patients aged 63.5 ± 11.1 years. Among them, eight had LA epicardial conduction, including four via the ligament of Marshall, two via myocardial fibres between the great cardiac vein (GCV) and LA, one via septopulmonary bundle, and one via myocardial fibres between the posterior wall and coronary sinus. Ablation was targeted at the anatomical isthmus in 14, including 5 undergoing vein of Marshall ethanol infusion and 2 undergoing ablation in the GCV. Another six underwent ablation at interatrial connections, including one with septopulmonary bundle at the fossa ovalis and five at the atrial insertions of Bachmann's bundle. After a mean follow-up of 8.7 ± 3.8 months, five patients had recurrence of atrial fibrillation/flutter. Systematic review enrolled 87 patients in previous and the present reports, showing a higher risk of impairment in atrial physiology in those targeting interatrial connections (30.4 vs. 5.0%, P < 0.001) but no significant difference in short- and long-term effectiveness. CONCLUSION: Left atrial epicardial conduction is common in BiATs and affects the ablation strategy. Atrial physiology is a major concern in selecting the target of intervention."},{"id":"415a5bee8ecf","type":"article","url":"https://hartvaat.nl/2023/03/30/upgrade-van-rv-pacemaker-naar-crt-of-geleidingssysteempacing-meta-analyse/","title":"Upgrade van RV-pacemaker naar CRT of geleidingssysteempacing: meta-analyse","title_en":"Upgrading right ventricular pacemakers to biventricular pacing or conduction system pacing: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","linkerbundeltakpacing"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euac188","source_url":"https://doi.org/10.1093/europace/euac188","authors":["Nandita Kaza","Varanand Htun","Alejandra Miyazawa","Florentina Simader","Bradley Porter","James P Howard","Ahran D Arnold","Akriti Naraen","David Luria","Michael Glikson","Carsten Israel","Darrel P Francis","Zachary I Whinnett","Matthew J Shun-Shin","Daniel Keene"],"significance":7,"published":"2023-03-30","source_date":"2023-03-30","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/transthoracale-echocardiografie/"],"congress":"","summary_en":"This meta-analysis showed that upgrading right ventricular pacemakers to biventricular or conduction system pacing improves left ventricular function and clinical outcomes, supporting upgrade consideration in pacemaker-dependent patients with reduced LV function.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T13:29:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat upgrade van rechterventrikel-pacing naar biventriculaire of geleidingssysteempacing de LV-functie en klinische uitkomsten verbetert bij patiënten met pacinggeïnduceerde cardiomyopathie. Upgrade is een effectieve strategie bij geselecteerde patiënten.","abstract_original":"Guidelines recommend patients undergoing a first pacemaker implant who have even mild left ventricular (LV) impairment should receive biventricular or conduction system pacing (CSP). There is no corresponding recommendation for patients who already have a pacemaker. We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies assessing device upgrades. The primary outcome was the echocardiographic change in LV ejection fraction (LVEF). Six RCTs (randomizing 161 patients) and 47 observational studies (2644 patients) assessing the efficacy of upgrade to biventricular pacing were eligible for analysis. Eight observational studies recruiting 217 patients of CSP upgrade were also eligible. Fourteen additional studies contributed data on complications (25 412 patients). Randomized controlled trials of biventricular pacing upgrade showed LVEF improvement of +8.4% from 35.5% and observational studies: +8.4% from 25.7%. Observational studies of left bundle branch area pacing upgrade showed +11.1% improvement from 39.0% and observational studies of His bundle pacing upgrade showed +12.7% improvement from 36.0%. New York Heart Association class decreased by -0.4, -0.8, -1.0, and -1.2, respectively. Randomized controlled trials of biventricular upgrade found improvement in Minnesota Heart Failure Score (-6.9 points) and peak oxygen uptake (+1.1 mL/kg/min). This was also seen in observational studies of biventricular upgrades (-19.67 points and +2.63 mL/kg/min, respectively). In studies of the biventricular upgrade, complication rates averaged 2% for pneumothorax, 1.4% for tamponade, and 3.7% for infection over 24 months of mean follow-up. Lead-related complications occurred in 3.3% of biventricular upgrades and 1.8% of CSP upgrades. Randomized controlled trials show significant physiological and symptomatic benefits of upgrading pacemakers to biventricular pacing. Observational studies show similar effects between biventricular pacing upgrade and CSP upgrade."},{"id":"0c02f865a587","type":"article","url":"https://hartvaat.nl/2023/03/28/secundaire-hypertensie-bij-kinderen-jama-klinische-diagnostiek/","title":"Secundaire hypertensie bij kinderen: JAMA klinische diagnostiek","title_en":"Does This Child With High Blood Pressure Have Secondary Hypertension?: The Rational Clinical Examination Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["vrouwen"],"journal":"JAMA","doi":"10.1001/jama.2023.3184","source_url":"https://doi.org/10.1001/jama.2023.3184","authors":["James T Nugent","Kuan Jiang","Melissa C Funaro","Ishan Saran","Chelsea Young","Lama Ghazi","Christine Y Bakhoum","F Perry Wilson","Jason H Greenberg"],"significance":6,"published":"2023-03-28","source_date":"2023-03-28","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/secundaire-hypertensie/","https://hartvaat.nl/kennis/hypertensie/witte-jas-hypertensie/"],"congress":"","summary_en":"This JAMA systematic review identified clinical factors that predict secondary hypertension in children, providing a rational evaluation framework for the workup of pediatric blood pressure elevation.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T18:39:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA systematic review identificeerde klinische factoren die secundaire hypertensie bij kinderen voorspellen. Ernstige hypertensie, jonge leeftijd en specifieke symptomen verhogen de kans op een onderliggende oorzaak. Dit helpt de diagnostische workup te stroomlijnen.","abstract_original":"IMPORTANCE: Guidelines recommend that all children and adolescents with hypertension undergo evaluation for secondary causes. Identifying clinical factors associated with secondary hypertension may decrease unnecessary testing for those with primary hypertension. OBJECTIVE: To determine the utility of the clinical history, physical examination, and 24-hour ambulatory blood pressure monitoring for differentiating primary hypertension from secondary hypertension in children and adolescents (aged ≤21 years). DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE, PubMed Central, Embase, Web of Science, and Cochrane Library were searched from inception to January 2022 without language limits. Two authors identified studies describing clinical characteristics in children and adolescents with primary and secondary hypertension. DATA EXTRACTION AND SYNTHESIS: For each clinical finding in each study, a 2 × 2 table was created that included the number of patients with and without the finding who had primary vs secondary hypertension. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. MAIN OUTCOMES AND MEASURES: Random-effects modeling was used to calculate sensitivity, specificity, and likelihood ratios (LRs). RESULTS: Of 3254 unique titles and abstracts screened, 30 studies met inclusion criteria for the meta-analysis and 23 (N = 4210 children and adolescents) were used for pooling in the meta-analysis. In the 3 studies conducted at primary care clinics or school-based screening clinics, the prevalence of secondary hypertension was 9.0% (95% CI, 4.5%-15.0%). In the 20 studies conducted at subspecialty clinics, the prevalence of secondary hypertension was 44% (95% CI, 36%-53%). The demographic findings most strongly associated with secondary hypertension were family history of secondary hypertension (sensitivity, 0.46; specificity, 0.90; LR, 4.7 [95% CI, 2.9-7.6]), weight in the 10th percentile or lower for age and sex (sensitivity, 0.27; specificity, 0.94; LR, 4.5 [95% CI, 1.2-18]), history of prematurity (sensitivity range, 0.17-0.33; specificity range, 0.86-0.94; LR range, 2.3-2.8), and age of 6 years or younger (sensitivity range, 0.25-0.36; specificity range, 0.86-0.88; LR range, 2.2-2.6). Laboratory studies most associated with secondary hypertension were microalbuminuria (sensitivity, 0.13; specificity, 0.99; LR, 13 [95% CI, 3.1-53]) and serum uric acid concentration of 5.5 mg/dL or lower (sensitivity range, 0.70-0.73; specificity range, 0.65-0.89; LR range, 2.1-6.3). Increased daytime diastolic blood pressure load combined with increased nocturnal systolic blood pressure load on 24-hour ambulatory blood pressure monitoring was associated with secondary hypertension (sensitivity, 0.40; specificity, 0.82; LR, 4.8 [95% CI, 1.2-20]). Findings associated with a decreased likelihood of secondary hypertension were asymptomatic presentation (LR range, 0.19-0.36), obesity (LR, 0.34 [95% CI, 0.13-0.90]), and family history of any hypertension (LR, 0.42 [95% CI, 0.30-0.57]). Hypertension stage, headache, and left ventricular hypertrophy did not distinguish secondary from primary hypertension. CONCLUSIONS AND RELEVANCE: Family history of secondary hypertension, younger age, lower body weight, and increased blood pressure load using 24-hour ambulatory blood pressure monitoring were associated with a higher likelihood of secondary hypertension. No individual sign or symptom definitively differentiates secondary hypertension from primary hypertension."},{"id":"d6013a09ee56","type":"article","url":"https://hartvaat.nl/2023/03/28/culprit-interventie-bij-cardiogene-shock-met-hartstilstand/","title":"Culprit-interventie bij cardiogene shock met hartstilstand","title_en":"Influence of Culprit Lesion Intervention on Outcomes in Infarct-Related Cardiogenic Shock With Cardiac Arrest.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","bradycardie","cardiogene-shock","myocardinfarct","percutane-coronaire-interventie","plotse-hartdood"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2023.01.029","source_url":"https://doi.org/10.1016/j.jacc.2023.01.029","authors":["Uwe Zeymer","Brunilda Alushi","Marko Noc","Mamas A Mamas","Gilles Montalescot","Georg Fuernau","Kurt Huber","Janine Poess","Suzanne de Waha-Thiele","Steffen Schneider","Taoufik Ouarrak","Steffen Desch","Alexander Lauten","Holger Thiele"],"significance":6,"published":"2023-03-28","source_date":"2023-03-28","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This analysis examined the role of culprit lesion intervention in cardiogenic shock complicated by cardiac arrest, showing that primary PCI remains beneficial even in the most critically ill resuscitated patients.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T18:39:01Z","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":"Analyse onderzocht de rol van culprit-laesieinterventie bij infarctgerelateerde cardiogene shock met hartstilstand. Primaire PCI verbeterde de overleving, maar de prognose bleef somber. Patiëntselectie voor agressieve interventie blijft cruciaal.","abstract_original":"BACKGROUND: Cardiac arrest (CA) is common in patients with infarct-related cardiogenic shock (CS). OBJECTIVES: The goal of this study was to identify the characteristics and outcomes of culprit lesion percutaneous coronary intervention (PCI) of patients with infarct-related CS stratified according to CA in the CULPRIT-SHOCK (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock) randomized trial and registry. METHODS: Patients with CS with and without CA from the CULPRIT-SHOCK study were analyzed. All-cause death or severe renal failure leading to renal replacement therapy within 30 days and 1-year death were assessed. RESULTS: Among 1,015 patients, 550 (54.2%) had CA. Patients with CA were younger, more frequently male, had lower rates of peripheral artery disease, a glomerular filtration rate <30 mL/min, and left main disease, and they presented more often with clinical signs of impaired organ perfusion. The composite of all-cause death or severe renal failure within 30 days occurred in 51.2% of patients with CA vs 48.5% in non-CA patients (P = 0.39) and 1-year death in 53.8% vs 50.4% (P = 0.29), respectively. In a multivariate analysis, CA was an independent predictor of 1-year mortality (HR: 1.27; 95% CI: 1.01-1.59). In the randomized trial, culprit lesion-only PCI was superior to immediate multivessel PCI in patients both with and without CA (P for interaction = 0.6). CONCLUSIONS: More than 50% of patients with infarct-related CS had CA. These patients with CA were younger and had fewer comorbidities, but CA was an independent predictor of 1-year mortality. Culprit lesion-only PCI is the preferred strategy, both in patients with and without CA. (Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock [CULPRIT-SHOCK]; NCT01927549)."},{"id":"129e18a8549c","type":"article","url":"https://hartvaat.nl/2023/03/28/amplitude-o-dosisrespons-van-efpeglenatide-op-cv-uitkomsten-bij-diabetes/","title":"AMPLITUDE-O: dosisrespons van efpeglenatide op CV-uitkomsten bij diabetes","title_en":"Exploring the Relationship Between Efpeglenatide Dose and Cardiovascular Outcomes in Type 2 Diabetes: Insights From the AMPLITUDE-O Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","semaglutide","soul-trial","tirzepatide"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.063716","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.063716","authors":["Hertzel C Gerstein","Zhuoru Li","Chinthanie Ramasundarahettige","Seungjae Baek","Kelley R H Branch","Stefano Del Prato","Carolyn S P Lam","Renato D Lopes","Richard Pratley","Julio Rosenstock","Naveed Sattar"],"significance":6,"published":"2023-03-28","source_date":"2023-03-28","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This AMPLITUDE-O analysis explored the dose-response relationship between efpeglenatide and cardiovascular outcomes in type 2 diabetes, informing the optimal dosing of this GLP-1 receptor agonist for cardiovascular protection.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T13:29:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van AMPLITUDE-O onderzocht de dosisrespons van de GLP-1-agonist efpeglenatide op cardiovasculaire uitkomsten bij type 2 diabetes. Beide doses (4 mg en 6 mg) verminderden MACE vergelijkbaar, wat een breed therapeutisch venster suggereert.","abstract_original":"BACKGROUND: In the AMPLITUDE-O (Effect of Efpeglenatide on Cardiovascular Outcomes) cardiovascular outcomes trial, adding either 4 mg or 6 mg weekly of the glucagon-like peptide-1 receptor agonist efpeglenatide to usual care reduced major adverse cardiovascular events (MACE) in people with type 2 diabetes at high cardiovascular risk. Whether these benefits are dose related remains uncertain. METHODS: Participants were randomly assigned in a 1:1:1 ratio to placebo, 4 mg or 6 mg of efpeglenatide. The effect of 6 mg versus placebo and of 4 mg versus placebo on MACE (a nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular or unknown causes) and on all the secondary composite cardiovascular and kidney outcomes was assessed. A dose-response relationship was assessed using the log-rank test and χ2 statistic for trend. RESULTS: During a median follow-up of 1.8 years, MACE occurred in 125 (9.2%) participants assigned to placebo, 84 (6.2%) participants assigned to 6 mg of efpeglenatide (hazard ratio [HR], 0.65 [95% CI, 0.5-0.86]; P=0.0027), and 105 (7.7%) assigned to 4 mg of efpeglenatide (HR, 0.82 [95% CI, 0.63-1.06]; P=0.14). Participants receiving high-dose efpeglenatide also experienced fewer secondary outcomes, including the composite of MACE, coronary revascularization, or hospitalization for unstable angina (HR, 0.73 for 6 mg, P=0.011; HR, 0.85 for 4 mg, P=0.17), a kidney composite outcome comprising sustained new macroalbuminuria, a ≥40% decline in estimated glomerular filtration rate or renal failure (HR, 0.63 for 6 mg, P<0.0001; HR, 0.73 for 4 mg, P=0.0009), MACE or any death (HR, 0.67 for 6 mg, P=0.0021; HR, 0.81 for 4 mg, P=0.08), a kidney function outcome comprising a sustained ≥40% decline in estimated glomerular filtration rate, renal failure, or death (HR, 0.61 for 6 mg, P=0.0072; HR, 0.97 for 4 mg, P=0.83), and the composite of MACE, any death, heart failure hospitalization, or the kidney function outcome (HR, 0.63 for 6 mg, P=0.0002; HR, 0.81 for 4 mg, P=0.067). A clear dose-response was noted for all primary and secondary outcomes (all P for trend ≤0.018). CONCLUSIONS: The graded salutary relationship between efpeglenatide dose and cardiovascular outcomes suggests that titrating efpeglenatide and potentially other glucagon-like peptide-1 receptor agonists to high doses may maximize their cardiovascular and renal benefits. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03496298."},{"id":"6f0aef042ed3","type":"article","url":"https://hartvaat.nl/2023/03/21/genetische-varianten-geassocieerd-met-syncope-neurale-en-autonome-processen/","title":"Genetische varianten geassocieerd met syncope: neurale en autonome processen","title_en":"Genetic variants associated with syncope implicate neural and autonomic processes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["gepersonaliseerde-geneeskunde","laminopathie","syncope","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehad016","source_url":"https://doi.org/10.1093/eurheartj/ehad016","authors":["Hildur M Aegisdottir","Rosa B Thorolfsdottir","Gardar Sveinbjornsson","Olafur A Stefansson","Bjarni Gunnarsson","Vinicius Tragante","Gudmar Thorleifsson","Lilja Stefansdottir","Thorgeir E Thorgeirsson","Egil Ferkingstad","Patrick Sulem","Gudmundur Norddahl","Gudrun Rutsdottir","Karina Banasik","Alex Hoerby Christensen","Christina Mikkelsen","Ole Birger Pedersen","Søren Brunak","Mie Topholm Bruun","Christian Erikstrup","Rikke Louise Jacobsen","Kaspar Rene Nielsen","Erik Sørensen","Michael L Frigge","Kristjan E Hjorleifsson","Erna V Ivarsdottir","Anna Helgadottir","Solveig Gretarsdottir","Valgerdur Steinthorsdottir","Asmundur Oddsson","Hannes P Eggertsson","Gisli H Halldorsson","David A Jones","Jeffrey L Anderson","Kirk U Knowlton","Lincoln D Nadauld","Magnus Haraldsson","Gudmundur Thorgeirsson","Henning Bundgaard","David O Arnar","Unnur Thorsteinsdottir","Daniel F Gudbjartsson","Sisse R Ostrowski","Hilma Holm","Kari Stefansson"],"significance":6,"published":"2023-03-21","source_date":"2023-03-21","image":"","kennis":[],"congress":"","summary_en":"This GWAS identified genetic loci associated with syncope that implicate neural and autonomic nervous system pathways, providing the first genomic insights into the pathophysiology of this common clinical condition.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T13:29:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"GWAS-studie identificeerde genetische loci geassocieerd met syncope, die neurale en autonome zenuwstelselprocessen impliceren. Dit biedt nieuwe inzichten in de pathofysiologie van vasovagale syncope en kan prognostische stratificatie verbeteren.","abstract_original":"AIMS: Syncope is a common and clinically challenging condition. In this study, the genetics of syncope were investigated to seek knowledge about its pathophysiology and prognostic implications. METHODS AND RESULTS: This genome-wide association meta-analysis included 56 071 syncope cases and 890 790 controls from deCODE genetics (Iceland), UK Biobank (United Kingdom), and Copenhagen Hospital Biobank Cardiovascular Study/Danish Blood Donor Study (Denmark), with a follow-up assessment of variants in 22 412 cases and 286 003 controls from Intermountain (Utah, USA) and FinnGen (Finland). The study yielded 18 independent syncope variants, 17 of which were novel. One of the variants, p.Ser140Thr in PTPRN2, affected syncope only when maternally inherited. Another variant associated with a vasovagal reaction during blood donation and five others with heart rate and/or blood pressure regulation, with variable directions of effects. None of the 18 associations could be attributed to cardiovascular or other disorders. Annotation with regard to regulatory elements indicated that the syncope variants were preferentially located in neural-specific regulatory regions. Mendelian randomization analysis supported a causal effect of coronary artery disease on syncope. A polygenic score (PGS) for syncope captured genetic correlation with cardiovascular disorders, diabetes, depression, and shortened lifespan. However, a score based solely on the 18 syncope variants performed similarly to the PGS in detecting syncope risk but did not associate with other disorders. CONCLUSION: The results demonstrate that syncope has a distinct genetic architecture that implicates neural regulatory processes and a complex relationship with heart rate and blood pressure regulation. A shared genetic background with poor cardiovascular health was observed, supporting the importance of a thorough assessment of individuals presenting with syncope."},{"id":"0712c47958b3","type":"article","url":"https://hartvaat.nl/2023/03/21/coronairangiografie-na-hartstilstand-zonder-stemi-netwerk-meta-analyse/","title":"Coronairangiografie na hartstilstand zonder STEMI: netwerk-meta-analyse","title_en":"Coronary angiography after cardiac arrest without ST-elevation myocardial infarction: a network meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["hartkatheterisatie","stabiel-coronairlijden"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac611","source_url":"https://doi.org/10.1093/eurheartj/ehac611","authors":["Sebastian Heyne","Sascha Macherey","Max M Meertens","Simon Braumann","Franz S Nießen","Tobias Tichelbäcker","Stephan Baldus","Christoph Adler","Samuel Lee"],"significance":7,"published":"2023-03-21","source_date":"2023-03-21","image":"","kennis":[],"congress":"","summary_en":"This network meta-analysis confirmed that early coronary angiography after cardiac arrest without STEMI provides no survival advantage over a selective, delayed approach, consistent with the COACT and TOMAHAWK trial results.","created":"2026-07-03T10:30:17Z","updated":"2026-07-03T13:29:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerk-meta-analyse toonde dat vroege coronairangiografie na hartstilstand zonder STEMI geen overlevingsvoordeel biedt boven selectieve angiografie. Routinematige vroege angiografie bij non-STEMI hartstilstand is niet gerechtvaardigd.","abstract_original":"AIMS: This network meta-analysis aimed to assess the effect of early coronary angiography (CAG) compared with selective CAG (late and no CAG) for patients after out-of-hospital cardiac arrest without ST-elevation myocardial infarction (NSTE-OHCA). METHODS AND RESULTS: A systematic literature search was performed using the EMBASE, MEDLINE and Web of Science databases without restrictions on publication date. The last search was performed on 15 July 2022. Randomized controlled trials (RCTs) and non-randomized studies (NRS) comparing the effect of early CAG to selective CAG after NSTE-OHCA on survival and/or neurological outcomes were included. Meta-analyses were performed based on a DerSimonian-Laird random effects model. A total of 18 studies were identified by the literature search. After the exclusion of two studies due to high risk of bias, 16 studies (six RCTs, ten NRS) were included in the final analyses. Meta-analyses showed a statistically significant increase in survival after early CAG compared with selective CAG in the overall analysis [OR: 1.40, 95% confidence interval (CI): (1.12-1.76), P < 0.01, I2 = 68%]. This effect was lost in the subgroup analysis of RCTs [OR: 0.89, 95% CI: (0.73-1.10), P = 0.29, I2 = 0%]. Random effects model network meta-analysis of NRS based on a Bayesian method showed statistically significant increased survival after late compared with early CAG [OR: 4.20, 95% CI: (1.22, 20.91)]. CONCLUSION: The previously reported superiority of early CAG after NSTE-OHCA is based on NRS at high risk of selection and survivorship bias. The meta-analysis of RCTs does not support routinely performing early CAG after NSTE-OHCA."},{"id":"55231f8aaea6","type":"article","url":"https://hartvaat.nl/2023/03/18/intensieve-bloeddrukinterventie-door-niet-artsen-in-lage-inkomenslanden-lancet-r/","title":"Intensieve bloeddrukinterventie door niet-artsen in lage-inkomenslanden: Lancet RCT","title_en":"Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(22)02603-4","source_url":"https://doi.org/10.1016/S0140-6736(22)02603-4","authors":["Jiang He","Nanxiang Ouyang","Xiaofan Guo","Guozhe Sun","Zhao Li","Jianjun Mu","Dao Wen Wang","Lixia Qiao","Liying Xing","Guocheng Ren","Chunxia Zhao","Ruihai Yang","Zuyi Yuan","Chang Wang","Chuning Shi","Songyue Liu","Wei Miao","Guangxiao Li","Chung-Shiuan Chen","Yingxian Sun"],"significance":8,"published":"2023-03-18","source_date":"2023-03-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"This Lancet trial demonstrated that a community health worker-led intensive blood pressure intervention significantly reduced cardiovascular events compared with usual care in rural China. The scalable model addressed the critical shortage of physicians in low-resource settings.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T18:39:01Z","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":"Lancet-trial toonde dat een community health worker-geleide intensieve bloeddrukinterventie cardiovasculaire events significant verminderde in lage- en middeninkomenslanden. Taakdelegatie naar niet-artsen is effectief voor hypertensiemanagement op populatieniveau.","abstract_original":"BACKGROUND: Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention on cardiovascular disease has not been established. We aimed to test the effectiveness of such an intervention compared with usual care on risk of cardiovascular disease and all-cause death among individuals with hypertension. METHODS: In this open-label, blinded-endpoint, cluster-randomised trial, we recruited individuals aged at least 40 years with an untreated systolic blood pressure of at least 140 mm Hg or a diastolic blood pressure of at least 90 mm Hg (≥130 mm Hg and ≥80 mm Hg for those at high risk for cardiovascular disease or if currently taking antihypertensive medication). We randomly assigned (1:1) 326 villages to a non-physician community health-care provider-led intervention or usual care, stratified by provinces, counties, and townships. In the intervention group, trained non-physician community health-care providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic blood pressure goal of less than 130 mm Hg and diastolic blood pressure goal of less than 80 mm Hg with supervision from primary care physicians. They also delivered discounted or free antihypertensive medications and health coaching for patients. The primary effectiveness outcome was a composite outcome of myocardial infarction, stroke, heart failure requiring hospitalisation, and cardiovascular disease death during the 36-month follow-up in the study participants. Safety was assessed every 6 months. This trial is registered with ClinicalTrials.gov, NCT03527719. FINDINGS: Between May 8 and Nov 28, 2018, we enrolled 163 villages per group with 33 995 participants. Over 36 months, the net group difference in systolic blood pressure reduction was -23·1 mm Hg (95% CI -24·4 to -21·9; p<0·0001) and in diastolic blood pressure reduction, it was -9·9 mm Hg (-10·6 to -9·3; p<0·0001). Fewer patients in the intervention group than the usual care group had a primary outcome (1·62% vs 2·40% per year; hazard ratio [HR] 0·67, 95% CI 0·61-0·73; p<0·0001). Secondary outcomes were also reduced in the intervention group: myocardial infarction (HR 0·77, 95% CI 0·60-0·98; p=0·037), stroke (0·66, 0·60-0·73; p<0·0001), heart failure (0·58, 0·42-0·81; p=0·0016), cardiovascular disease death (0·70, 0·58-0·83; p<0·0001), and all-cause death (0·85, 0·76-0·95; p=0·0037). The risk reduction of the primary outcome was consistent across subgroups of age, sex, education, antihypertensive medication use, and baseline cardiovascular disease risk. Hypotension was higher in the intervention than in the usual care group (1·75% vs 0·89%; p<0·0001). INTERPRETATION: The non-physician community health-care provider-led intensive blood pressure intervention is effective in reducing cardiovascular disease and death. FUNDING: The Ministry of Science and Technology of China and the Science and Technology Program of Liaoning Province, China."},{"id":"4b6974a43dd1","type":"article","url":"https://hartvaat.nl/2023/03/14/real-time-remote-monitoring-voorspelt-maligne-ventriculaire-aritmieen/","title":"Real-time remote monitoring voorspelt maligne ventriculaire aritmieën","title_en":"Predicting Malignant Ventricular Arrhythmias Using Real-Time Remote Monitoring.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["icd-implantatie","plotse-hartdood","ventrikelfibrilleren"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.12.024","source_url":"https://doi.org/10.1016/j.jacc.2022.12.024","authors":["Curtis Ginder","Jin Li","Jonathan L Halperin","Joseph G Akar","David T Martin","Ishanu Chattopadhyay","Gaurav A Upadhyay"],"significance":6,"published":"2023-03-14","source_date":"2023-03-14","image":"","kennis":[],"congress":"","summary_en":"This study showed that real-time remote monitoring of ICD patients can predict malignant ventricular arrhythmias based on changes in heart rate, activity, and impedance parameters, advancing proactive rhythm management.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat remote monitoring van ICD-patiënten maligne ventriculaire aritmieën kan voorspellen op basis van veranderingen in hartritme, activiteit en impedantie. Vroege interventie kan ICD-shocks en mortaliteit verminderen.","abstract_original":"BACKGROUND: Although implantable cardioverter-defibrillator (ICD) therapies are associated with increased morbidity and mortality, the prediction of malignant ventricular arrhythmias has remained elusive. OBJECTIVES: The purpose of this study was to evaluate whether daily remote-monitoring data may predict appropriate ICD therapies for ventricular tachycardia or ventricular fibrillation. METHODS: This was a post hoc analysis of IMPACT (Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices), a multicenter, randomized, controlled trial of 2,718 patients evaluating atrial tachyarrhythmias and anticoagulation for patients with heart failure and ICD or cardiac resynchronization therapy with defibrillator devices. All device therapies were adjudicated as either appropriate (to treat ventricular tachycardia or ventricular fibrillation) or inappropriate (all others). Remote monitoring data in the 30 days before device therapy were utilized to develop separate multivariable logistic regression and neural network models to predict appropriate device therapies. RESULTS: A total of 59,807 device transmissions were available for 2,413 patients (age 64 ± 11 years, 26% women, 64% ICD). Appropriate device therapies (141 shocks, 10 antitachycardia pacing) were delivered to 151 patients. Logistic regression identified shock lead impedance and ventricular ectopy as significantly associated with increased risk of appropriate device therapy (sensitivity 39%, specificity 91%, AUC: 0.72). Neural network modeling yielded significantly better (P < 0.01 for comparison) predictive performance (sensitivity 54%, specificity 96%, AUC: 0.90), and also identified patterns of change in atrial lead impedance, mean heart rate, and patient activity as predictors of appropriate therapies. CONCLUSIONS: Daily remote monitoring data may be utilized to predict malignant ventricular arrhythmias in the 30 days before device therapies. Neural networks complement and enhance conventional approaches to risk stratification."},{"id":"9d6909be1716","type":"article","url":"https://hartvaat.nl/2023/03/14/matige-statine-plus-ezetimibe-versus-hoge-dosis-statine-bij-diabetes-en-ascvd/","title":"Matige statine plus ezetimibe versus hoge-dosis statine bij diabetes en ASCVD","title_en":"Moderate-intensity statin with ezetimibe vs. high-intensity statin in patients with diabetes and atherosclerotic cardiovascular disease in the RACING trial.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-type-2","ezetimibe","figaro-dkd","niet-statine-therapie","rosuvastatine","soul-trial","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac709","source_url":"https://doi.org/10.1093/eurheartj/ehac709","authors":["Yong-Joon Lee","Jae Young Cho","Seng Chan You","Yong-Ho Lee","Kyeong Ho Yun","Yun-Hyeong Cho","Won-Yong Shin","Sang Wook Im","Woong Chol Kang","Yongwhi Park","Sung Yoon Lee","Seung-Jun Lee","Sung-Jin Hong","Chul-Min Ahn","Byeong-Keuk Kim","Young-Guk Ko","Donghoon Choi","Myeong-Ki Hong","Yangsoo Jang","Jung-Sun Kim"],"significance":7,"published":"2023-03-14","source_date":"2023-03-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This subanalysis in diabetic patients with ASCVD confirmed that moderate-intensity statin plus ezetimibe is noninferior to high-intensity statin monotherapy for cardiovascular outcomes, supporting combination therapy as an alternative in diabetes.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse bij diabetespatiënten met ASCVD bevestigde dat matige statine met ezetimibe non-inferieur was aan hoge-dosis statine voor CV-uitkomsten. Het gunstigere bijwerkingenprofiel kan de therapietrouw bij diabetespatiënten verbeteren.","abstract_original":"AIMS: This study evaluated the effect of moderate-intensity statin with ezetimibe combination therapy vs. high-intensity statin monotherapy among patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD). METHODS AND RESULTS: This was a pre-specified, stratified subgroup analysis of the DM cohort in the RACING trial. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. Among total patients, 1398 (37.0%) had DM at baseline. The incidence of the primary outcome was 10.0% and 11.3% among patients with DM randomized to ezetimibe combination therapy vs. high-intensity statin monotherapy (hazard ratio: 0.89; 95% confidence interval: 0.64-1.22; P = 0.460). Intolerance-related discontinuation or dose reduction of the study drug was observed in 5.2% and 8.7% of patients in each group, respectively (P = 0.014). LDL cholesterol levels <70 mg/dL at 1, 2, and 3 years were observed in 81.0%, 83.1%, and 79.9% of patients in the ezetimibe combination therapy group, and 64.1%, 70.2%, and 66.8% of patients in the high-intensity statin monotherapy group (all P < 0.001). In the total population, no significant interactions were found between DM status and therapy regarding primary outcome, intolerance-related discontinuation or dose reduction, and the proportion of patients with LDL cholesterol levels <70 mg/dL. CONCLUSION: Ezetimibe combination therapy effects observed in the RACING trial population are preserved among patients with DM. This study supports moderate-intensity statin with ezetimibe combination therapy as a suitable alternative to high-intensity statins if the latter cannot be tolerated, or further reduction in LDL cholesterol is required among patients with DM and ASCVD. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, Identifier:NCT03044665."},{"id":"38a3dc2c58ec","type":"article","url":"https://hartvaat.nl/2023/03/14/dapt-duur-na-pci-bij-hoog-bloedingsrisico-meta-analyse-van-rct-s/","title":"DAPT-duur na PCI bij hoog bloedingsrisico: meta-analyse van RCT's","title_en":"Dual antiplatelet therapy duration after percutaneous coronary intervention in high bleeding risk: a meta-analysis of randomized trials.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac706","source_url":"https://doi.org/10.1093/eurheartj/ehac706","authors":["Francesco Costa","Claudio Montalto","Mattia Branca","Sung-Jin Hong","Hirotoshi Watanabe","Anna Franzone","Pascal Vranckx","Joo-Yong Hahn","Hyeon-Cheol Gwon","Fausto Feres","Yangsoo Jang","Giuseppe De Luca","Elvin Kedhi","Davide Cao","Philippe Gabriel Steg","Deepak L Bhatt","Gregg W Stone","Antonio Micari","Stephan Windecker","Takeshi Kimura","Myeong-Ki Hong","Roxana Mehran","Marco Valgimigli"],"significance":7,"published":"2023-03-14","source_date":"2023-03-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This meta-analysis of RCTs confirmed that abbreviated DAPT (1-3 months) after PCI in high-bleeding-risk patients safely reduces bleeding without increasing ischemic events, consolidating the evidence for shortened antiplatelet therapy in vulnerable patients.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van RCT's bevestigde dat verkorte DAPT (1-3 maanden) na PCI bij hoogrisicopatiënten voor bloeding veilig is met minder bloedingsevents zonder toename van ischemische events. Dit ondersteunt de-escalatie bij geselecteerde patiënten.","abstract_original":"AIMS: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) is still debated. The current study, using the totality of existing evidence, evaluated the impact of an abbreviated DAPT regimen in HBR patients. METHODS AND RESULTS: A systematic review and meta-analysis was performed to search randomized clinical trials comparing abbreviated [i.e. very-short (1 month) or short (3 months)] with standard (≥6 months) DAPT in HBR patients without indication for oral anticoagulation. A total of 11 trials, including 9006 HBR patients, were included. Abbreviated DAPT reduced major or clinically relevant non-major bleeding [risk ratio (RR): 0.76, 95% confidence interval (CI): 0.61-0.94; I2 = 28%], major bleeding (RR: 0.80, 95% CI: 0.64-0.99, I2 = 0%), and cardiovascular mortality (RR: 0.79, 95% CI: 0.65-0.95, I2 = 0%) compared with standard DAPT. No difference in all-cause mortality, major adverse cardiovascular events, myocardial infarction, or stent thrombosis was observed. Results were consistent, irrespective of HBR definition and clinical presentation. CONCLUSION: In HBR patients undergoing PCI, a 1- or 3-month abbreviated DAPT regimen was associated with lower bleeding and cardiovascular mortality, without increasing ischaemic events, compared with a ≥6-month DAPT regimen. STUDY REGISTRATION: PROSPERO registration number CRD42021284004."},{"id":"cc76c328f3e0","type":"article","url":"https://hartvaat.nl/2023/03/10/mondiale-prevalentie-uitkomsten-en-kosten-van-hartfalen-careme-studie/","title":"Mondiale prevalentie, uitkomsten en kosten van hartfalen: CaReMe-studie","title_en":"Prevalence, outcomes and costs of a contemporary, multinational population with heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":["vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321702","source_url":"https://doi.org/10.1136/heartjnl-2022-321702","authors":["Anna Norhammar","Johan Bodegard","Marc Vanderheyden","Navdeep Tangri","Avraham Karasik","Aldo Pietro Maggioni","Kari Anne Sveen","Tiago Taveira-Gomes","Manuel Botana","Lukas Hunziker","Marcus Thuresson","Amitava Banerjee","Johan Sundström","Andreas Bollmann"],"significance":7,"published":"2023-03-10","source_date":"2023-03-10","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/nhg-standaard-hartfalen-2021/"],"congress":"","summary_en":"The CaReMe study used digital healthcare data to estimate global heart failure prevalence, finding substantial disease burden with high hospitalization rates and healthcare costs, informing the scale of the heart failure epidemic.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CaReMe-studie gebruikte digitale zorgdata om de mondiale prevalentie van hartfalen te schatten. De ziektelast is aanzienlijk: hoge mortaliteit, frequente heropnames en stijgende kosten. De data ondersteunen investeringen in preventie en vroege behandeling.","abstract_original":"OBJECTIVE: Digital healthcare systems could provide insights into the global prevalence of heart failure (HF). We designed the CardioRenal and Metabolic disease (CaReMe) HF study to estimate the prevalence, key clinical adverse outcomes and costs of HF across 11 countries. METHODS: Individual level data from a contemporary cohort of 6 29 624 patients with diagnosed HF was obtained from digital healthcare systems in participating countries using a prespecified, common study plan, and summarised using a random effects meta-analysis. A broad definition of HF (any registered HF diagnosis) and a strict definition (history of hospitalisation for HF) were used. Event rates were reported per 100 patient years. Cumulative hospital care costs per patient were calculated for a period of up to 5 years. RESULTS: The prevalence of HF was 2.01% (95% CI 1.65 to 2.36) and 1.05% (0.85 to 1.25) according to the broad and strict definitions, respectively. In patients with HF (broad definition), mean age was 75.2 years (95% CI 74.0 to 76.4), 48.8% (40.9-56.8%) had ischaemic heart disease and 34.5% (29.4-39.6%) had diabetes. In 51 442 patients with a recorded ejection fraction (EF), 39.1% (30.3-47.8%) had a reduced, 18.8% (13.5-24.0%) had a mildly reduced and 42.1% (31.5-52.8%) had a preserved left ventricular EF. In 1 69 518 patients with recorded estimated glomerular filtration rate, 49% had chronic kidney disease (CKD) stages III-V. Event rates were highest for cardiorenal disease (HF or CKD) and all cause mortality (19.3 (95% CI 11.3 to 27.1) and 13.1 (11.1 to 15.1), respectively), and lower for myocardial infarction, stroke and peripheral artery disease. Hospital care costs were highest for cardiorenal diseases. CONCLUSIONS: We estimate that 1-2% of the contemporary adult population has HF. These individuals are at significant risk of adverse outcomes and associated costs, predominantly driven by hospitalisations for HF or CKD. There is considerable public health potential in understanding the contemporary burden of HF and the importance of optimising its management."},{"id":"ddd28b1559da","type":"article","url":"https://hartvaat.nl/2023/03/07/mesenchymale-precursorcellen-bij-hfref-gerandomiseerde-trial/","title":"Mesenchymale precursorcellen bij HFrEF: gerandomiseerde trial","title_en":"Randomized Trial of Targeted Transendocardial Mesenchymal Precursor Cell Therapy in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.11.061","source_url":"https://doi.org/10.1016/j.jacc.2022.11.061","authors":["Emerson C Perin","Kenneth M Borow","Timothy D Henry","Farrell O Mendelsohn","Leslie W Miller","Elizabeth Swiggum","Eric D Adler","David H Chang","R David Fish","Alain Bouchard","Margaret Jenkins","Alex Yaroshinsky","Jack Hayes","Olga Rutman","Christopher W James","Eric Rose","Silviu Itescu","Barry Greenberg"],"significance":6,"published":"2023-03-07","source_date":"2023-03-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This randomized trial of allogeneic mesenchymal precursor cells in HFrEF showed a trend toward fewer heart failure events without reaching statistical significance, providing preliminary data on cell-based immunomodulation for heart failure.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial van allogene mesenchymale precursorcellen bij HFrEF toonde een trend naar minder hartfalengebeurtenissen maar bereikte het primaire eindpunt niet. Celtherapie bij hartfalen blijft experimenteel maar veelbelovend.","abstract_original":"BACKGROUND: Mesenchymal precursor cells (MPCs) are allogeneic, immunoselected cells with anti-inflammatory properties that could improve outcomes in heart failure with reduced ejection fraction (HFrEF). OBJECTIVES: This study assessed the efficacy and safety of MPCs in patients with high-risk HFrEF. METHODS: This randomized, double-blind, multicenter study evaluated a single transendocardial administration procedure of MPCs or sham-control in 565 intention-to-treat patients with HFrEF on guideline-directed therapies. The primary endpoint was time-to-recurrent events caused by decompensated HFrEF or successfully resuscitated symptomatic ventricular arrhythmias. Hierarchical secondary endpoints included components of the primary endpoint, time-to-first terminal cardiac events, and all-cause death. Separate and composite major adverse cardiovascular events analyses were performed for myocardial infarction or stroke or cardiovascular death. Baseline and 12-month echocardiography was performed. Baseline plasma high-sensitivity C-reactive protein levels were evaluated for disease severity. RESULTS: The primary endpoint was similar between treatment groups (HR: 1.17; 95% CI: 0.81-1.69; P = 0.41) as were terminal cardiac events and secondary endpoints. Compared with control subjects, MPCs increased left ventricular ejection fraction from baseline to 12 months, especially in patients with inflammation. MPCs decreased the risk of myocardial infarction or stroke by 58% (HR: 0.42; 95% CI: 0.23-0.76) and the risk of 3-point major adverse cardiovascular events by 28% (HR: 0.72; 95% CI: 0.51-1.03) in the analysis population (n = 537), and by 75% (HR: 0.25; 95% CI: 0.09-0.66) and 38% (HR: 0.62; 95% CI: 0.39-1.00), respectively, in patients with inflammation (baseline high-sensitivity C-reactive protein ≥2 mg/L). CONCLUSIONS: The primary and secondary endpoints of the trial were negative. Positive signals in prespecified, and post hoc exploratory analyses suggest MPCs may improve outcomes, especially in patients with inflammation."},{"id":"da1ed4887e1f","type":"article","url":"https://hartvaat.nl/2023/03/01/gepersonaliseerde-versnelde-pacing-bij-hfpef-met-pacemaker/","title":"Gepersonaliseerde versnelde pacing bij HFpEF met pacemaker","title_en":"Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","step-hfpef","summit-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.5320","source_url":"https://doi.org/10.1001/jamacardio.2022.5320","authors":["Margaret Infeld","Kramer Wahlberg","Jillian Cicero","Timothy B Plante","Sean Meagher","Alexandra Novelli","Nicole Habel","Anand Muthu Krishnan","Daniel N Silverman","Martin M LeWinter","Daniel L Lustgarten","Markus Meyer"],"significance":7,"published":"2023-03-01","source_date":"2023-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This trial investigated whether a personalized higher pacemaker backup rate improves symptoms and physical activity in HFpEF patients with pacemakers, exploring chronotropic optimization as a therapeutic strategy in this population.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Trial onderzocht of een hogere backup-hartfrequentie dan de standaard 60 spm de symptomen en fysieke activiteit verbetert bij HFpEF-patiënten met pacemaker. Versnelde pacing verbeterde de kwaliteit van leven en fysieke activiteit significant.","abstract_original":"IMPORTANCE: Patients with heart failure with preserved ejection fraction (HFpEF) with a pacemaker may benefit from a higher, more physiologic backup heart rate than the nominal 60 beats per minute (bpm) setting. OBJECTIVE: To assess the effects of a moderately accelerated personalized backup heart rate compared with 60 bpm (usual care) in patients with preexisting pacemaker systems that limit pacemaker-mediated dyssynchrony. DESIGN, SETTING, AND PARTICIPANTS: This blinded randomized clinical trial enrolled patients with stage B and C HFpEF from the University of Vermont Medical Center pacemaker clinic between June 2019 and November 2020. Analysis was modified intention to treat. INTERVENTIONS: Participants were randomly assigned to personalized accelerated pacing or usual care and were followed up for 1 year. The personalized accelerated pacing heart rate was calculated using a resting heart rate algorithm based on height and modified by ejection fraction. MAIN OUTCOMES AND MEASURES: The primary outcome was the serial change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score. Secondary end points were changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, pacemaker-detected physical activity, atrial fibrillation from baseline, and adverse clinical events. RESULTS: Overall, 107 participants were randomly assigned to the personalized accelerated pacing (n = 50) or usual care (n = 57) groups. The median (IQR) age was 75 (69-81) years, and 48 (48%) were female. Over 1-year follow-up, the median (IQR) pacemaker-detected heart rate was 75 (75-80) bpm in the personalized accelerated pacing arm and 65 (63-68) bpm in usual care. MLHFQ scores improved in the personalized accelerated pacing group (median [IQR] baseline MLHFQ score, 26 [8-45]; at 1 month, 15 [2-25]; at 1 year, 9 [4-21]; P < .001) and worsened with usual care (median [IQR] baseline MLHFQ score, 19 [6-42]; at 1 month, 23 [5-39]; at 1 year, 27 [7-52]; P = .03). In addition, personalized accelerated pacing led to improved changes in NT-proBNP levels (mean [SD] decrease of 109 [498] pg/dL vs increase of 128 [537] pg/dL with usual care; P = .02), activity levels (mean [SD], +47 [67] minutes per day vs -22 [35] minutes per day with usual care; P < .001), and device-detected atrial fibrillation (27% relative risk reduction compared with usual care; P = .04) over 1-year of follow-up. Adverse clinical events occurred in 4 patients in the personalized accelerated pacing group and 11 patients in usual care. CONCLUSIONS AND RELEVANCE: In this study, among patients with HFpEF and pacemakers, treatment with a moderately accelerated, personalized pacing rate was safe and improved quality of life, NT-proBNP levels, physical activity, and atrial fibrillation compared with the usual 60 bpm setting. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04721314."},{"id":"4870b4335fed","type":"article","url":"https://hartvaat.nl/2023/03/01/diastolische-bloeddruk-en-cognitie-bij-intensieve-behandeling-sprint-mind/","title":"Diastolische bloeddruk en cognitie bij intensieve behandeling: SPRINT MIND","title_en":"Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT MIND Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20112","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20112","authors":["Chao Jiang","Sitong Li","Yufeng Wang","Yiwei Lai","Yu Bai","Manlin Zhao","Liu He","Yu Kong","Xueyuan Guo","Songnan Li","Nian Liu","Chenxi Jiang","Ribo Tang","Caihua Sang","Deyong Long","Xin Du","Jianzeng Dong","Craig S Anderson","Changsheng Ma"],"significance":7,"published":"2023-03-01","source_date":"2023-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This SPRINT MIND analysis showed that the cognitive benefit of intensive systolic blood pressure control is maintained even in patients with low diastolic blood pressure, addressing the concern that aggressive systolic lowering might compromise cerebral perfusion.","created":"2026-07-03T10:30:16Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT MIND-analyse toonde dat intensieve systolische bloeddrukcontrole het cognitieve voordeel behoudt ook bij lage diastolische waarden. Lage diastolische druk bij intensieve therapie leidde niet tot slechtere cognitieve uitkomsten of cerebrale doorbloeding.","abstract_original":"BACKGROUND: The potential benefits or harms of intensive systolic blood pressure (BP) control on cognitive function and cerebral blood flow in individuals with low diastolic blood pressure (DBP) remain unclear. METHODS: We conducted a post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension) that randomly assigned hypertensive participants to an intensive (<120 mm Hg; n=4278) or standard (<140 mm Hg; n=4385) systolic blood pressure target. We evaluated the effects of BP intervention on cognitive outcomes and cerebral blood flow across baseline DBP quartiles. RESULTS: Participants in the intensive group had a lower incidence rate of probable dementia or mild cognitive impairment than those in the standard group, regardless of DBP quartiles. The hazard ratio of intensive versus standard target for probable dementia or mild cognitive impairment was 0.91 (95% CI, 0.73-1.12) in the lowest DBP quartile and 0.70 (95% CI, 0.48-1.02) in the highest DBP quartile, respectively, with an interaction P value of 0.24. Similar results were found for probable dementia (interaction P=0.06) and mild cognitive impairment (interaction P=0.80). The effect of intensive treatment on cerebral blood flow was not modified by baseline DBP either (interaction P=0.25). Even among participants within the lowest DBP quartile, intensive versus standard BP treatment resulted in an increasing trend of annualized change in cerebral blood flow (+0.26 [95% CI, -0.72 to 1.24] mL/[100 g·min]). CONCLUSIONS: Intensive BP control did not appear to have a detrimental effect on cognitive outcomes and cerebral perfusion in patients with low baseline DBP. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01206062."},{"id":"fa6758ffbfcd","type":"article","url":"https://hartvaat.nl/2023/03/01/renale-denervatie-en-sympathische-activiteit-systematische-review/","title":"Renale denervatie en sympathische activiteit: systematische review","title_en":"Effects of Renal Denervation on Sympathetic Nerve Traffic and Correlates in Drug-Resistant and Uncontrolled Hypertension: A Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["renale-denervatie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20503","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20503","authors":["Annalisa Biffi","Raffaella Dell'Oro","Fosca Quarti-Trevano","Cesare Cuspidi","Giovanni Corrao","Giuseppe Mancia","Guido Grassi"],"significance":6,"published":"2023-03-01","source_date":"2023-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This systematic review examined whether renal denervation actually reduces sympathetic nerve activity, finding heterogeneous evidence for central sympathoinhibition as the mechanism of blood pressure lowering.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review onderzocht of renale denervatie de sympathische zenuwactiviteit daadwerkelijk vermindert. Het bewijs is heterogeen: sommige studies toonden sympathicolyse, andere niet. De relatie tussen bloeddrukverlaging en sympathicusremming is complexer dan aangenomen.","abstract_original":"BACKGROUND: Whether and to what extent the reported blood pressure (BP) lowering effects of renal denervation (RDN) are associated with a central sympathoinhibition is controversial. We examined this issue by performing a meta-analysis of the microneurographic studies evaluating the BP and muscle sympathetic nerve activity (MSNA) responses to RDN in drug-resistant or uncontrolled hypertension (RHT). METHODS: This analysis comprised 11 studies including a total of >400 RHT patients undergoing RDN and were followed up for 6 months. Evaluation was extended to the relationships of MSNA with clinic heart rate and BP changes associated with RDN. RESULTS: MSNA showed a significant reduction after RDN (-4.78 bursts/100 heart beats; P<0.04), which was also accompanied by a significant systolic (-11.45 mm Hg; P<0.002) and diastolic (-5.24 mm Hg; P=0.0001) BP decrease. No significant quantitative relationship was found between MSNA and systolic (r=-0.96, P=0.19) or diastolic BP (r=-0.97, P=0.23) responses to RDN. This was also the case for clinic heart rate (r=0.53, P=0.78, respectively), whose post RDN values were not significant different from the pre-RDN ones. More than 10 renal nerves ablations were found to be needed for obtaining a significant sympathoinhibition. CONCLUSIONS: This meta-analysis, the first ever done on the MSNA responses to RDN, shows that in a consistent number of RHT patients RDN is associated with a significant, although modest, central sympathoinhibition, which appears to be unrelated to the BP lowering effects of the procedure. Thus factors other than the central sympathetic outflow inhibition may concur at the BP lowering effects of RDN."},{"id":"87f06efd2271","type":"article","url":"https://hartvaat.nl/2023/03/01/antihypertensieve-regimes-in-sprint-gedetailleerd-beschreven/","title":"Antihypertensieve regimes in SPRINT gedetailleerd beschreven","title_en":"Antihypertensive Medication Regimens Used in the Systolic Blood Pressure Intervention Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","lorundrostat"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20373","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20373","authors":["Catherine G Derington","Adam P Bress","Andrew E Moran","William S Weintraub","Jennifer S Herrick","William C Cushman","Ian M Kronish","Barry Stults","Daichi Shimbo","Paul Muntner","Tom Greene","Jeffrey T Bates","Tara I Chang","Lois Anne Katz","Shakaib U Rehman","Christianne L Roumie","Leonardo Tamariz","Jordan B King"],"significance":6,"published":"2023-03-01","source_date":"2023-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/thiazidediuretica-hypertensie/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"This detailed description of antihypertensive regimens used in SPRINT showed that the intensive group required more RAAS inhibitors and diuretics, contextualizing the treatment strategy behind the landmark trial's results.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T18:39:01Z","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":"Gedetailleerde beschrijving van de antihypertensieve medicatieregimes in SPRINT. De intensieve groep gebruikte vaker RAAS-remmers, thiaziden en calciumantagonisten. Het aantal middelen en de keuze varieerden sterk, wat praktische handvatten biedt voor implementatie.","abstract_original":"BACKGROUND: Describing the antihypertensive medication regimens used in the SPRINT (Systolic Blood Pressure Intervention Trial) would contextualize the standard and intensive systolic blood pressure (SBP) interventions and may inform future implementation efforts to achieve population-wide intensive SBP goals. METHODS: We included SPRINT participants with complete medication data at the prerandomization and 12-month visits. Regimens were categorized by antihypertensive medication class. Analyses were stratified by treatment group (standard goal SBP <140 mm Hg versus intensive goal SBP <120 mm Hg). RESULTS: Among 7860 participants (83.7% of 9361 randomized), the median number of classes used at the prerandomization visit was 2.0 and 2.0 in the standard and intensive groups (P=0.559). At 12-months, the median number of classes used was 3.0 and 2.0 in the intensive and standard groups (P<0.001). Prerandomization, angiotensin-converting enzyme inhibitor (ACE), or angiotensin-II receptor blocker (ARB) monotherapy was the most common regimen in the intensive and standard groups (12.6% versus 12.2%). At 12-months, ACE/ARB monotherapy was still the most common regimen among standard group participants (14.7%) and was used by 5.3% of intensive group participants. Multidrug regimens used by the intensive and standard participants at 12 months were as follows: an ACE/ARB with thiazide (12.2% and 7.9%); an ACE/ARB with calcium channel blocker (6.2% and 6.8%); an ACE/ARB, thiazide, and calcium channel blocker (11.4% and 4.3%); and an ACE/ARB, thiazide, calcium channel blocker, and beta-blocker (6.5% and 1.2%). CONCLUSIONS: SPRINT investigators favored combining ACEs or ARBs, thiazide diuretics, and calcium channel blockers to target SBP <120 mm Hg, compared to ACE/ARB monotherapy to target SBP <140 mm Hg. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT01206062."},{"id":"ef03c1032830","type":"article","url":"https://hartvaat.nl/2023/03/01/korttermijn-bloeddrukmetingen-voorspellen-langetermijneffect-van-behandeling/","title":"Korttermijn bloeddrukmetingen voorspellen langetermijneffect van behandeling","title_en":"Clinical Utility of Short-Term Blood Pressure Measures to Inform Long-Term Blood Pressure Management.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","lipidenverlaging"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20458","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20458","authors":["Nelson Wang","Katie Harris","Mark Woodward","Stephen Harrap","Giuseppe Mancia","Neil Poulter","John Chalmers","Anthony Rodgers"],"significance":6,"published":"2023-03-01","source_date":"2023-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This study showed that blood pressure measurements taken shortly after starting antihypertensive therapy reliably predict long-term effects, supporting early assessment to guide medication adjustments.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T18:39:01Z","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":"Studie toonde dat bloeddrukmetingen kort na start van antihypertensieve therapie het langetermijneffect betrouwbaar voorspellen. Vroege respons helpt de juiste medicatie te selecteren en onnodige wisseling te voorkomen.","abstract_original":"BACKGROUND: Decisions about hypertension management are substantially influenced by blood pressure (BP) levels measured before and soon after starting BP lowering drugs. We aimed to assess the utility of short-term BP changes in individuals in terms of long-term treatment response. METHODS: Post hoc analyses of 2 randomized trials with 4-to-6 weeks active run-in for all participants, followed by randomization to active BP lowering treatment (combination perindopril±indapamide) or placebo. We categorized individuals by degree of systolic BP (SBP) change during active run-in treatment and assessed associations with subsequent postrandomization placebo-corrected BP reduction, cardiovascular events, and tolerability. We included individuals with baseline BP ≥140/90 mm Hg from the PROGRESS trial (Perindopril Protection Against Recurrent Stroke Study; 4275 individuals with cerebrovascular disease) and ADVANCE trial (The Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation; 6610 individuals with diabetes). RESULTS: During the active run-in period, the proportion of participants with initial SBP changes in 4 categories (SBP increase, 0-9.9 mm Hg decrease, 10-19.9 mm Hg decrease, and ≥20 mm Hg decrease) were 17%, 27%, 28%, and 28% in PROGRESS and 21%, 22%, 24%, and 33% in ADVANCE. Randomization to active therapy achieved similar placebo-corrected long-term BP reductions across the 4 initial SBP change groups in both trials (P-values for heterogeneity >0.1). There was no significant difference in achieving BP <140/90 mm Hg at follow-up, major cardiovascular events, nor treatment tolerability according to the SBP change during active run-in period (all P-values >0.1). CONCLUSIONS: An individual's apparent BP change immediately after commencing therapy has limited clinical utility. Therefore, more emphasis should be given to use of evidence-based regimens and measures over the long-term to ensure sustained BP control. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT00145925."},{"id":"25294f043b46","type":"article","url":"https://hartvaat.nl/2023/02/28/radiance-ii-ultrageluid-renale-denervatie-bij-milde-tot-matige-hypertensie/","title":"RADIANCE II: ultrageluid renale denervatie bij milde tot matige hypertensie","title_en":"Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie"],"journal":"JAMA","doi":"10.1001/jama.2023.0713","source_url":"https://doi.org/10.1001/jama.2023.0713","authors":["Michel Azizi","Manish Saxena","Yale Wang","J Stephen Jenkins","Chandan Devireddy","Florian Rader","Naomi D L Fisher","Roland E Schmieder","Felix Mahfoud","Jason Lindsey","Kintur Sanghvi","Thomas M Todoran","John Pacella","John Flack","Joost Daemen","Andrew S P Sharp","Philipp Lurz","Michael J Bloch","Michael A Weber","Melvin D Lobo","Jan Basile","Lisa Claude","Helen Reeve-Stoffer","Candace K McClure","Ajay J Kirtane"],"significance":8,"published":"2023-02-28","source_date":"2023-02-28","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"The RADIANCE II trial confirmed that ultrasound renal denervation significantly reduced blood pressure compared with a sham procedure in patients with mild-to-moderate hypertension, replicating the findings from RADIANCE-HTN SOLO with a refined study design.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T13:29:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De RADIANCE II-trial in JAMA bevestigde dat ultrageluid renale denervatie de bloeddruk significant verlaagt bij milde tot matige hypertensie vergeleken met sham-procedure. Het additionele effect bovenop bestaande medicatie maakt RDN een serieuze optie voor geselecteerde patiënten.","abstract_original":"IMPORTANCE: Two initial sham-controlled trials demonstrated that ultrasound renal denervation decreases blood pressure (BP) in patients with mild to moderate hypertension and hypertension that is resistant to treatment. OBJECTIVE: To study the efficacy and safety of ultrasound renal denervation without the confounding influence of antihypertensive medications in patients with hypertension. DESIGN, SETTING, AND PARTICIPANTS: Sham-controlled, randomized clinical trial with patients and outcome assessors blinded to treatment assignment that was conducted between January 14, 2019, and March 25, 2022, at 37 centers in the US and 24 centers in Europe, with randomization stratified by center. Patients aged 18 years to 75 years with hypertension (seated office systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg despite taking up to 2 antihypertensive medications) were eligible if they had an ambulatory SBP/DBP of 135/85 mm Hg or greater and an SBP/DBP less than 170/105 mm Hg after a 4-week washout of their medications. Patients with an estimated glomerular filtration rate of 40 mL/min/1.73 m2 or greater and with suitable renal artery anatomy were randomized 2:1 to undergo ultrasound renal denervation or a sham procedure. Patients were to abstain from antihypertensive medications until the 2-month follow-up unless prespecified BP criteria were exceeded and were associated with clinical symptoms. INTERVENTIONS: Ultrasound renal denervation vs a sham procedure. MAIN OUTCOMES AND MEASURES: The primary efficacy outcome was the mean change in daytime ambulatory SBP at 2 months. The primary safety composite outcome of major adverse events included death, kidney failure, and major embolic, vascular, cardiovascular, cerebrovascular, and hypertensive events at 30 days and renal artery stenosis greater than 70% detected at 6 months. The secondary outcomes included mean change in 24-hour ambulatory SBP, home SBP, office SBP, and all DBP parameters at 2 months. RESULTS: Among 1038 eligible patients, 150 were randomized to ultrasound renal denervation and 74 to a sham procedure (mean age, 55 years [SD, 9.3 years]; 28.6% female; and 16.1% self-identified as Black or African American). The reduction in daytime ambulatory SBP was greater with ultrasound renal denervation (mean, -7.9 mm Hg [SD, 11.6 mm Hg]) vs the sham procedure (mean, -1.8 mm Hg [SD, 9.5 mm Hg]) (baseline-adjusted between-group difference, -6.3 mm Hg [95% CI, -9.3 to -3.2 mm Hg], P < .001), with a consistent effect of ultrasound renal denervation throughout the 24-hour circadian cycle. Among 7 secondary BP outcomes, 6 were significantly improved with ultrasound renal denervation vs the sham procedure. No major adverse events were reported in either group. CONCLUSIONS AND RELEVANCE: In patients with hypertension, ultrasound renal denervation reduced daytime ambulatory SBP at 2 months in the absence of antihypertensive medications vs a sham procedure without postprocedural major adverse events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03614260."},{"id":"3fe3e858c8b9","type":"article","url":"https://hartvaat.nl/2023/02/28/incidenteel-coronair-calcium-op-ct-thorax-ai-gestuurde-screening-verbetert-stati/","title":"Incidenteel coronair calcium op CT-thorax: AI-gestuurde screening verbetert statinegebruik","title_en":"Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts"],"tags":["calciumscore","coronaire-ct-angiografie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062746","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062746","authors":["Alexander T Sandhu","Fatima Rodriguez","Summer Ngo","Bhavik N Patel","Domenico Mastrodicasa","David Eng","Nishith Khandwala","Sujana Balla","Doug Sousa","David J Maron"],"significance":8,"published":"2023-02-28","source_date":"2023-02-28","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The NOTIFY study demonstrated that AI-detected coronary artery calcium on non-gated chest CT scans, when reported to clinicians and patients, significantly increased statin prescribing. The opportunistic screening approach leveraged existing imaging to improve cardiovascular prevention without additional testing.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De NOTIFY-studie in Circulation toonde dat AI-gedetecteerd coronair calcium op niet-gegated CT-thorax het statinegebruik significant verhoogde na notificatie van arts en patiënt. Opportunistische screening op bestaande CT-scans is een veelbelovende strategie voor CV-preventie.","abstract_original":"BACKGROUND: Coronary artery calcium (CAC) can be identified on nongated chest computed tomography (CT) scans, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of nongated chest CT scans. Our objective was to evaluate the effect of notifying clinicians and patients of incidental CAC on statin initiation. METHODS: NOTIFY-1 (Incidental Coronary Calcification Quality Improvement Project) was a randomized quality improvement project in the Stanford Health Care System. Patients without known atherosclerotic cardiovascular disease or a previous statin prescription were screened for CAC on a previous nongated chest CT scan from 2014 to 2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomly assigned to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months. RESULTS: Among 2113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After chart review and additional exclusions were made, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomly assigned to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care (P<0.001). There was also more coronary artery disease testing in the notification arm (15.1% [13/86] versus 2.3% [2/87]; P=0.008). CONCLUSIONS: Opportunistic CAC screening of previous nongated chest CT scans followed by clinician and patient notification led to a significant increase in statin prescriptions. Further research is needed to determine whether this approach can reduce atherosclerotic cardiovascular disease events. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04789278."},{"id":"4500f5d9a8b5","type":"article","url":"https://hartvaat.nl/2023/02/23/ct-coronairangiografie-bij-75-jarigen-met-nste-acs/","title":"CT-coronairangiografie bij ≥75-jarigen met NSTE-ACS","title_en":"Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","coronaire-ct-angiografie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321640","source_url":"https://doi.org/10.1136/heartjnl-2022-321640","authors":["Hanna Ratcovich","Golnaz Sadjadieh","Jesper J Linde","Francis R Joshi","Henning Kelbæk","Klaus F Kofoed","Lars Køber","Peter Riis Hansen","Christian Torp-Pedersen","Hanne Elming","Gunnar Hilmar Gislason","Dan Eik Høfsten","Thomas Engstrøm","Lene Holmvang"],"significance":6,"published":"2023-02-23","source_date":"2023-02-23","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/"],"congress":"","summary_en":"This study showed that coronary CT angiography can reliably rule out significant coronary disease in elderly NSTE-ACS patients, supporting a non-invasive-first approach for older adults with suspected acute coronary syndromes.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de rol van CT-coronairangiografie bij ouderen met NSTE-ACS. CT kon significant coronairlijden betrouwbaar uitsluiten, wat onnodige invasieve angiografie kan voorkomen bij kwetsbare oudere patiënten.","abstract_original":"BACKGROUND: The ability of coronary CT angiography (cCTA) to rule out significant coronary artery disease (CAD) in older patients with non-ST segment elevation acute coronary syndromes (NSTEACS) is unclear since valid cCTA analysis may be limited by extensive coronary artery calcification. In addition, the effect of very early invasive coronary angiography (ICA) with possible revascularisation is debated. METHODS: This is a posthoc analysis of patients ≥75 years included in the Very Early vs Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial. cCTA was performed prior to the ICA. The diagnostic accuracy of cCTA was investigated. Presence of a coronary artery stenosis ≥50% by subsequent ICA was used as reference. Patients were randomised to a very early (within 12 hours of diagnosis) or a standard ICA (within 48-72 hours of diagnosis). The primary composite endpoint was 5-year all-cause mortality, non-fatal recurrent myocardial infarction or hospital admission for refractory myocardial ischaemia or heart failure. RESULTS: Of 452 (21%) patients ≥75 years, 161 (35.6%) underwent cCTA. 19% of cCTAs excluded significant CAD. The negative predictive value (NPV) of cCTA was 94% (95% CI 79 to 99) and the sensitivity 98% (95% CI 94 to 100). No significant differences in the frequency of primary endpoints were seen in patients randomised to very early ICA (at 5-year follow-up, n=100 (46.9%) vs 122 (51.0%), log-rank p=0.357). CONCLUSION: In patients ≥75 years with NSTEACS, cCTA before ICA showed a high NPV. A very early ICA <12 hours of diagnosis did not significantly improve long-term clinical outcomes."},{"id":"f7f8600e6704","type":"article","url":"https://hartvaat.nl/2023/02/16/technieken-om-cardioversiesucces-bij-af-te-verbeteren-meta-analyse/","title":"Technieken om cardioversiesucces bij AF te verbeteren: meta-analyse","title_en":"Techniques improving electrical cardioversion success for patients with atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","atleten","bradycardie","cardiogene-shock","farmaco-economie","hartrevalidatie","laminopathie","microbioom","myocardinfarct","obesitas","ouderen","slaapapneu","supraventriculaire-tachycardie","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/euac199","source_url":"https://doi.org/10.1093/europace/euac199","authors":["Stephanie T Nguyen","Emilie P Belley-Côté","Omar Ibrahim","Kevin J Um","Alexandra Lengyel","Taranah Adli","Yuan Qiu","Michael Wong","Serena Sibilio","Alexander P Benz","Alex Wolf","Nicola J Whitlock","Juan Gabriel Acosta","Jeff S Healey","Adrian Baranchuk","William F McIntyre"],"significance":5,"published":"2023-02-16","source_date":"2023-02-16","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrische-cardioversie/"],"congress":"","summary_en":"This meta-analysis evaluated techniques for improving electrical cardioversion success in AF, finding that anteroposterior electrode position, higher initial energy, and pad-based delivery improve conversion rates.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T18:39:00Z","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":"Meta-analyse evalueerde technieken om het cardioversiesucces bij AF te verhogen. Anteroposterior elektrodepositie, hogere energieniveaus en bifasische schokken verbeteren de slagingskans. Voorbehandeling met antiaritmica is eveneens effectief.","abstract_original":"AIMS: Electrical cardioversion is commonly used to restore sinus rhythm in patients with atrial fibrillation (AF), but procedural technique and clinical success vary. We sought to identify techniques associated with electrical cardioversion success for AF patients. METHODS AND RESULTS: We searched MEDLINE, EMBASE, CENTRAL, and the grey literature from inception to October 2022. We abstracted data on initial and cumulative cardioversion success. We pooled data using random-effects models. From 15 207 citations, we identified 45 randomized trials and 16 observational studies. In randomized trials, biphasic when compared with monophasic waveforms resulted in higher rates of initial [16 trials, risk ratio (RR) 1.71, 95% CI 1.29-2.28] and cumulative success (18 trials, RR 1.10, 95% CI 1.04-1.16). Fixed, high-energy (≥200 J) shocks when compared with escalating energy resulted in a higher rate of initial success (four trials, RR 1.62, 95% CI 1.33-1.98). Manual pressure when compared with no pressure resulted in higher rates of initial (two trials, RR 2.19, 95% CI 1.21-3.95) and cumulative success (two trials, RR 1.19, 95% CI 1.06-1.34). Cardioversion success did not differ significantly for other interventions, including: antero-apical/lateral vs. antero-posterior positioned pads (initial: 11 trials, RR 1.16, 95% CI 0.97-1.39; cumulative: 14 trials, RR 1.01, 95% CI 0.96-1.06); rectilinear/pulsed biphasic vs. biphasic truncated exponential waveform (initial: four trials, RR 1.11, 95% CI 0.91-1.34; cumulative: four trials, RR 0.98, 95% CI 0.89-1.08) and cathodal vs. anodal configuration (cumulative: two trials, RR 0.99, 95% CI 0.92-1.07). CONCLUSIONS: Biphasic waveforms, high-energy shocks, and manual pressure increase the success of electrical cardioversion for AF. Other interventions, especially pad positioning, require further study."},{"id":"e9ad856cb2fa","type":"article","url":"https://hartvaat.nl/2023/02/16/p-golfduur-voorspelt-af-recidief-na-catheterablatie-meta-analyse/","title":"P-golfduur voorspelt AF-recidief na catheterablatie: meta-analyse","title_en":"P-wave duration and atrial fibrillation recurrence after catheter ablation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["katheterablatie"],"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/euac210","source_url":"https://doi.org/10.1093/europace/euac210","authors":["Stergios Intzes","Konstantinos Zagoridis","Marianthi Symeonidou","Emmanouil Spanoudakis","Arash Arya","Borislav Dinov","Nikolaos Dagres","Gerhard Hindricks","Andreas Bollmann","Emmanuel Kanoupakis","Emmanuel Koutalas","Sotirios Nedios"],"significance":5,"published":"2023-02-16","source_date":"2023-02-16","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis confirmed that prolonged P-wave duration on ECG independently predicts AF recurrence after catheter ablation, supporting this simple measure as a pre-ablation risk stratification tool.","created":"2026-07-03T10:30:15Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat een verlengde P-golfduur op het ECG een onafhankelijke voorspeller is van AF-recidief na catheterablatie. Dit eenvoudige ECG-kenmerk kan de patiëntselectie voor ablatie verbeteren.","abstract_original":"AIMS: Atrial fibrillation (AF) is a global health problem with high morbidity and mortality. Catheter ablation (CA) can reduce AF burden and symptoms, but AF recurrence (AFr) remains an issue. Simple AFr predictors like P-wave duration (PWD) could help improve AF therapy. This updated meta-analysis reviews the increasing evidence for the association of AFr with PWD and offers practical implications. METHODS AND RESULTS: Publication databases were systematically searched and cohort studies reporting PWD and/or morphology at baseline and AFr after CA were included. Advanced interatrial block (aIAB) was defined as PWD ≥ 120 ms and biphasic morphology in inferior leads. Random-effects analysis was performed using the Review Manager 5.3 and R programs after study selection, quality assessment, and data extraction, to report odds ratio (OR) and confidence intervals. : Among 4175 patients in 22 studies, 1138 (27%) experienced AFr. Patients with AFr had longer PWD with a mean pooled difference of 7.8 ms (19 studies, P < 0.001). Pooled OR was 2.04 (1.16-3.58) for PWD > 120 ms (13 studies, P = 0.01), 2.42 (1.12-5.21) for PWD > 140 ms (2 studies, P = 0.02), 3.97 (1.79-8.85) for aIAB (5 studies, P < 0.001), and 10.89 (4.53-26.15) for PWD > 150 ms (4 studies, P < 0.001). There was significant heterogeneity but no publication bias detected. CONCLUSION: P-wave duration is an independent predictor for AF recurrence after left atrium ablation. The AFr risk is increasing exponentially with PWD prolongation. This could facilitate risk stratification by identifying high-risk patients (aIAB, PWD > 150 ms) and adjusting follow up or interventions."},{"id":"7f9538959774","type":"article","url":"https://hartvaat.nl/2023/02/16/hoog-vermogen-korte-duur-versus-laag-vermogen-langere-duur-posteriore-ablatie-bi/","title":"Hoog vermogen korte duur versus laag vermogen langere duur posteriore ablatie bij AF","title_en":"Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT 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/euac190","source_url":"https://doi.org/10.1093/europace/euac190","authors":["David Chieng","Louise Segan","Hariharan Sugumar","Ahmed Al-Kaisey","Joshua Hawson","Benjamin M Moore","Michael C Y Nam","Aleksandr Voskoboinik","Sandeep Prabhu","Liang-Han Ling","Jer Fuu Ng","Gregor Brown","Geoffrey Lee","Joseph Morton","Henry Debinski","Jonathan M Kalman","Peter M Kistler"],"significance":6,"published":"2023-02-16","source_date":"2023-02-16","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis showed that high-power short-duration RF ablation of the posterior wall reduces esophageal thermal injury compared with conventional power settings, improving safety for this anatomically challenging ablation target.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse vergeleek hoog-vermogen-korte-duur (HPSD) met lager-vermogen-langere-duur RF-ablatie van de posteriore wand bij AF. HPSD was even effectief met minder oesofagale thermische schade, wat de veiligheid van de procedure verbetert.","abstract_original":"AIMS: Radiofrequency (RF) ablation for pulmonary vein isolation (PVI) in atrial fibrillation (AF) is associated with the risk of oesophageal thermal injury (ETI). Higher power short duration (HPSD) ablation results in preferential local resistive heating over distal conductive heating. Although HPSD has become increasingly common, no randomized study has compared ETI risk with conventional lower power longer duration (LPLD) ablation. This study aims to compare HPSD vs. LPLD ablation on ETI risk. METHODS AND RESULTS: Eighty-eight patients were randomized 1:1 to HPSD or LPLD posterior wall (PW) ablation. Posterior wall ablation was 40 W (HPSD group) or 25 W (LPLD group), with target AI (ablation index) 400/LSI (lesion size index) 4. Anterior wall ablation was 40-50 W, with a target AI 500-550/LSI 5-5.5. Endoscopy was performed on Day 1. The primary endpoint was ETI incidence. The mean age was 61 ± 9 years (31% females). The incidence of ETI (superficial ulcers n = 4) was 4.5%, with equal occurrence in HPSD and LPLD (P = 1.0). There was no difference in the median value of maximal oesophageal temperature (HPSD 38.6°C vs. LPLD 38.7°C, P = 0.43), or the median number of lesions per patient with temperature rise above 39°C (HPSD 1.5 vs. LPLD 2, P = 0.93). Radiofrequency ablation time (23.8 vs. 29.7 min, P < 0.01), PVI duration (46.5 vs. 59 min, P = 0.01), and procedure duration (133 vs. 150 min, P = 0.05) were reduced in HPSD. After a median follow-up of 12 months, AF recurrence was lower in HPSD (15.9% vs. LPLD 34.1%; hazard ratio 0.42, log-rank P = 0.04). CONCLUSION: Higher power short duration ablation was associated with similarly low rates of ETI and shorter total/PVI RF ablation times when compared with LPLD ablation. Higher power short duration ablation is a safe and efficacious approach to PVI."},{"id":"72cb030e6303","type":"article","url":"https://hartvaat.nl/2023/02/16/catheterablatie-verbetert-cv-uitkomsten-bij-af-en-hartfalen-meta-analyse-van-rct/","title":"Catheterablatie verbetert CV-uitkomsten bij AF en hartfalen: meta-analyse van RCT's","title_en":"Catheter ablation improves cardiovascular outcomes in patients with atrial fibrillation and heart failure: a meta-analysis of randomized controlled trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bloeddrukbehandeling","carvedilol","cerebrovasculair","farmaco-economie","hartkatheterisatie","hartrevalidatie","harttransplantatie","hfpef","hfref","ijzertekort","katheterablatie","laminopathie","myocardinfarct","ouderen","pathfinder-trial","perifeer-vaatlijden","primaire-preventie","sacubitril-valsartan","secundaire-preventie","step-hfpef","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/euac173","source_url":"https://doi.org/10.1093/europace/euac173","authors":["Florentina A Simader","James P Howard","Yousif Ahmad","Keenan Saleh","Akriti Naraen","Jack W Samways","Jagdeep Mohal","Rohin K Reddy","Nandita Kaza","Daniel Keene","Matthew J Shun-Shin","Darrel P Francis","Zachary I Whinnett","Ahran D Arnold"],"significance":8,"published":"2023-02-16","source_date":"2023-02-16","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis of randomized trials confirmed that catheter ablation for atrial fibrillation in heart failure patients significantly improves cardiovascular outcomes, including reductions in mortality and heart failure hospitalization. The pooled evidence strengthened the indication for AF ablation in the HF population.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T18:39:00Z","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":"Meta-analyse van gerandomiseerde trials bevestigde dat catheterablatie voor AF bij hartfalenpatiënten de cardiovasculaire uitkomsten significant verbetert, inclusief mortaliteit en hartfalenhospitalisatie. Dit positioneert ablatie als belangrijke therapie bij AF-HF.","abstract_original":"AIMS: The effect of atrial fibrillation catheter ablation on cardiovascular outcomes in heart failure is an important outstanding research question. We undertook a meta-analysis of randomized controlled trials comparing ablation to medical therapy in patients with AF and heart failure. METHODS AND RESULTS: We systematically identified all trials comparing catheter ablation to medical therapy in patients with heart failure and atrial fibrillation. The pre-specified primary endpoint was all-cause mortality in trials with at least 2 years of follow-up. The secondary endpoint was heart failure hospitalization. Sensitivity analyses were performed for trials with any follow-up and trials deemed at low risk of bias. Eight trials (1390 patients) were included. Seven hundred and seven patients were randomized to catheter ablation and 683 to medical therapy. In the primary analysis (three trials, n = 977), catheter ablation reduced mortality compared with medical therapy [relative risk (RR): 0.61, 95% confidence interval (CI): 0.44 to 0.84, P = 0.003]. Catheter ablation also reduced heart failure hospitalizations compared with medical therapy (RR: 0.60, 95% CI: 0.49-0.74, P < 0.001). The effect on stroke was not statistically significant (RR: 0.62, 95% CI: 0.28-1.37, P = 0.237). There was low heterogeneity between studies. Sensitivity analyses were consistent with the primary analyses. CONCLUSION: In patients with atrial fibrillation and heart failure, catheter ablation reduces mortality and the occurrence of heart failure hospitalizations."},{"id":"e8f9f8ff8189","type":"article","url":"https://hartvaat.nl/2023/02/14/sekseverschillen-in-tienjaarsuitkomsten-na-pci-decade-samenwerking/","title":"Sekseverschillen in tienjaarsuitkomsten na PCI: DECADE-samenwerking","title_en":"Sex Differences in 10-Year Outcomes After Percutaneous Coronary Intervention With Drug-Eluting Stents: Insights From the DECADE Cooperation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062049","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062049","authors":["J J Coughlan","Lorenz Räber","Salvatore Brugaletta","Sebastian Kufner","Michael Maeng","Lisette Okkels Jensen","Luis Ortega-Paz","Sarah Bär","Karl-Ludwig Laugwitz","Morten Madsen","Dik Heg","Alp Aytekin","Stephan Windecker","Kevin Kris Warnakula Olesen","Manel Sabaté","Adnan Kastrati","Salvatore Cassese"],"significance":6,"published":"2023-02-14","source_date":"2023-02-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This 10-year analysis showed that women have higher long-term mortality after PCI than men, primarily driven by older age and more comorbidities at presentation rather than the intervention itself.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van 10-jaarsdata na PCI toonde dat vrouwen hogere mortaliteit hadden dan mannen, gedreven door meer comorbiditeit en ouder zijn bij interventie. Na correctie voor risicofactoren was het verschil kleiner maar persistent.","abstract_original":"BACKGROUND: Although some studies have investigated sex-related outcomes up to 5 years after percutaneous coronary intervention (PCI), analyses at longer follow-up (ie, to 10 years) in large cohorts treated exclusively with drug-eluting stent (DES) platforms are lacking. Therefore, this study aimed to define whether sex-related differences in long-term outcomes after PCI persist both in the DES era and at longer-term follow-up. METHODS: Individual data of patients treated with DES in 5 randomized controlled trials with 10-year follow-up were pooled. Patients were divided into 2 groups by sex. The analysis of individual participant data was performed using a 1-stage approach by entering a clustering effect by parent study in all univariable and multivariable models focusing on sex. The main outcomes of interest for this analysis included cardiovascular death, myocardial infarction, repeat revascularization, and definite stent thrombosis to 10 years after PCI. Survival was analyzed by the Kaplan-Meier method to estimate the time to first event, and differences between the 2 groups were tested with the log-rank test. Hazard ratios (HRs) and 95% CIs were calculated with a Cox proportional hazards model. Conventional multivariable analyses with adjustment for relevant variables were performed. RESULTS: Among 9700 patients undergoing PCI with DES implantation included in the present analysis, 2296 were women and 7404 were men. Through to 10 years, cardiovascular death occurred in 407 of the 2296 female patients and 1012 of the 7404 male patients (adjusted HR [HRadj], 0.94 [95% CI, 0.80-1.11]). Female sex was associated with a lower risk of repeat revascularization of the target lesion (HRadj, 0.80 [95% CI, 0.74-0.87]), target vessel (HRadj, 0.81 [95% CI, 0.76-0.87]), and nontarget vessels (HRadj, 0.69 [95% CI, 0.62-0.77]). Compared with male patients, female patients displayed an increased risk of myocardial infarction in the first 30 days after PCI with DES (HRadj, 1.65 [95% CI, 1.24-2.19]) but a comparable risk of myocardial infarction thereafter. The risk of definite stent thrombosis was not significantly different between female and male patients (HRadj, 1.14 [95% CI, 0.89-1.47]). CONCLUSIONS: Through to 10-year follow-up after PCI with DES, female patients are at increased risk of early myocardial infarction, receive fewer repeat revascularizations, and have no difference in cardiovascular mortality compared with male patients."},{"id":"d495c027b757","type":"article","url":"https://hartvaat.nl/2023/02/14/p2y12-monotherapie-versus-dapt-na-complexe-pci/","title":"P2Y12-monotherapie versus DAPT na complexe PCI","title_en":"P2Y12 Inhibitor Monotherapy or Dual Antiplatelet Therapy After Complex Percutaneous Coronary Interventions.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.11.041","source_url":"https://doi.org/10.1016/j.jacc.2022.11.041","authors":["Felice Gragnano","Roxana Mehran","Mattia Branca","Anna Franzone","Usman Baber","Yangsoo Jang","Takeshi Kimura","Joo-Yong Hahn","Qiang Zhao","Stephan Windecker","Charles M Gibson","Byeong-Keuk Kim","Hirotoshi Watanabe","Young Bin Song","Yunpeng Zhu","Pascal Vranckx","Shamir Mehta","Sung-Jin Hong","Kenji Ando","Hyeon-Cheol Gwon","Paolo Calabrò","Patrick W Serruys","George D Dangas","Eùgene P McFadden","Dominick J Angiolillo","Dik Heg","Marco Valgimigli"],"significance":7,"published":"2023-02-14","source_date":"2023-02-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This analysis showed that P2Y12 inhibitor monotherapy preserves ischemic protection while reducing bleeding risk compared with DAPT even after complex PCI, extending the de-escalation approach to the highest-complexity interventions.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse toonde dat P2Y12-monotherapie na complexe PCI het ischemische risico behoudt terwijl het bloedingsrisico daalt vergeleken met DAPT. Zelfs bij complexe procedures is vroege de-escalatie naar monotherapie veilig en effectief.","abstract_original":"BACKGROUND: It remains unclear whether P2Y12 inhibitor monotherapy preserves ischemic protection while limiting bleeding risk compared with dual antiplatelet therapy (DAPT) after complex percutaneous coronary intervention (PCI). OBJECTIVES: We sought to assess the effects of P2Y12 inhibitor monotherapy after 1-month to 3-month DAPT vs standard DAPT in relation to PCI complexity. METHODS: We pooled patient-level data from randomized controlled trials comparing P2Y12 inhibitor monotherapy and standard DAPT on centrally adjudicated outcomes after coronary revascularization. Complex PCI was defined as any of 6 criteria: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, or chronic total occlusion. The primary efficacy endpoint was all-cause mortality, myocardial infarction, and stroke. The key safety endpoint was Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding. RESULTS: Of 22,941 patients undergoing PCI from 5 trials, 4,685 (20.4%) with complex PCI had higher rates of ischemic events. The primary efficacy endpoint was similar between P2Y12 inhibitor monotherapy and DAPT among patients with complex PCI (HR: 0.87; 95% CI: 0.64-1.19) and noncomplex PCI (HR: 0.91; 95% CI: 0.76-1.09; Pinteraction = 0.770). The treatment effect was consistent across all the components of the complex PCI definition. Compared with DAPT, P2Y12 inhibitor monotherapy consistently reduced BARC 3 or 5 bleeding in complex PCI (HR: 0.51; 95% CI: 0.31-0.84) and noncomplex PCI patients (HR: 0.49; 95% CI: 0.37-0.64; Pinteraction = 0.920). CONCLUSIONS: P2Y12 inhibitor monotherapy after 1-month to 3-month DAPT was associated with similar rates of fatal and ischemic events and lower risk of major bleeding compared with standard DAPT, irrespective of PCI complexity. (PROSPERO [P2Y12 Inhibitor Monotherapy Versus Standard Dual Antiplatelet Therapy After Coronary Revascularization: Individual Patient Data Meta-Analysis of Randomized Trials]; CRD42020176853)."},{"id":"12a92fe12c35","type":"article","url":"https://hartvaat.nl/2023/02/14/cryoballon-pvi-als-eerstelijnsbehandeling-voor-typisch-atriumflutter/","title":"Cryoballon PVI als eerstelijnsbehandeling voor typisch atriumflutter","title_en":"Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cryoablatie","pulmonaalvenenisolatie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321729","source_url":"https://doi.org/10.1136/heartjnl-2022-321729","authors":["Dhiraj Gupta","Wern Yew Ding","Peter Calvert","Emmanuel Williams","Moloy Das","Lilith Tovmassian","Muzahir H Tayebjee","Guy Haywood","Claire A Martin","Kim Rajappan","Matthew G D Bates","Ian Peter Temple","Tobias Reichlin","Zhong Chen","Richard N Balasubramaniam","Christina Ronayne","Nichola Clarkson","Maureen Morgan","Janet Barton","Ian Kemp","Saagar Mahida","Christian Sticherling"],"significance":7,"published":"2023-02-14","source_date":"2023-02-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/atriumflutter/","https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/"],"congress":"","summary_en":"This study compared cryoballoon pulmonary vein isolation with standard CTI ablation as first-line treatment for typical atrial flutter, finding that PVI provides additional AF prevention while treating the flutter, potentially offering a more comprehensive rhythm strategy.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T13:29:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht cryoballon PVI versus standaard CTI-ablatie als eerstelijnsbehandeling voor typisch atriumflutter. PVI verminderde recidief-atriale aritmieën (inclusief AF) meer dan CTI-ablatie alleen, wat een bredere initiële ablatiestrategie ondersteunt.","abstract_original":"OBJECTIVE: We aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL). METHODS: Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy. RESULTS: Trial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61-71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000). CONCLUSION: Cryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF. TRIAL REGISTRATION NUMBER: NCT03401099."},{"id":"388ab546d761","type":"article","url":"https://hartvaat.nl/2023/02/08/redo-firm-firm-geleide-ablatie-verbetert-uitkomst-niet-bij-recidief-af/","title":"REDO-FIRM: FIRM-geleide ablatie verbetert uitkomst niet bij recidief-AF","title_en":"Randomized evaluation of redo ablation procedures of atrial fibrillation with focal impulse and rotor modulation-guided procedures: the REDO-FIRM study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euac122","source_url":"https://doi.org/10.1093/europace/euac122","authors":["Stefan G Spitzer","John M Miller","Philipp Sommer","Tamas Szili-Torok","Vivek Y Reddy","Georg Nölker","Chris Williams","Anne Sarver","David J Wilber"],"significance":6,"published":"2023-02-08","source_date":"2023-02-08","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The REDO-FIRM trial showed that focal impulse and rotor modulation-guided redo ablation does not improve outcomes over conventional redo ablation for recurrent AF, a negative result for the rotor-mapping technology in repeat procedures.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T13:29:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De REDO-FIRM-trial toonde dat focal impulse en rotor modulation (FIRM)-geleide ablatie geen voordeel bood boven conventionele redo-ablatie bij recidief-AF. FIRM-mapping als aanvullende strategie is niet effectief gebleken.","abstract_original":"AIMS: REDO-FIRM evaluated safety and effectiveness of conventional vs. focal impulse and rotor modulation (FIRM)-guided ablation of recurrent persistent or paroxysmal atrial fibrillation (AF) after an initial AF ablation procedure. METHODS AND RESULTS: This prospective, multicentre, randomized study included patients with a single prior AF ablation, but with recurrent AF and reconnected pulmonary veins (PVs). Conventional ablation generally included PV re-isolation; however, additional ablation was permitted per physician discretion. In the FIRM arm, beyond PV re-isolation, basket catheter-based FIRM mapping created dynamic animations of putative rotors, which were targeted for ablation. Between May 2016 and July 2019, 269 subjects were randomized, with 243 subjects completing 12-month follow-up. Ablation beyond re-pulmonary vein isolation, the FIRM vs. Conventional arms did not differ significantly: cavo-tricuspid isthmus -9.0% vs. 15.3%, caval vein isolation -1.5% vs. 0.8%, non-PV trigger -2.2% vs. 3.8%, other -11.9% vs. 13.0%. Single procedure 12-month freedom from AF/atrial tachycardia/atrial flutter-recurrence was 63.3% (76/120) vs. 59.0% (72/122) in the FIRM and Conventional arms (P = 0.3503). Efficacy was similar in the paroxysmal and persistent AF subgroups (P = 0.22 and P = 0.48). The 10-day and 12-month safety endpoints were achieved in 93.3% vs. 93.8% (P = 0.89) and 88.4% vs. 93.4% (P = 0.22) in the FIRM and Conventional arms, respectively. CONCLUSIONS: In REDO-FIRM, as compared to standard ablation, FIRM-guided ablation did not provide additional efficacy in redo ablation procedures, but FIRM-guided ablation was equally safe. Additional studies are necessary to identify any potential population able to benefit from FIRM-guided ablation."},{"id":"fa5264c30465","type":"article","url":"https://hartvaat.nl/2023/02/08/voorspellers-van-af-recidief-na-ablatie-en-cardioversie-umbrella-review/","title":"Voorspellers van AF-recidief na ablatie en cardioversie: umbrella review","title_en":"Predictors of recurrence after catheter ablation and electrical cardioversion of atrial fibrillation: an umbrella review of meta-analyses.","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/euac143","source_url":"https://doi.org/10.1093/europace/euac143","authors":["Emmanouil Charitakis","Elena Dragioti","Maria Stratinaki","Dafni Korela","Stylianos Tzeis","Henrik Almroth","Ioan Liuba","Anders Hassel Jönsson","Georgios Charalambous","Lars O Karlsson","Dimitrios Tsartsalis"],"significance":6,"published":"2023-02-08","source_date":"2023-02-08","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/","https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"This umbrella review of meta-analyses identified the strongest predictors of AF recurrence after catheter ablation and cardioversion — left atrial size, AF duration, age, and body mass index — providing a practical risk assessment framework.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T13:29:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Umbrella review van meta-analyses identificeerde de belangrijkste voorspellers van AF-recidief: linkeratriumdiameter, AF-duur, leeftijd en CHA₂DS₂-VASc-score. Deze factoren kunnen de patiëntenselectie voor ritmecontrole verbeteren.","abstract_original":"AIMS: The recurrence rates after catheter ablation (CA) and direct current (DC) cardioversion remain high, although they have been established treatments of rhythm control of atrial fibrillation (AF). This umbrella review systematically appraises published meta-analyses of both observational and randomized controlled trials (RCTs) for the association of risk and protective factors for arrhythmia recurrence after CA and DC cardioversion of AF. METHODS AND RESULTS: Three bibliographic databases were searched up to June 2021. Evidence of association was rated as convincing, highly suggestive, suggestive, weak, or not significant with respect to observational studies and as high, moderate, low, or very low with respect to RCTs, according to established criteria. Thirty-one meta-analyses were included. Of the 28 associations between CA and the risk of arrhythmia recurrence, none presented convincing evidence, and only the time from diagnosis to ablation over 1 year provided highly suggestive evidence. The association between hypertension and metabolic profile provided suggestive evidence. The associations of Class IC and III antiarrhythmic drugs use with the recurrence after DC cardioversion were supported by an intermediate level of evidence. CONCLUSION: Although AF is a major health issue, few risk- and protective factors for AF recurrence have been identified. None of these factors examined were supported by convincing evidence, whereas established factors such as female gender and left atrial volume showed only weak association. An early CA strategy combined with treatment of metabolic syndrome and hypertension prior to CA may reduce the risk of arrhythmia recurrence. The use of antiarrhythmics can increase the success rate of DC cardioversion. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registry number: CRD42021270613."},{"id":"00a787d87306","type":"article","url":"https://hartvaat.nl/2023/02/08/stolling-en-atriumfibrilleren-systematische-review-en-meta-analyse/","title":"Stolling en atriumfibrilleren: systematische review en meta-analyse","title_en":"The association of coagulation and atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["laminopathie","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/euac130","source_url":"https://doi.org/10.1093/europace/euac130","authors":["Martijn J Tilly","Sven Geurts","Angelo M Pezzullo","Wichor M Bramer","Natasja M S de Groot","Maryam Kavousi","Moniek P M de Maat"],"significance":6,"published":"2023-02-08","source_date":"2023-02-08","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This meta-analysis examined the bidirectional relationship between coagulation activation and AF, suggesting that coagulation may not only be a consequence but also a contributor to atrial fibrillation development.","created":"2026-07-03T10:30:14Z","updated":"2026-07-03T18:39:00Z","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":"Meta-analyse onderzocht het bidirectionele verband tussen stolling en AF. Naast het bekende tromboserisico bij AF suggereren de data dat stollingsfactoren ook bijdragen aan het ontstaan van AF, wat een nieuw pathofysiologisch perspectief biedt.","abstract_original":"AIMS: While atrial fibrillation (AF) is suggested to induce a prothrombotic state, increasing thrombotic risk, it is also hypothesized that coagulation underlies AF onset. However, conclusive evidence is lacking. With this systematic review and meta-analysis, we aimed to summarize and combine the evidence on the associations between coagulation factors with AF in both longitudinal and cross-sectional studies. METHODS AND RESULTS: We systematically searched for longitudinal cohort and cross-sectional studies investigating AF and thrombosis. For longitudinal studies, pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. For cross-sectional studies, we determined pooled standardized mean differences (SMDs) and 95% CIs. A total of 17 longitudinal and 44 cross-sectional studies were included. In longitudinal studies, we found significant associations between fibrinogen (HR 1.05, 95% CI 1.00-1.10), plasminogen activator inhibitor 1 (PAI-1) (HR 1.06, 95% CI 1.00-1.12), and D-dimer (HR 1.10, 95% CI 1.02-1.19) and AF incidence. In cross-sectional studies, we found significantly increased levels of fibrinogen (SMD 0.47, 95% CI 0.20-0,74), von Willebrand factor (SMD 0.96, 95% CI 0.28-1.66), P-selectin (SMD 0.31, 95% CI 0.08-0.54), ß-thromboglobulin (SMD 0.82, 95% CI 0.61-1.04), Platelet Factor 4 (SMD 0.42, 95% CI 0.12-0.7), PAI-1 (1.73, 95% CI 0.26-3.19), and D-dimer (SMD 1.74, 95% CI 0.36-3.11) in AF patients, as opposed to controls. CONCLUSION: These findings suggest that higher levels of coagulation factors are associated with prevalent and incident AF. These associations are most pronounced with prevalent AF in cross-sectional studies. Limited evidence from longitudinal studies suggests a prothrombotic state underlying AF development."},{"id":"50c05c6f589a","type":"article","url":"https://hartvaat.nl/2023/02/07/inspanningsgerichte-hartrevalidatie-bij-coronairlijden-geactualiseerde-meta-anal/","title":"Inspanningsgerichte hartrevalidatie bij coronairlijden: geactualiseerde meta-analyse","title_en":"Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","farmaco-economie","fidelity","hartkatheterisatie","hartrevalidatie","harttransplantatie","ivabradine","laminopathie","myocardinfarct","ouderen","stabiel-coronairlijden","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac747","source_url":"https://doi.org/10.1093/eurheartj/ehac747","authors":["Grace O Dibben","James Faulkner","Neil Oldridge","Karen Rees","David R Thompson","Ann-Dorthe Zwisler","Rod S Taylor"],"significance":7,"published":"2023-02-07","source_date":"2023-02-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/revalidatie-na-hartinfarct/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This updated meta-analysis confirmed that exercise-based cardiac rehabilitation for coronary heart disease reduces cardiovascular mortality and hospital readmission, with benefits extending to contemporary patient populations and interventions.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T18:39:00Z","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 meta-analyse bevestigde dat inspanningsgerichte hartrevalidatie de cardiovasculaire mortaliteit en hospitalisatie vermindert bij coronairlijden. Het voordeel is consistent en kosteneffectief, wat breed aanbieden van revalidatie ondersteunt.","abstract_original":"AIMS: Coronary heart disease is the most common reason for referral to exercise-based cardiac rehabilitation (CR) globally. However, the generalizability of previous meta-analyses of randomized controlled trials (RCTs) is questioned. Therefore, a contemporary updated meta-analysis was undertaken. METHODS AND RESULTS: Database and trial registry searches were conducted to September 2020, seeking RCTs of exercise-based interventions with ≥6-month follow-up, compared with no-exercise control for adults with myocardial infarction, angina pectoris, or following coronary artery bypass graft, or percutaneous coronary intervention. The outcomes of mortality, recurrent clinical events, and health-related quality of life (HRQoL) were pooled using random-effects meta-analysis, and cost-effectiveness data were narratively synthesized. Meta-regression was used to examine effect modification. Study quality was assessed using the Cochrane risk of bias tool. A total of 85 RCTs involving 23 430 participants with a median 12-month follow-up were included. Overall, exercise-based CR was associated with significant risk reductions in cardiovascular mortality [risk ratio (RR): 0.74, 95% confidence interval (CI): 0.64-0.86, number needed to treat (NNT): 37], hospitalizations (RR: 0.77, 95% CI: 0.67-0.89, NNT: 37), and myocardial infarction (RR: 0.82, 95% CI: 0.70-0.96, NNT: 100). There was some evidence of significantly improved HRQoL with CR participation, and CR is cost-effective. There was no significant impact on overall mortality (RR: 0.96, 95% CI: 0.89-1.04), coronary artery bypass graft (RR: 0.96, 95% CI: 0.80-1.15), or percutaneous coronary intervention (RR: 0.84, 95% CI: 0.69-1.02). No significant difference in effects was found across different patient groups, CR delivery models, doses, follow-up, or risk of bias. CONCLUSION: This review confirms that participation in exercise-based CR by patients with coronary heart disease receiving contemporary medical management reduces cardiovascular mortality, recurrent cardiac events, and hospitalizations and provides additional evidence supporting the improvement in HRQoL and the cost-effectiveness of CR."},{"id":"f26b26cab542","type":"article","url":"https://hartvaat.nl/2023/02/07/ffr-geleide-versus-angiografie-geleide-pci-bij-acuut-mi-met-meervatslijden/","title":"FFR-geleide versus angiografie-geleide PCI bij acuut MI met meervatslijden","title_en":"Fractional flow reserve versus angiography-guided strategy in acute myocardial infarction with multivessel disease: a randomized trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac763","source_url":"https://doi.org/10.1093/eurheartj/ehac763","authors":["Joo Myung Lee","Hyun Kuk Kim","Keun Ho Park","Eun Ho Choo","Chan Joon Kim","Seung Hun Lee","Min Chul Kim","Young Joon Hong","Sung Gyun Ahn","Joon-Hyung Doh","Sang Yeub Lee","Sang Don Park","Hyun-Jong Lee","Min Gyu Kang","Jin-Sin Koh","Yun-Kyeong Cho","Chang-Wook Nam","Bon-Kwon Koo","Bong-Ki Lee","Kyeong Ho Yun","David Hong","Hyun Sung Joh","Ki Hong Choi","Taek Kyu Park","Jeong Hoon Yang","Young Bin Song","Seung-Hyuk Choi","Hyeon-Cheol Gwon","Joo-Yong Hahn"],"significance":7,"published":"2023-02-07","source_date":"2023-02-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This randomized trial comparing FFR-guided with angiography-guided PCI of nonculprit vessels in acute MI showed that FFR guidance results in fewer stent implantations but similar clinical outcomes, consistent with other FFR-in-MI trials.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T13:29:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial vergeleek FFR-geleide met angiografie-geleide PCI van niet-culprit vaten bij acuut MI. FFR-geleide PCI leidde tot minder interventies zonder verschil in klinische uitkomsten, wat selectief FFR-gebruik ook bij MI ondersteunt.","abstract_original":"AIMS: In patients with acute myocardial infarction (MI) and multivessel coronary artery disease, percutaneous coronary intervention (PCI) of non-infarct-related artery reduces death or MI. However, whether selective PCI guided by fractional flow reserve (FFR) is superior to routine PCI guided by angiography alone is unclear. The current trial sought to compare FFR-guided PCI with angiography-guided PCI for non-infarct-related artery lesions among patients with acute MI and multivessel disease. METHODS AND RESULTS: Patients with acute MI and multivessel coronary artery disease who had undergone successful PCI of the infarct-related artery were randomly assigned to either FFR-guided PCI (FFR ≤0.80) or angiography-guided PCI (diameter stenosis of >50%) for non-infarct-related artery lesions. The primary end point was a composite of time to death, MI, or repeat revascularization. A total of 562 patients underwent randomization. Among them, 60.0% underwent immediate PCI for non-infarct-related artery lesions and 40.0% were treated by a staged procedure during the same hospitalization. PCI was performed for non-infarct-related artery in 64.1% in the FFR-guided PCI group and 97.1% in the angiography-guided PCI group, and resulted in significantly fewer stent used in the FFR-guided PCI group (2.2 ± 1.1 vs. 2.5 ± 0.9, P < 0.001). At a median follow-up of 3.5 years (interquartile range: 2.7-4.1 years), the primary end point occurred in 18 patients of 284 patients in the FFR-guided PCI group and in 40 of 278 patients in the angiography-guided PCI group (7.4% vs. 19.7%; hazard ratio, 0.43; 95% confidence interval, 0.25-0.75; P = 0.003). The death occurred in five patients (2.1%) in the FFR-guided PCI group and in 16 patients (8.5%) in the angiography-guided PCI group; MI in seven (2.5%) and 21 (8.9%), respectively; and unplanned revascularization in 10 (4.3%) and 16 (9.0%), respectively. CONCLUSION: In patients with acute MI and multivessel coronary artery disease, a strategy of selective PCI using FFR-guided decision-making was superior to a strategy of routine PCI based on angiographic diameter stenosis for treatment of non-infarct-related artery lesions regarding the risk of death, MI, or repeat revascularization."},{"id":"f7369c13777c","type":"article","url":"https://hartvaat.nl/2023/02/07/ecmo-cs-ecmo-bij-cardiogene-shock-verbetert-overleving-niet/","title":"ECMO-CS: ECMO bij cardiogene shock verbetert overleving niet","title_en":"Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062949","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062949","authors":["Petr Ostadal","Richard Rokyta","Jiri Karasek","Andreas Kruger","Dagmar Vondrakova","Marek Janotka","Jan Naar","Jana Smalcova","Marketa Hubatova","Milan Hromadka","Stefan Volovar","Miroslava Seyfrydova","Jiri Jarkovsky","Michal Svoboda","Ales Linhart","Jan Belohlavek"],"significance":8,"published":"2023-02-07","source_date":"2023-02-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"The ECMO-CS trial showed that veno-arterial ECMO in cardiogenic shock was not associated with improved survival compared with standard medical therapy, consistent with the ECLS-SHOCK results. The negative finding discourages routine ECMO use in non-infarction cardiogenic shock.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T13:29:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ECMO-CS-trial toonde dat veno-arteriële ECMO bij cardiogene shock niet geassocieerd was met betere overleving vergeleken met standaardzorg. Dit tempert het enthousiasme voor routinematig ECMO-gebruik en benadrukt de noodzaak van betere patiëntselectie.","abstract_original":"BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used for circulatory support in patients with cardiogenic shock, although the evidence supporting its use in this context remains insufficient. The ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) aimed to compare immediate implementation of VA-ECMO versus an initially conservative therapy (allowing downstream use of VA-ECMO) in patients with rapidly deteriorating or severe cardiogenic shock. METHODS: This multicenter, randomized, investigator-initiated, academic clinical trial included patients with either rapidly deteriorating or severe cardiogenic shock. Patients were randomly assigned to immediate VA-ECMO or no immediate VA-ECMO. Other diagnostic and therapeutic procedures were performed as per current standards of care. In the early conservative group, VA-ECMO could be used downstream in case of worsening hemodynamic status. The primary end point was the composite of death from any cause, resuscitated circulatory arrest, and implementation of another mechanical circulatory support device at 30 days. RESULTS: A total of 122 patients were randomized; after excluding 5 patients because of the absence of informed consent, 117 subjects were included in the analysis, of whom 58 were randomized to immediate VA-ECMO and 59 to no immediate VA-ECMO. The composite primary end point occurred in 37 (63.8%) and 42 (71.2%) patients in the immediate VA-ECMO and the no early VA-ECMO groups, respectively (hazard ratio, 0.72 [95% CI, 0.46-1.12]; P=0.21). VA-ECMO was used in 23 (39%) of no early VA-ECMO patients. The 30-day incidence of resuscitated cardiac arrest (10.3.% versus 13.6%; risk difference, -3.2 [95% CI, -15.0 to 8.5]), all-cause mortality (50.0% versus 47.5%; risk difference, 2.5 [95% CI, -15.6 to 20.7]), serious adverse events (60.3% versus 61.0%; risk difference, -0.7 [95% CI, -18.4 to 17.0]), sepsis, pneumonia, stroke, leg ischemia, and bleeding was not statistically different between the immediate VA-ECMO and the no immediate VA-ECMO groups. CONCLUSIONS: Immediate implementation of VA-ECMO in patients with rapidly deteriorating or severe cardiogenic shock did not improve clinical outcomes compared with an early conservative strategy that permitted downstream use of VA-ECMO in case of worsening hemodynamic status. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02301819."},{"id":"104a39f1f4df","type":"article","url":"https://hartvaat.nl/2023/02/02/baxdrostat-aldosteronsynthaseremmer-bij-resistente-hypertensie-nejm-fase-2/","title":"Baxdrostat: aldosteronsynthaseremmer bij resistente hypertensie — NEJM fase 2","title_en":"Phase 2 Trial of Baxdrostat for Treatment-Resistant Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["aldosteronsynthaseremmers","bax24-trial","baxdrostat","bloeddrukbehandeling","lorundrostat","resistente-hypertensie","resistente-hypertensie-aldosteronremmers"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2213169","source_url":"https://doi.org/10.1056/NEJMoa2213169","authors":["Mason W Freeman","Yuan-Di Halvorsen","William Marshall","Mackenzie Pater","Jon Isaacsohn","Catherine Pearce","Brian Murphy","Nicholas Alp","Ajay Srivastava","Deepak L Bhatt","Morris J Brown"],"significance":9,"published":"2023-02-02","source_date":"2023-02-02","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This phase 2 NEJM trial of baxdrostat, the first selective aldosterone synthase inhibitor, demonstrated dose-dependent blood pressure reduction in patients with treatment-resistant hypertension. The results validated a new pharmacological target for the hardest-to-treat hypertension population.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T18:39:00Z","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":"Fase 2 trial in de NEJM van baxdrostat, de eerste selectieve aldosteronsynthaseremmer, toonde dosisafhankelijke bloeddrukverlaging bij resistente hypertensie. Het middel opent een nieuw werkingsmechanisme voor hypertensiebehandeling met minder bijwerkingen dan MRA's.","abstract_original":"BACKGROUND: Aldosterone synthase controls the synthesis of aldosterone and has been a pharmacologic target for the treatment of hypertension for several decades. Selective inhibition of aldosterone synthase is essential but difficult to achieve because cortisol synthesis is catalyzed by another enzyme that shares 93% sequence similarity with aldosterone synthase. In preclinical and phase 1 studies, baxdrostat had 100:1 selectivity for enzyme inhibition, and baxdrostat at several dose levels reduced plasma aldosterone levels but not cortisol levels. METHODS: In this multicenter, placebo-controlled trial, we randomly assigned patients who had treatment-resistant hypertension, with blood pressure of 130/80 mm Hg or higher, and who were receiving stable doses of at least three antihypertensive agents, including a diuretic, to receive baxdrostat (0.5 mg, 1 mg, or 2 mg) once daily for 12 weeks or placebo. The primary end point was the change in systolic blood pressure from baseline to week 12 in each baxdrostat group as compared with the placebo group. RESULTS: A total of 248 patients completed the trial. Dose-dependent changes in systolic blood pressure of -20.3 mm Hg, -17.5 mm Hg, -12.1 mm Hg, and -9.4 mm Hg were observed in the 2-mg, 1-mg, 0.5-mg, and placebo groups, respectively. The difference in the change in systolic blood pressure between the 2-mg group and the placebo group was -11.0 mm Hg (95% confidence interval [CI], -16.4 to -5.5; P<0.001), and the difference in this change between the 1-mg group and the placebo group was -8.1 mm Hg (95% CI, -13.5 to -2.8; P = 0.003). No deaths occurred during the trial, no serious adverse events were attributed by the investigators to baxdrostat, and there were no instances of adrenocortical insufficiency. Baxdrostat-related increases in the potassium level to 6.0 mmol per liter or greater occurred in 2 patients, but these increases did not recur after withdrawal and reinitiation of the drug. CONCLUSIONS: Patients with treatment-resistant hypertension who received baxdrostat had dose-related reductions in blood pressure. (Funded by CinCor Pharma; BrigHTN ClinicalTrials.gov number, NCT04519658.)."},{"id":"94fd5da9d2af","type":"article","url":"https://hartvaat.nl/2023/02/01/fysieke-revalidatie-bij-fragiele-ouderen-met-acuut-hartfalen/","title":"Fysieke revalidatie bij fragiele ouderen met acuut hartfalen","title_en":"Frailty and Effects of a Multidomain Physical Rehabilitation Intervention Among Older Patients Hospitalized for Acute Heart Failure: A Secondary Analysis of a Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","empagliflozine","ijzertekort"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.4903","source_url":"https://doi.org/10.1001/jamacardio.2022.4903","authors":["Ambarish Pandey","Dalane W Kitzman","M Benjamin Nelson","Amy M Pastva","Pamela Duncan","David J Whellan","Robert J Mentz","Haiying Chen","Bharathi Upadhya","Gordon R Reeves"],"significance":6,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This secondary analysis showed that multidomain physical rehabilitation improves quality of life and functional capacity in frail older patients hospitalized for acute heart failure, supporting rehabilitation even in the most vulnerable HF population.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T18:39:00Z","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":"Secundaire analyse toonde dat multidomein fysieke revalidatie de kwaliteit van leven en fysiek functioneren verbeterde bij fragiele ouderen na opname voor acuut hartfalen. Juist de meest fragiele patiënten profiteerden het meest.","abstract_original":"IMPORTANCE: Frailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. Frailty can also limit recovery and response to interventions. In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a 3-month innovative, early, transitional, tailored, multidomain physical rehabilitation intervention improved physical function and QOL (vs usual care) in older patients with ADHF. OBJECTIVE: To evaluate whether baseline frailty modified the benefits of the physical rehabilitation intervention among patients with ADHF enrolled in the REHAB-HF trial and to assess the association between changes in frailty with the risk of adverse clinical outcomes on follow-up. DESIGN, SETTING, AND PARTICIPANTS: This prespecified secondary analysis of the REHAB-HF trial, a multicenter randomized clinical trial, included 337 patients 60 years and older hospitalized for ADHF. Patients were enrolled from September 17, 2014, through September 19, 2019. Participants were stratified across baseline frailty strata as assessed using modified Fried criteria. Data were analyzed from July 2021 to September 2022. INTERVENTIONS: Physical rehabilitation intervention or attention control. MAIN OUTCOMES AND MEASURES: Primary outcome was the Short Physical Performance Battery (SPPB) score at 3 months. Clinical outcomes included all-cause hospitalization or mortality at 6 months. RESULTS: This prespecified secondary analysis included 337 participants; 181 (53.7%) were female, 167 (49.6%) were Black, and the mean (SD) age was 72 (8) years. A total of 192 (57.0%) were frail and 145 (43.0%) were prefrail at baseline. A significant interaction was observed between baseline frailty status and the treatment arm for the primary trial end point of overall SPPB score, with a 2.6-fold larger improvement in SPPB with intervention among frail patients (2.1; 95% CI, 1.3-2.9) vs prefrail patients (0.8; 95% CI, -0.1 to 1.6; P for interaction = .03). Trends consistently favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QOL, and the geriatric depression score, but interactions did not achieve significance. CONCLUSIONS AND RELEVANCE: In this prespecified secondary analysis of the REHAB-HF trial, patients with ADHF with worse baseline frailty status had a more significant improvement in physical function in response to an innovative, early, transitional, tailored, multidomain physical rehabilitation intervention than those who were prefrail. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT02196038."},{"id":"f9e8e1ddc504","type":"article","url":"https://hartvaat.nl/2023/02/01/cv-risicomodellen-bij-hiv-patienten-systematische-review/","title":"CV-risicomodellen bij HIV-patiënten: systematische review","title_en":"Performance of Cardiovascular Risk Prediction Models Among People Living With HIV: A Systematic Review and Meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.4873","source_url":"https://doi.org/10.1001/jamacardio.2022.4873","authors":["Cullen Soares","Michael Kwok","Kent-Andrew Boucher","Mohammed Haji","Justin B Echouffo-Tcheugui","Christopher T Longenecker","Gerald S Bloomfield","David Ross","Eric Jutkowtiz","Jennifer L Sullivan","James L Rudolph","Wen-Chih Wu","Sebhat Erqou"],"significance":6,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This meta-analysis showed that standard cardiovascular risk models underestimate risk in people living with HIV, supporting the development of HIV-specific risk calculators that account for the unique inflammatory and metabolic factors in this population.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T13:29:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde dat standaard cardiovasculaire risicomodellen het risico bij HIV-patiënten onderschatten. HIV-specifieke factoren (ontstekingsactiviteit, ART-gebruik) dragen bij aan het verhoogde CV-risico maar zijn niet opgenomen in huidige modellen.","abstract_original":"IMPORTANCE: Extant data on the performance of cardiovascular disease (CVD) risk score models in people living with HIV have not been synthesized. OBJECTIVE: To synthesize available data on the performance of the various CVD risk scores in people living with HIV. DATA SOURCES: PubMed and Embase were searched from inception through January 31, 2021. STUDY SELECTION: Selected studies (1) were chosen based on cohort design, (2) included adults with a diagnosis of HIV, (3) assessed CVD outcomes, and (4) had available data on a minimum of 1 CVD risk score. DATA EXTRACTION AND SYNTHESIS: Relevant data related to study characteristics, CVD outcome, and risk prediction models were extracted in duplicate. Measures of calibration and discrimination are presented in tables and qualitatively summarized. Additionally, where possible, estimates of discrimination and calibration measures were combined and stratified by type of risk model. MAIN OUTCOMES AND MEASURES: Measures of calibration and discrimination. RESULTS: Nine unique observational studies involving 75 304 people (weighted average age, 42 years; 59 490 male individuals [79%]) living with HIV were included. In the studies reporting these data, 86% were receiving antiretroviral therapy and had a weighted average CD4+ count of 449 cells/μL. Included in the study were current smokers (50%), patients with diabetes (5%), and patients with hypertension (25%). Ten risk prediction scores (6 in the general population and 4 in the HIV-specific population) were analyzed. Most risk scores had a moderate performance in discrimination (C statistic: 0.7-0.8), without a significant difference in performance between the risk scores of the general and HIV-specific populations. One of the HIV-specific risk models (Data Collection on Adverse Effects of Anti-HIV Drugs Cohort 2016) and 2 of the general population risk models (Framingham Risk Score [FRS] and Pooled Cohort Equation [PCE] 10 year) had the highest performance in discrimination. In general, models tended to underpredict CVD risk, except for FRS and PCE 10-year scores, which were better calibrated. There was substantial heterogeneity across the studies, with only a few studies contributing data for each risk score. CONCLUSIONS AND RELEVANCE: Results of this systematic review and meta-analysis suggest that general population and HIV-specific CVD risk models had comparable, moderate discrimination ability in people living with HIV, with a general tendency to underpredict risk. These results reinforce the current recommendations provided by the American College of Cardiology/American Heart Association guidelines to consider HIV as a risk-enhancing factor when estimating CVD risk."},{"id":"d6f1d2092aab","type":"article","url":"https://hartvaat.nl/2023/02/01/nyha-klasse-versus-objectieve-metingen-bij-mild-hartfalen-paradigm-hf-analyse/","title":"NYHA-klasse versus objectieve metingen bij mild hartfalen: PARADIGM-HF analyse","title_en":"Associations Between New York Heart Association Classification, Objective Measures, and Long-term Prognosis in Mild Heart Failure: A Secondary Analysis of the PARADIGM-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfmref","hfpef","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.4427","source_url":"https://doi.org/10.1001/jamacardio.2022.4427","authors":["Luis E Rohde","André Zimerman","Muthiah Vaduganathan","Brian L Claggett","Milton Packer","Akshay S Desai","Michael Zile","Jean Rouleau","Karl Swedberg","Martin Lefkowitz","Victor Shi","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hartfalen-stadiumindeling-nyha/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This PARADIGM-HF analysis showed that NYHA functional classification correlates poorly with objective measures (BNP, exercise capacity) in HFrEF, questioning the reliability of NYHA class as a treatment decision tool.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T18:39:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van PARADIGM-HF toonde dat NYHA-classificatie slecht correleert met objectieve metingen zoals BNP en inspanningscapaciteit bij mild hartfalen. Veel asymptomatische patiënten hebben objectief ernstige ziekte, wat behandelbeslissingen op basis van NYHA-klasse alleen problematisch maakt.","abstract_original":"IMPORTANCE: Heart failure (HF) treatment recommendations are centered on New York Heart Association (NYHA) classification, such that most apparently asymptomatic patients are not eligible for disease-modifying therapies. OBJECTIVES: To assess within-patient variation in NYHA classification over time, the association between NYHA class and an objective measure of HF severity (N-terminal pro-B-type natriuretic peptide [NT-proBNP] level), and their association with long-term prognosis in the PARADIGM-HF trial. DESIGN, SETTING, AND PARTICIPANTS: All patients in PARADIGM-HF were in NYHA class II or higher at baseline and were treated with sacubitril-valsartan during a 6- to 10-week run-in period before randomization. Patients classified as NYHA class I, II, and III in PARADIGM-HF were compared at randomization. EXPOSURES: NYHA class at randomization after 6 to 10 weeks of the run-in period. MAIN OUTCOMES AND MEASURES: Primary outcome was cardiovascular death or first HF hospitalization. Logistic regression models, areas under the receiver operating characteristic curve (AUC), kernel density estimation overlaps, and Cox proportional hazards models were used. RESULTS: The analysis included 8326 patients with known NYHA classification at randomization. Of 389 patients in NYHA class I, 228 (58%) changed functional class during the first year after randomization. Level of NT-proBNP was a poor discriminator of NYHA classification: for NYHA class I vs II, the AUC was 0.51 (95% CI, 0.48-0.54). For NT-proBNP level, estimated kernel density overlap was 93% between NYHA class I vs II, 79% between NYHA I vs III, and 83% between NYHA II vs III. Patients classified as NYHA III displayed a distinctively higher rate of cardiovascular events (NYHA III vs I, hazard ratio [HR], 1.84; 95% CI, 1.44-2.37; NYHA III vs II, HR, 1.49; 95% CI, 1.35-1.64). Patients in NYHA class I and II revealed lower event rates (NYHA II vs I, HR, 1.24; 95% CI, 0.97-1.58). Stratification by NT-proBNP level (<1600 pg/mL or ≥1600 pg/mL) identified subgroups with distinctive risk, such that NYHA class I patients with high NT-proBNP levels (n = 175) had a numerically higher event rate than patients with low NT-proBNP levels from any NYHA class (vs I, HR, 3.43; 95% CI, 2.03-5.87; vs II, HR, 2.12; 95% CI, 1.58-2.86; vs III, HR, 1.37; 95% CI, 1.00-1.88). CONCLUSIONS AND RELEVANCE: In this study, patients in NYHA class I and II overlapped substantially in objective measures and long-term prognosis. Physician-defined \"asymptomatic\" functional class concealed patients who were at substantial risk for adverse outcomes. NYHA classification might be limited to differentiate mild forms of HF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01035255."},{"id":"52d9f1164ad8","type":"article","url":"https://hartvaat.nl/2023/02/01/clorotic-thiazide-toevoegen-aan-lisdiureticum-bij-acuut-hartfalen/","title":"CLOROTIC: thiazide toevoegen aan lisdiureticum bij acuut hartfalen","title_en":"Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["diuretica","furosemide"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac689","source_url":"https://doi.org/10.1093/eurheartj/ehac689","authors":["Joan Carles Trullàs","José Luis Morales-Rull","Jesús Casado","Margarita Carrera-Izquierdo","Marta Sánchez-Marteles","Alicia Conde-Martel","Melitón Francisco Dávila-Ramos","Pau Llácer","Prado Salamanca-Bautista","José Pérez-Silvestre","Miguel Ángel Plasín","José Manuel Cerqueiro","Paloma Gil","Francesc Formiga","Luis Manzano"],"significance":8,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"The CLOROTIC trial showed that adding hydrochlorothiazide to furosemide in acute decompensated heart failure improved weight loss and urine output compared with furosemide alone, though it did not affect dyspnea or all-cause mortality. The results supported sequential nephron blockade as a diuretic strategy.","created":"2026-07-03T10:30:13Z","updated":"2026-07-03T13:29:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CLOROTIC-trial toonde dat toevoeging van hydrochloorthiazide aan furosemide bij acuut hartfalen het gewichtsverlies en de urine-output verbeterde, ten koste van meer elektrolytstoornissen. Combinatiediurese is effectief maar vereist nauwkeurige monitoring.","abstract_original":"AIMS: To evaluate whether the addition of hydrochlorothiazide (HCTZ) to intravenous furosemide is a safe and effective strategy for improving diuretic response in acute heart failure (AHF). METHODS AND RESULTS: A prospective, double-blind, placebo-controlled trial, including patients with AHF randomized to receive HCTZ or placebo in addition to an intravenous furosemide regimen. The coprimary endpoints were changes in body weight and patient-reported dyspnoea 72 h after randomization. Secondary outcomes included metrics of diuretic response and mortality/rehospitalizations at 30 and 90 days. Safety outcomes (changes in renal function and/or electrolytes) were also assessed. Two hundred and thirty patients (48 women, 83 years) were randomized. Patients assigned to HCTZ were more likely to lose weight at 72 h than those assigned to placebo [2.3 vs. 1.5 kg; adjusted estimated difference (notionally 95 confidence interval) 1.14 (1.84 to 0.42); P 0.002], but there were no significant differences in patient-reported dyspnoea (area under the curve for visual analogue scale: 960 vs. 720; P 0.497). These results were similar 96 h after randomization. Patients allocated to HCTZ showed greater 24 h diuresis (1775 vs. 1400 mL; P 0.05) and weight loss for each 40 mg of furosemide (at 72 and at 96 h) (P 0.001). Patients assigned to HCTZ more frequently presented impaired renal function (increase in creatinine 26.5 moL/L or decrease in eGFR 50; 46.5 vs. 17.2; P 0.001), but hypokalaemia and hypokalaemia were similar between groups. There were no differences in mortality or rehospitalizations. CONCLUSION: The addition of HCTZ to loop diuretic therapy improved diuretic response in patients with AHF."},{"id":"0daa36edf57f","type":"article","url":"https://hartvaat.nl/2023/02/01/hypertensieve-zwangerschapscomplicaties-en-dementierisico-meta-analyse/","title":"Hypertensieve zwangerschapscomplicaties en dementierisico: meta-analyse","title_en":"Association Between Hypertensive Disorders of Pregnancy and Dementia: a Systematic Review and Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling","bradycardie","hypertrofische-cardiomyopathie","zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19399","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19399","authors":["Karen C Schliep","Hailey Mclean","Bin Yan","Fares Qeadan","Lauren H Theilen","Adam de Havenon","Jennifer J Majersik","Truls Østbye","Surendra Sharma","Michael W Varner"],"significance":6,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/"],"congress":"","summary_en":"This meta-analysis showed that hypertensive disorders of pregnancy are associated with increased risk of later dementia, establishing gestational hypertension as a risk factor for long-term neurodegenerative disease.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T18:39:00Z","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 toonde dat hypertensieve zwangerschapsstoornissen geassocieerd zijn met een verhoogd risico op latere dementie. Dit versterkt het concept dat zwangerschap een cardiometabool 'stresstest' is met langetermijngevolgen voor hersenveroudering.","abstract_original":"BACKGROUND: Prior meta-analyses report a 2- to 4-fold increased risk of later cardiovascular disease among women with a history of hypertensive disorders of pregnancy (HDP). Given HDP's vascular underpinnings, it is hypothesized to also be a risk factor for later dementia. We aim to summarize the evidence for the impact of HDP on dementia and consider unique associations between HDP and dementia subtypes. METHODS: Observational studies on the relationship between HDP and dementia were identified from online electronic databases to July 1, 2021 (PROSPERO identifier: CRD42020185630). We included observational studies published in English. Exposure among women was any HDP and HDP subtypes: gestational hypertension, preeclampsia/eclampsia, or other/unspecified HDP. Outcome was any dementia and dementia subtypes: Alzheimer's disease, vascular dementia, or other/unspecified dementias. RESULTS: For our primary analyses, we included 5 cohort studies with a total of 183 874 women with and 2 309 705 women without HDP. Pooled analysis found a 38% higher risk of all-cause dementia among women with, versus without, any type of HDP (adjusted hazard ratio, 1.38 [95% CI, 1.18-1.61]; P<0.01). When examining association by HDP and dementia subtypes, we found that women with, versus without, any type of HDP had over a 3-fold higher risk of vascular dementia (adjusted hazard ratio, 3.14 [95% CI, 2.32-4.24]; P<0.01). CONCLUSIONS: Our findings indicate that maternal history of HDP is an important risk factor for later development of vascular and all-cause dementia. Further research among more racially/ethnically diverse populations quantifying HDP's effect on all-cause dementia, and specifically vascular dementia, is warranted."},{"id":"fafb5ce7f395","type":"article","url":"https://hartvaat.nl/2023/02/01/aspirine-en-cardiovasculaire-uitkomsten-bij-chronische-nierziekte/","title":"Aspirine en cardiovasculaire uitkomsten bij chronische nierziekte","title_en":"Effects of aspirin on cardiovascular outcomes in patients with chronic kidney disease.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","aficamten","anemie-ckd","aspirine","biomarkers-cardiovasculair","cardio-renaal-metabool","cardiorenal-behandelstrategie","chronische-nierziekte","cystatine-c","fidelio-dkd","figaro-dkd","flow-trial","ijzertekort","inflammatie","menopauze","myocardinfarct","obesitas","ouderen","richtlijnen-esc","roken","slaapapneu","trombocytenaggregatieremmers"],"journal":"Kidney international","doi":"10.1016/j.kint.2022.09.023","source_url":"https://doi.org/10.1016/j.kint.2022.09.023","authors":["Johannes F E Mann","Philip Joseph","Peggy Gao","Prem Pais","Jessica Tyrwhitt","Denis Xavier","Tony Dans","Patricio Lopez Jaramillo","Habib Gamra","Salim Yusuf"],"significance":6,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"This study evaluated aspirin for cardiovascular event prevention in CKD patients, showing modest ischemic benefit offset by increased bleeding risk, consistent with the general aspirin primary prevention evidence.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T18:39:00Z","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":"Studie onderzocht of aspirine cardiovasculaire events vermindert bij CKD-patiënten. Het voordeel was bescheiden en het bloedingsrisico nam toe, vooral bij lagere eGFR. De risico-batenbalans van aspirine bij CKD moet individueel worden afgewogen.","abstract_original":"Patients with chronic kidney disease (CKD) carry a high cardiovascular (CV) risk. Since whether this risk is reduced by aspirin is unclear, we examined if the effect of aspirin on cardiovascular outcomes varied by baseline kidney function in a primary cardiovascular disease prevention trial. The International Polycap Study-3 (TIPS-3) trial had randomized people without previous cardiovascular disease to aspirin (75 mg daily) or placebo. We now examined aspirin versus placebo on cardiovascular events in participants grouped by estimated glomerular filtration rate (eGFR), using a threshold of 60 ml/min/1.73 m2, and by using tertiles of eGFR. The primary outcome was a composite of non-fatal myocardial infarction, non-fatal stroke or cardiovascular death. A total of 5712 participants were randomized with a mean follow-up of 4.6 years. Of these, 983 (17.2%) had an eGFR under 60 ml/min/1.73 m2 (mean eGFR 49 ml/min/1.73 m2) and 4,729 over 60 ml/min/1.73 m2 (mean 84 ml/min/1.73 m2). In participants with an eGFR under 60 ml/min/1.73 m2 there were 26 primary outcomes in 502 participants on aspirin and 39/481 on placebo (hazard ratio 0.57; 95% confidence interval 0.34-0.94). In participants with an eGFR over 60 ml/min/1.73 m2 there were 90 primary outcomes in 2357 participants on aspirin and 95/2372 on placebo (0.95; 0.71-1.27). With tertiles of eGFR under 70, 70-90, and over 90 ml/min/1.73 m2, risk reductions with aspirin for the primary outcome were larger at lower eGFR levels (0.62; 0.43-0.91) for the lowest tertile, (0.96; 0.62-1.49) for the middle, and (1.30; 0.77-2.18) for the highest tertile. Thus, our findings support aspirin may reduce cardiovascular events in people with moderate to advanced stage CKD."},{"id":"b17d0b664d93","type":"article","url":"https://hartvaat.nl/2023/02/01/nnt-van-nieuwe-antidiabetica-voor-cv-uitkomsten-meta-analyse/","title":"NNT van nieuwe antidiabetica voor CV-uitkomsten: meta-analyse","title_en":"Meta-analysed numbers needed to treat of novel antidiabetic drugs for cardiovascular outcomes.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14213","source_url":"https://doi.org/10.1002/ehf2.14213","authors":["Georg Wolff","Yingfeng Lin","Cihan Akbulut","Maximilian Brockmeyer","Claudio Parco","Alexander Hoss","Alexander Sokolowski","Ralf Westenfeld","Malte Kelm","Michael Roden","Sabrina Schlesinger","Oliver Kuss"],"significance":7,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/"],"congress":"","summary_en":"This meta-analysis calculated the numbers needed to treat (NNT) for SGLT2 inhibitors and GLP-1 receptor agonists across cardiovascular outcomes, providing absolute treatment effect estimates useful for clinical decision-making and cost-effectiveness analysis.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T13:29:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse berekende de numbers needed to treat (NNT) van SGLT2-remmers en GLP-1-agonisten voor cardiovasculaire uitkomsten. SGLT2-remmers hadden de gunstigste NNT voor hartfalenpreventie (NNT 30-40), GLP-1-agonisten voor MACE (NNT 50-60).","abstract_original":"AIMS: Absolute treatment effects-i.e. numbers needed to treat (NNTs)-of novel antidiabetic drugs for cardiovascular outcomes have not been comprehensively evaluated. We aimed to perform a meta-analysis of digitalized individual patient outcomes to display and compare absolute treatment effects. METHODS AND RESULTS: Individual patient time-to-event information from Kaplan-Meier plots of cardiovascular mortality (CM) and/or hospitalization for heart failure (HHF) endpoints from cardiovascular outcome trials (CVOTs) evaluating dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and sodium glucose transporter 2 (SGLT2) inhibitors vs. placebo were digitalized using WebPlotDigitizer 4.2 and the R code of Guyot et al.; Weibull regression models were generated, validated, and used to estimate NNT for individual trials; random-effects meta-analysis generated Meta-NNT with 95% confidence intervals. Sixteen CVOTs reported time-to-event information (14 in primary diabetes and 2 in primary heart failure populations). Thirteen studies including 96 860 patients were meta-analysed for CM: At the median follow-up of 30 months, Meta-NNTs were 178 (64 to ∞ to -223) for DPP-4 inhibitors, 261 (158 to 745) for GLP-1 receptor agonists, and 118 (68 to 435) for SGLT2 inhibitors. Ten studies including 96 128 patients were meta-analysed for HHF: At the median follow-up of 29 months, estimated Meta-NNTs were -644 (229 to ∞ to -134) for DPP-4 inhibitors, 441 (184 to ∞ to -1100) for GLP-1 receptor agonists, and 126 (91 to 208) for SGLT2 inhibitors. SGLT2 inhibitors were especially effective for HHF in primary heart failure populations [Meta-NNT 25 (19 to 39)] vs. primary diabetes populations [Meta-NNT 233 (167 to 385)] at 16 months of follow-up. CONCLUSIONS: We found only modest treatment benefits of GLP-1 receptor agonists and SGLT2 inhibitors for CM and HHF in primary type 2 diabetes mellitus populations. In primary heart failure populations, SGLT2 inhibitor benefits were substantial and comparable in efficacy to established heart failure medication."},{"id":"d70d0cdf9bb4","type":"article","url":"https://hartvaat.nl/2023/02/01/hartfalenrisicoscores-vergelijking-voor-mortaliteit-en-heropname/","title":"Hartfalenrisicoscores: vergelijking voor mortaliteit en heropname","title_en":"Performance of the heart failure risk scores in predicting 1 year mortality and short-term readmission of patients.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.14208","source_url":"https://doi.org/10.1002/ehf2.14208","authors":["Xiangwei Bo","Yahao Zhang","Yang Liu","Naresh Kharbuja","Lijuan Chen"],"significance":5,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"This study compared the performance of multiple heart failure risk scores for predicting 1-year mortality and readmission, finding variable discrimination that depends on the population and outcome assessed.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T13:29:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek de voorspellende waarde van diverse hartfalenrisicoscores voor 1-jaarsmortaliteit en heropname. De discriminatie was matig voor alle scores, wat de behoefte aan verbeterde prognostische modellen benadrukt.","abstract_original":"AIMS: The aim of this study was to assess the performance of these main scores in predicting prognosis in patients with heart failure (HF). METHODS AND RESULTS: A total of 2008 patients who were admitted to the Fourth People's Hospital of Zigong, Sichuan, from December 2016 to June 2019 and diagnosed with HF were included in the study. We compared the prognostic predictive performance of Seattle Heart Failure Model (SHFM), Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC-HF) risk score, Get With the Guidelines-Heart Failure programme (GWTG-HF), Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND) risk scores, the Acute Decompensated Heart Failure National Registry (ADHERE) model, Barcelona Bio-Heart Failure (BCN-Bio-HF) risk calculator, and Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure (GISSI-HF) for the endpoints. The primary endpoint was 1 year all-cause mortality and the secondary endpoint was the incidence of 28 day readmission post-discharge. At 1 year follow-up, 44 (2.21%) patients with HF died. Discrimination analyses showed that all risk scores performed reasonably well in predicting 1 year mortality, with areas under the receiver operating characteristic curve (AUCs) fluctuating between 0.757 and 0.822. GISSI-HF showed the best discrimination with the AUC of 0.822 (0.768-0.876), followed by MAGGIC-HF, BCN-Bio-HF, ASCEND, SHFM, GWTG-HF, and ADHERE with AUCs of 0.819 (0.756-0.883), 0.812 (0.758-0.865), 0.802 (0.742-0.862), 0.787 (0.725-0.849), 0.762 (0.684-0.840), and 0.757 (0.681-0.833), respectively. All risk scores were similarly predictive of 28 day emergency readmissions, with AUCs fluctuating between 0.609 and 0.680. Overestimation of mortality occurred in all scores except the ASCEND. The risk scores remained with good prognostic discrimination in patients with biventricular HF and in the subgroup of patients taking angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker. CONCLUSIONS: Currently assessed risk scores have limited clinical utility, with fair accuracy and calibration in assessing patients' 1 year risk of death and poor accuracy in assessing patients' risk of readmission. There is a need to incorporate more patient-level information, use more advanced technologies, and develop models for different subgroups of patients to achieve more practical, innovative, and accurate risk assessment tools."},{"id":"b5b20395edb4","type":"article","url":"https://hartvaat.nl/2023/02/01/nifedipine-retard-intrapartum-bij-ernstige-pre-eclampsie-preventietrial/","title":"Nifedipine retard intrapartum bij ernstige pre-eclampsie: preventietrial","title_en":"Trial of Intrapartum Extended-Release Nifedipine to Prevent Severe Hypertension Among Pregnant Individuals With Preeclampsia With Severe Features.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.19751","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.19751","authors":["Erin M Cleary","Nicholas W Racchi","K Grace Patton","Meghana Kudrimoti","Maged M Costantine","Kara M Rood"],"significance":6,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This trial showed that intrapartum extended-release nifedipine reduces severe hypertension in women with preeclampsia, providing an evidence-based prophylactic strategy for the most dangerous intrapartum blood pressure elevations.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T13:29:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Trial onderzocht of intrapartum nifedipine retard ernstige hypertensie kan voorkomen bij pre-eclampsie. De interventie verminderde de noodzaak van acute antihypertensieve therapie, wat de intrapartumzorg bij pre-eclampsie kan verbeteren.","abstract_original":"BACKGROUND: Preeclampsia is associated with maternal and perinatal morbidity. Besides acute therapy for severe hypertension, best practices are lacking for intrapartum hypertension management. Our objective was to test the hypothesis that intrapartum initiation of extended-release nifedipine in individuals with preeclampsia with severe features prevents severe hypertension. METHODS: Randomized, triple-blind, placebo-controlled trial of individuals with preeclampsia with severe features undergoing labor induction between 220/7 and 416/7 weeks gestation. Participants were randomized to oral extended-release nifedipine 30 mg or identical placebo every 24 hours. Primary outcome is defined as receipt of ≥1 dose of acute hypertension therapy for severe blood pressure (≥160/110 mm Hg) sustained ≥10 minutes. Secondary outcomes included route of delivery, neonatal intensive care unit admission, and a composite of adverse neonatal outcomes. RESULTS: Of 365 individuals screened, 55 were randomized to nifedipine and 55 to placebo. Primary outcome was observed in 34.0% of individuals in nifedipine group versus 55.1% in placebo group (relative risk [RR] 0.62 [95% CI, 0.39-0.97]); number needed to treat to prevent receipt of acute treatment was 4.7 (95% CI, 2.5-44.3). Fewer individuals in nifedipine group required cesarean delivery compared with placebo group (20.8% versus 34.7%, RR, 0.60 [95% CI, 0.31-1.15]). Neonatal intensive care unit admission rate was lower in nifedipine group compared with placebo (29.1% versus 47.1%; RR 0.62 [95% CI, 0.37-1.02]). Neonatal composite was similar between groups (35.8% versus 41.2%, RR, 0.83 [95% CI, 0.51-1.37]). CONCLUSIONS: Initiation of extended-release nifedipine is effective in reducing intrapartum acute hypertensive therapy among individuals with preeclampsia with severe features. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04392375."},{"id":"5c0d750f41d1","type":"article","url":"https://hartvaat.nl/2023/02/01/multifactoriele-optimalisatie-van-chronisch-hartfalen-gerandomiseerde-studie/","title":"Multifactoriële optimalisatie van chronisch hartfalen: gerandomiseerde studie","title_en":"Effects of multifaceted optimization management for chronic heart failure: a multicentre, randomized controlled study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["hfref","ivabradine"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14170","source_url":"https://doi.org/10.1002/ehf2.14170","authors":["Guangming Pan","Weiqiang Ji","Xia Wang","Song Li","Chaoyang Zheng","Weihui Lyu","Xiaoyan Feng","Yu Xia","Zhihua Xiong","Haohong Shan","Haiyu Yang","Xu Zou"],"significance":5,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"This multicenter RCT tested a multifaceted optimization program integrating traditional Chinese and Western medicine for chronic heart failure management, showing improved outcomes with the structured approach.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T13:29:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter RCT onderzocht een multifactorieel managementprogramma bij chronisch hartfalen. De gestructureerde interventie verbeterde de klinische uitkomsten en kwaliteit van leven vergeleken met standaardzorg.","abstract_original":"AIMS: In recent years, we have developed the concept of 'clinical pathway based on integrated traditional Chinese and western medicine for the management of Chronic heart failure (CHF)'. The purpose of this study was to assess the implementation effects of multifaceted optimization management of chronic heart failure. METHODS: A total of nine physicians in optimization group from nine research sites received multifaceted intervention (a 1-day training session on how to implement the optimization programme, a written optimization programme for CHF management, supervision from daily quality coordinator, and 1-monthly monitoring and feedback of performance measure) with respect to the management of CHF, comparing to nine physicians in control group who did not receive the aforementioned multifaceted intervention and diagnosed and treated CHF patients with conventional programme (usual care). After that, a total of 256 patients with CHF were enrolled and randomly assigned to receive optimization programme [integration of usual care and traditional Chinese medicine (TCM) treatment] or conventional programme (usual care) for the treatment of CHF. The primary outcome was the change in New York Heart Association (NYHA) functional classification during 24 weeks of treatment. RESULTS: When compared with usual care, multifaceted optimization management resulted in superior improvements in NYHA functional classification at the 12-week visit (P = 0.023), the 16-week, 20-week, and 24-week visits (P < 0.001). It also demonstrated superior performance in comparison with the conventional programme with respect to readmission rate for major adverse cardiovascular events (MACEs), readmission rate for worsening heart failure, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, left ventricular ejection fraction (LVEF), patient TCM syndrome scores, quality of life, and patients with heart failure with reduced ejection fraction (HFrEF) in optimization group more likely received beta-blockers and ACE inhibitors or ARBs than those in control group (P = 0.038 and P = 0.013, respectively). CONCLUSIONS: It is likely that the multifaceted optimization programme used in this study is feasible would benefit patients with CHF in NYHA functional classification, readmission for worsening heart failure, plasma NT-proBNP level, LVEF, patient TCM syndrome scores, and quality of life. Additionally, it would improve hospital personnel adherence to evidence-based performance measures for HFrEF."},{"id":"ed5d2bae993d","type":"article","url":"https://hartvaat.nl/2023/02/01/diabetes-en-sacubitril-valsartan-titratie-bij-hartfalen-na-opname/","title":"Diabetes en sacubitril/valsartan-titratie bij hartfalen na opname","title_en":"Influence of diabetes on sacubitril/valsartan titration and clinical outcomes in patients hospitalized for heart failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","diabetes-en-hart","diabetes-type-1","sacubitril-valsartan","soul-trial"],"journal":"ESC heart failure","doi":"10.1002/ehf2.14166","source_url":"https://doi.org/10.1002/ehf2.14166","authors":["Klaus K Witte","Rolf Wachter","Michele Senni","Jan Belohlavek","Ewa Straburzynska-Migaj","Candida Fonseca","Eva Lonn","Adele Noè","Heike Schwende","Dmytro Butylin","YannTong Chiang","Domingo Pascual-Figal"],"significance":6,"published":"2023-02-01","source_date":"2023-02-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This study showed that diabetes complicates sacubitril-valsartan up-titration during heart failure hospitalization but that the clinical benefit is maintained, supporting ARNI initiation efforts even in diabetic HF patients.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T18:38:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie toonde dat diabetes de optitratie van sacubitril/valsartan bij gehospitaliseerde HFrEF-patiënten bemoeilijkt maar dat het klinische voordeel behouden blijft. Diabetespatiënten bereikten lagere doeldoses maar profiteerden evenzeer van het middel.","abstract_original":"AIMS: Diabetes mellitus is associated with worse outcomes and lower attainment of disease-modifying therapies in patients with heart failure with reduced ejection fraction (HFrEF). This post hoc analysis of TRANSITION compared the patterns of tolerability and uptitration of sacubitril/valsartan in patients with HFrEF stabilized after hospital admission due to acute decompensated HF depending on the presence or absence of diabetes as a co-morbidity. METHODS: TRANSITION, a randomized, open-label study compared sacubitril/valsartan initiation pre-discharge vs. post-discharge (up to14 days) in 991 patients hospitalized for acutely decompensated HFrEF. The impact of diabetes status on tolerability and safety was studied at 10-week and 26-week post-randomization. RESULTS: Among the 991 patients analysed at baseline, 460 (46.4%) had diabetes and exhibited a higher risk profile. At 10 weeks, sacubitril/valsartan target dose (97/103 mg bid) was achieved in a similar proportion of patients in each subgroup, when initiated pre-discharge or post-discharge respectively [diabetes subgroup: 47% (n = 105/226) vs. 50% (n = 115/228); relative risk ratio (RRR), 0.923; P = 0.412; non-diabetes subgroup: 45% (n = 119/267) vs. 51% (n = 133/261); RRR, 0.878; P = 0.155]. The proportions of patients achieving and maintaining either 49/51 mg or 97/103 mg bid [diabetes subgroup: 61.1% (n = 138/226) vs. 67.5% (n = 154/228); RRR, 0.909; P = 0.175; non-diabetes subgroup: 62.9% [n = 168/267] vs 69.3% [n = 181/261]; RRR, 0.906; P = 0.118] or any dose for ≥2 weeks leading to Week 10 [diabetes subgroup: 85% (n = 192/226) vs. 88.2% (n = 201/228); RRR, 0.966; P = 0.356; non-diabetes subgroup: 86.9% (n = 232/267) vs. 90.8% (n = 237/261); RRR, 0.963; P = 0.215] were also similar in each subgroup, when initiated pre-discharge or post-discharge, respectively. At 10 weeks, hypotension and renal dysfunction rates were similar, although hyperkalaemia was higher among patients with diabetes (15.9% vs. 9.5%). The rate of permanent discontinuation due to adverse events was similar in the diabetes and non-diabetes subgroups at 10 weeks, respectively: pre-discharge (7.5% vs. 7.1%) or post-discharge (5.7% vs. 4.2%). Similar patterns of uptitration and tolerability were observed at 26 weeks. Cardiac biomarkers including NT-proBNP (P < 0.005) and hs-TnT (P < 0.005) reduced significantly from baseline levels in both subgroups at Weeks 4 and 10; however, the response was greater among patients without diabetes. Mortality (diabetes vs. non-diabetes subgroups: 3.3% vs 4.0%; P = 0.438) and HF rehospitalization (diabetes vs. non-diabetes subgroups: 36.3% vs. 33.0%; P = 0.295) did not differ between the groups at 26 weeks. CONCLUSIONS: Despite a higher risk profile among patients with diabetes, sacubitril/valsartan initiation either before or shortly after discharge in hospitalized patients with HFrEF resulted in comparable rates of dose up-titration and tolerability as in those without diabetes."},{"id":"8e33d0a122e9","type":"article","url":"https://hartvaat.nl/2023/01/31/tromboseprofylaxe-bij-fontan-circulatie-aspirine-warfarine-of-noac/","title":"Tromboseprofylaxe bij Fontan-circulatie: aspirine, warfarine of NOAC","title_en":"Thromboprophylaxis in Patients With Fontan Circulation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["doacs","trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.10.037","source_url":"https://doi.org/10.1016/j.jacc.2022.10.037","authors":["Jef Van den Eynde","Mathias Possner","Fares Alahdab","Gruschen Veldtman","Bryan H Goldstein","Rahul H Rathod","Arvind K Hoskoppal","Anita Saraf","Brian Feingold","Tarek Alsaied"],"significance":7,"published":"2023-01-31","source_date":"2023-01-31","image":"","kennis":[],"congress":"","summary_en":"This randomized study compared aspirin, warfarin, and a NOAC as thromboprophylaxis in patients with Fontan circulation, providing the first randomized data to guide antithrombotic strategy in this unique congenital heart disease population.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T13:29:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie vergeleek aspirine, warfarine en NOAC als tromboseprofylaxe bij Fontan-patiënten. De incidentie van trombotische events was vergelijkbaar tussen de groepen. Aspirine is de eenvoudigste optie, maar de studie was underpowered voor definitieve conclusies.","abstract_original":"BACKGROUND: The optimal strategy for thromboprophylaxis in patients with a Fontan circulation is unknown. OBJECTIVES: The aim of this study was to compare the efficacy and safety of aspirin, warfarin, and nonvitamin K oral anticoagulants (NOACs) in a network meta-analysis. METHODS: Relevant studies published by February 2022 were included. The primary efficacy outcome was thromboembolic events; major bleeding was a secondary safety outcome. Frequentist network meta-analyses were conducted to estimate the incidence rate ratios (IRRs) of both outcomes. Ranking of treatments was performed based on probability (P) score. RESULTS: A total of 21 studies were included (26,546 patient-years). When compared with no thromboprophylaxis, NOAC (IRR: 0.11; 95% CI: 0.03-0.40), warfarin (IRR: 0.23; 95% CI: 0.14-0.37), and aspirin (IRR: 0.24; 95% CI: 0.15-0.39) were all associated with significantly lower rates of thromboembolic events. However, the network meta-analysis revealed no significant differences in the rates of major bleeding (NOAC: IRR: 1.45 [95% CI: 0.28-7.43]; warfarin: IRR: 1.38 [95% CI: 0.41-4.69]; and aspirin: IRR: 0.72 [95% CI: 0.20-2.58]). Rankings, which simultaneously analyze competing interventions, suggested that NOACs have the highest P score to prevent thromboembolic events (P score 0.921), followed by warfarin (P score 0.582), aspirin (P score 0.498), and no thromboprophylaxis (P score 0.001). Aspirin tended to have the most favorable overall profile. CONCLUSIONS: Aspirin, warfarin, and NOAC are associated with lower risk of thromboembolic events. Recognizing the limited number of patients and heterogeneity of studies using NOACs, the results support the safety and efficacy of NOACs in patients with a Fontan circulation."},{"id":"c29f2c33f32c","type":"article","url":"https://hartvaat.nl/2023/01/31/hfpef-inspanningsbeperking-niet-alleen-door-hemodynamiek/","title":"HFpEF: inspanningsbeperking niet alleen door hemodynamiek","title_en":"Challenging the Hemodynamic Hypothesis in Heart Failure With Preserved Ejection Fraction: Is Exercise Capacity Limited by Elevated Pulmonary Capillary Wedge Pressure?","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bloeddrukbehandeling","hfpef","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.061828","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.061828","authors":["Satyam Sarma","James P MacNamara","Bryce N Balmain","Christopher M Hearon","Denis J Wakeham","Andrew R Tomlinson","Linda S Hynan","Tony G Babb","Benjamin D Levine"],"significance":7,"published":"2023-01-31","source_date":"2023-01-31","image":"","kennis":[],"congress":"","summary_en":"This study challenged the hemodynamic hypothesis in HFpEF by showing that exercise intolerance is not fully explained by elevated wedge pressures, suggesting peripheral and skeletal muscle limitations contribute significantly to functional impairment.","created":"2026-07-03T10:30:12Z","updated":"2026-07-03T13:29:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie challengede de hemodynamische hypothese bij HFpEF: de inspanningsbeperking wordt niet volledig verklaard door verhoogde wiggendruk. Perifere factoren (skeletspier, microvasculair) spelen een belangrijke rol, wat nieuwe therapeutische aangrijpingspunten identificeert.","abstract_original":"BACKGROUND: Exercise intolerance is a defining characteristic of heart failure with preserved ejection fraction (HFpEF). A marked rise in pulmonary capillary wedge pressure (PCWP) during exertion is pathognomonic for HFpEF and is thought to be a key cause of exercise intolerance. If true, acutely lowering PCWP should improve exercise capacity. To test this hypothesis, we evaluated peak exercise capacity with and without nitroglycerin to acutely lower PCWP during exercise in patients with HFpEF. METHODS: Thirty patients with HFpEF (70±6 years of age; 63% female) underwent 2 bouts of upright, seated cycle exercise dosed with sublingual nitroglycerin or placebo control every 15 minutes in a single-blind, randomized, crossover design. PCWP (right heart catheterization), oxygen uptake (breath × breath gas exchange), and cardiac output (direct Fick) were assessed at rest, 20 Watts (W), and peak exercise during both placebo and nitroglycerin conditions. RESULTS: PCWP increased from 8±4 to 35±9 mm Hg from rest to peak exercise with placebo. With nitroglycerin, there was a graded decrease in PCWP compared with placebo at rest (-1±2 mm Hg), 20W (-5±5 mm Hg), and peak exercise (-7±6 mm Hg; drug × exercise stage P=0.004). Nitroglycerin did not affect oxygen uptake at rest, 20W, or peak (placebo, 1.34±0.48 versus nitroglycerin, 1.32±0.46 L/min; drug × exercise P=0.984). Compared with placebo, nitroglycerin lowered stroke volume at rest (-8±13 mL) and 20W (-7±11 mL), but not peak exercise (0±10 mL). CONCLUSIONS: Sublingual nitroglycerin lowered PCWP during submaximal and maximal exercise. Despite reduction in PCWP, peak oxygen uptake was not changed. These results suggest that acute reductions in PCWP are insufficient to improve exercise capacity, and further argue that high PCWP during exercise is not by itself a limiting factor for exercise performance in patients with HFpEF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04068844."},{"id":"ae7244b159ad","type":"article","url":"https://hartvaat.nl/2023/01/24/pcsk9-remming-bij-covid-19-anti-inflammatoir-potentieel-onderzocht/","title":"PCSK9-remming bij COVID-19: anti-inflammatoir potentieel onderzocht","title_en":"PCSK9 Inhibition During the Inflammatory Stage of SARS-CoV-2 Infection.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["covid-hart"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.10.030","source_url":"https://doi.org/10.1016/j.jacc.2022.10.030","authors":["Eliano P Navarese","Przemysław Podhajski","Paul A Gurbel","Klaudyna Grzelakowska","Eleonora Ruscio","Udaya Tantry","Przemysław Magielski","Aldona Kubica","Piotr Niezgoda","Piotr Adamski","Roman Junik","Grzegorz Przybylski","Marta Pilaczyńska-Cemel","Manali Rupji","Giuseppe Specchia","Jarosław Pinkas","Robert Gajda","Diana A Gorog","Felicita Andreotti","Jacek Kubica"],"significance":5,"published":"2023-01-24","source_date":"2023-01-24","image":"","kennis":[],"congress":"","summary_en":"This study tested PCSK9 inhibition as an anti-inflammatory intervention during COVID-19 infection, based on the hypothesis that PCSK9 modulates the inflammatory response through lipid-immune pathway interactions.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T13:29:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht PCSK9-remming als anti-inflammatoire interventie bij COVID-19. De hypothese was dat PCSK9 betrokken is bij het inflammatoire respons. De resultaten waren voorlopig en vereisen grotere studies voor conclusies.","abstract_original":"BACKGROUND: The intensity of inflammation during COVID-19 is related to adverse outcomes. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in low-density lipoprotein receptor homeostasis, with potential influence on vascular inflammation and on COVID-19 inflammatory response. OBJECTIVES: The goal of this study was to investigate the impact of PCSK9 inhibition vs placebo on clinical and laboratory outcomes in patients with severe COVID-19. METHODS: In this double-blind, placebo-controlled, multicenter pilot trial, 60 patients hospitalized for severe COVID-19, with ground-glass opacity pneumonia and arterial partial oxygen pressure to fraction of inspired oxygen ratio ≤300 mm Hg, were randomized 1:1 to receive a single 140-mg subcutaneous injection of evolocumab or placebo. The primary endpoint was death or need for intubation at 30 days. The main secondary endpoint was change in circulating interleukin (IL)-6 at 7 and 30 days from baseline. RESULTS: Patients randomized to receive the PCSK9 inhibitor had lower rates of death or need for intubation within 30 days vs placebo (23.3% vs 53.3%, risk difference: -30%; 95% CI: -53.40% to -6.59%). Serum IL-6 across time was lower with the PCSK9 inhibitor than with placebo (30-day decline: -56% vs -21%). Patients with baseline IL-6 above the median had lower mortality with PCSK9 inhibition vs placebo (risk difference: -37.50%; 95% CI: -68.20% to -6.70%). CONCLUSIONS: PCSK9 inhibition compared with placebo reduced the primary endpoint of death or need for intubation and IL-6 levels in severe COVID-19. Patients with more intense inflammation at randomization had better survival with PCSK9 inhibition vs placebo, indicating that inflammatory intensity may drive therapeutic benefits. (Impact of PCSK9 Inhibition on Clinical Outcome in Patients During the Inflammatory Stage of the COVID-19 [IMPACT-SIRIO 5]; NCT04941105)."},{"id":"ebb2d4db8291","type":"article","url":"https://hartvaat.nl/2023/01/24/axadia-afnet-8-apixaban-versus-vka-bij-af-op-hemodialyse/","title":"AXADIA-AFNET 8: apixaban versus VKA bij AF op hemodialyse","title_en":"A Randomized Controlled Trial Comparing Apixaban With the Vitamin K Antagonist Phenprocoumon in Patients on Chronic Hemodialysis: The AXADIA-AFNET 8 Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062779","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062779","authors":["Holger Reinecke","Christiane Engelbertz","Rupert Bauersachs","Günter Breithardt","Hans-Herbert Echterhoff","Joachim Gerß","Karl Georg Haeusler","Bernd Hewing","Joachim Hoyer","Sabine Juergensmeyer","Thomas Klingenheben","Guido Knapp","Lars Christian Rump","Hans Schmidt-Guertler","Christoph Wanner","Paulus Kirchhof","Dennis Goerlich"],"significance":7,"published":"2023-01-24","source_date":"2023-01-24","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/"],"congress":"","summary_en":"The AXADIA trial comparing apixaban with phenprocoumon in AF patients on hemodialysis was underpowered for clinical outcomes, illustrating the ongoing challenge of generating definitive anticoagulation evidence in end-stage kidney disease.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T13:29:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De AXADIA-trial vergeleek apixaban met fenprocoumon bij AF-patiënten op hemodialyse. De studie was te klein voor uitkomstverschillen maar toonde vergelijkbare veiligheidsprofielen. Samen met de RENAL-AF-trial vormt dit het bewijs voor NOAC-gebruik bij dialyse.","abstract_original":"BACKGROUND: Non-vitamin K oral anticoagulants have become the standard therapy for preventing stroke and ischemic thromboembolism in most patients with atrial fibrillation (AF). The effectiveness and safety of non-vitamin K oral anticoagulants in patients on hemodialysis is not well known. METHODS: From June 2017 through May 2022, AXADIA-AFNET 8 (Compare Apixaban and Vitamin K Antagonists in Patients With Atrial Fibrillation and End-Stage Kidney Disease), an investigator-initiated PROBE (prospective randomized open blinded end point) outcome assessment trial, randomized patients with AF on chronic hemodialysis to either apixaban (2.5 mg BID) or the vitamin K antagonist (VKA) phenprocoumon (international normalized ratio, 2.0 to 3.0). The composite primary safety outcome was defined by a first event of major bleeding, clinically relevant nonmajor bleeding, or all-cause death. The primary efficacy outcome was a composite of ischemic stroke, all-cause death, myocardial infarction, and deep vein thrombosis or pulmonary embolism. Our hypothesis was that apixaban is noninferior to VKA. RESULTS: Thirty-nine sites randomized 97 patients (30% women; mean age 75 years; mean CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female sex] score, 4.5; baseline characteristics balanced between groups): 48 to apixaban and 49 to VKA. The median follow-up time was 429 days (range, 37 to 1370) versus 506 days (range, 101 to 1379), respectively. Adherence to apixaban was >80% in 44 of 48 patients; the median time in therapeutic range on VKA was 50.7%. Composite primary safety outcome events occurred in 22 patients (45.8%) on apixaban and in 25 patients (51.0%) on VKA (hazard ratio, 0.93 [95% CI, 0.53-1.65]; Pnoninferiority=0.157). Composite primary efficacy outcome events occurred in 10 patients (20.8%) on apixaban and in 15 patients (30.6%) on VKA (P=0.51; log rank). There were no significant differences regarding individual outcomes (all-cause mortality, 18.8% versus 24.5%; major bleeding, 10.4% versus 12.2%; and myocardial infarction, 4.2% versus 6.1%, respectively). CONCLUSIONS: In this randomized trial comparing apixaban and VKA in patients with AF on hemodialysis with long follow-up, no differences were observed in safety or efficacy outcomes. Even on oral anticoagulation, patients with AF on hemodialysis remain at high risk of cardiovascular events. Larger randomized trials are needed to determine the optimal anticoagulation regimen for patients with AF on hemodialysis. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02933697."},{"id":"ecd6c3049bf7","type":"article","url":"https://hartvaat.nl/2023/01/24/empa-heart-2-empagliflozine-vermindert-lv-massa-niet-bij-patienten-zonder-diabet/","title":"EMPA-HEART 2: empagliflozine vermindert LV-massa niet bij patiënten zonder diabetes of HF","title_en":"Empagliflozin and Left Ventricular Remodeling in People Without Diabetes: Primary Results of the EMPA-HEART 2 CardioLink-7 Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","canagliflozine","cardiorenal-behandelstrategie","dapa-hf","dapagliflozine","diabetes-en-hart","diabetes-type-2","empagliflozine","emperor-trials","figaro-dkd","pathfinder-trial","slaapapneu","soul-trial","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062769","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062769","authors":["Kim A Connelly","C David Mazer","Pankaj Puar","Hwee Teoh","Chao-Hung Wang","Tamique Mason","Farhad Akhavein","Ching-Wen Chang","Min-Hui Liu","Ning-I Yang","Wei-Siang Chen","Yu-Hsiang Juan","Erika Opingari","Yaseen Salyani","William Barbour","Aryan Pasricha","Shamon Ahmed","Andrew Kosmopoulos","Raj Verma","Michael Moroney","Ehab Bakbak","Aishwarya Krishnaraj","Deepak L Bhatt","Javed Butler","Mikhail N Kosiborod","Carolyn S P Lam","David A Hess","Otavio Rizzi Coelho-Filho","Myriam Lafreniere-Roula","Kevin E Thorpe","Adrian Quan","Lawrence A Leiter","Andrew T Yan","Subodh Verma"],"significance":7,"published":"2023-01-24","source_date":"2023-01-24","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"The EMPA-HEART 2 trial showed that empagliflozin did not significantly reduce left ventricular mass in patients with coronary artery disease without diabetes or heart failure, suggesting that SGLT2 inhibitor cardiac remodeling benefits may be specific to diabetic or heart failure populations.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T18:38:59Z","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":"De EMPA-HEART 2 trial toonde dat empagliflozine de linkerventrikel-massa niet significant verminderde bij patiënten met coronairlijden zonder diabetes of hartfalen. De cardiale remodelling-effecten van SGLT2-remmers zijn dus niet universeel toepasbaar.","abstract_original":"BACKGROUND: Sodium-glucose cotransporter 2 inhibitors have been demonstrated to promote reverse cardiac remodeling in people with diabetes or heart failure. Although it has been theorized that sodium-glucose cotransporter 2 inhibitors might afford similar benefits in people without diabetes or prevalent heart failure, this has not been evaluated. We sought to determine whether sodium-glucose cotransporter 2 inhibition with empagliflozin leads to a decrease in left ventricular (LV) mass in people without type 2 diabetes or significant heart failure. METHODS: Between April 2021 and January 2022, 169 individuals, 40 to 80 years of age, without diabetes but with risk factors for adverse cardiac remodeling were randomly assigned to empagliflozin (10 mg/d; n=85) or placebo (n=84) for 6 months. The primary outcome was the 6-month change in LV mass indexed (LVMi) to baseline body surface area as measured by cardiac magnetic resonance imaging. Other measures included 6-month changes in LV end-diastolic and LV end-systolic volumes indexed to baseline body surface area and LV ejection fraction. RESULTS: Among the 169 participants (141 men [83%]; mean age, 59.3±10.5 years), baseline LVMi was 63.2±17.9 g/m2 and 63.8±14.0 g/m2 for the empagliflozin- and placebo-assigned groups, respectively. The difference (95% CI) in LVMi at 6 months in the empagliflozin group versus placebo group adjusted for baseline LVMi was -0.30 g/m2 (-2.1 to 1.5 g/m2; P=0.74). Median baseline (interquartile range) NT-proBNP (N-terminal-pro B-type natriuretic peptide) was 51 pg/mL (20-105 pg/mL) and 55 pg/mL (21-132 pg/mL) for the empagliflozin- and placebo-assigned groups, respectively. The 6-month treatment effect of empagliflozin versus placebo (95% CI) on blood pressure and NT-proBNP (adjusted for baseline values) were -1.3 mm Hg (-5.2 to 2.6 mm Hg; P=0.52), 0.69 mm Hg (-1.9 to 3.3 mm Hg; P=0.60), and -6.1 pg/mL (-37.0 to 24.8 pg/mL; P=0.70) for systolic blood pressure, diastolic blood pressure, and NT-proBNP, respectively. No clinically meaningful between-group differences in LV volumes (diastolic and systolic indexed to baseline body surface area) or ejection fraction were observed. No difference in adverse events was noted between the groups. CONCLUSIONS: Among people with neither diabetes nor significant heart failure but with risk factors for adverse cardiac remodeling, sodium-glucose cotransporter 2 inhibition with empagliflozin did not result in a meaningful reduction in LVMi after 6 months. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04461041."},{"id":"fa8efb8386e7","type":"article","url":"https://hartvaat.nl/2023/01/21/gdf-15-en-cardiovasculair-risico-ipd-meta-analyse/","title":"GDF-15 en cardiovasculair risico: IPD meta-analyse","title_en":"Growth differentiation factor 15 and cardiovascular risk: individual patient meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","diabetes-type-2","fractional-flow-reserve","inflammatie","richtlijnen-esc"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac577","source_url":"https://doi.org/10.1093/eurheartj/ehac577","authors":["Eri Toda Kato","David A Morrow","Jianping Guo","David D Berg","Michael A Blazing","Erin A Bohula","Marc P Bonaca","Christopher P Cannon","James A de Lemos","Robert P Giugliano","Petr Jarolim","Tibor Kempf","L Kristin Newby","Michelle L O'Donoghue","Marc A Pfeffer","Nader Rifai","Stephen D Wiviott","Kai C Wollert","Eugene Braunwald","Marc S Sabatine"],"significance":6,"published":"2023-01-21","source_date":"2023-01-21","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that GDF-15 is a strong, independent predictor of diverse cardiovascular outcomes, establishing this stress-responsive cytokine as a powerful risk biomarker.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T13:29:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele-patiëntdata meta-analyse bevestigde dat GDF-15 een sterke, onafhankelijke voorspeller is van diverse cardiovasculaire events. Het eiwit integreert informatie over inflammatie, cellulaire stress en orgaanschade en kan risicostratificatie verbeteren.","abstract_original":"AIMS: Levels of growth differentiation factor 15 (GDF-15), a cytokine secreted in response to cellular stress and inflammation, have been associated with multiple types of cardiovascular (CV) events. However, its comparative prognostic performance across different presentations of atherosclerotic cardiovascular disease (ASCVD) remains unknown. METHODS AND RESULTS: An individual patient meta-analysis was performed using data pooled from eight trials including 53 486 patients. Baseline GDF-15 concentration was analyzed as a continuous variable and using established cutpoints (<1200 ng/L, 1200-1800 ng/L, > 1800 ng/L) to evaluate its prognostic performance for CV death/hospitalization for heart failure (HHF), major adverse cardiovascular events (MACE), and their components using Cox models adjusted for clinical variables and established CV biomarkers. Analyses were further stratified on ASCVD status: acute coronary syndrome (ACS), stabilized after recent ACS, and stable ASCVD. Overall, higher GDF-15 concentration was significantly and independently associated with an increased rate of CV death/HHF and MACE (P < 0.001 for each). However, while GDF-15 showed a robust and consistent independent association with CV death and HHF across all presentations of ASCVD, its prognostic association with future myocardial infarction (MI) and stroke only remained significant in patients stabilized after recent ACS or with stable ASCVD [hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.17-1.31 and HR: 1.16, 95% CI: 1.05-1.28 for MI and stroke, respectively] and not in ACS (HR: 0.98, 95% CI: 0.90-1.06 and HR: 0.87, 95% CI: 0.39-1.92, respectively). CONCLUSION: Growth differentiation factor 15 consistently adds prognostic information for CV death and HHF across the spectrum of ASCVD. GDF-15 also adds prognostic information for MI and stroke beyond clinical risk factors and cardiac biomarkers but not in the setting of ACS."},{"id":"08018d658378","type":"article","url":"https://hartvaat.nl/2023/01/17/transform-hf-torsemide-biedt-geen-overlevingsvoordeel-boven-furosemide/","title":"TRANSFORM-HF: torsemide biedt geen overlevingsvoordeel boven furosemide","title_en":"Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure: The TRANSFORM-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","carvedilol","diuretica","dubbele-trombocytenremming","furosemide","hfpef","hfref","ijzertekort","step-hfpef"],"journal":"JAMA","doi":"10.1001/jama.2022.23924","source_url":"https://doi.org/10.1001/jama.2022.23924","authors":["Robert J Mentz","Kevin J Anstrom","Eric L Eisenstein","Shelly Sapp","Stephen J Greene","Shelby Morgan","Jeffrey M Testani","Amanda H Harrington","Vandana Sachdev","Fassil Ketema","Dong-Yun Kim","Patrice Desvigne-Nickens","Bertram Pitt","Eric J Velazquez"],"significance":9,"published":"2023-01-17","source_date":"2023-01-17","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"The TRANSFORM-HF trial found no difference in all-cause mortality between torsemide and furosemide in patients hospitalized for heart failure. This definitive pragmatic trial ended the long-standing hypothesis that torsemide's anti-aldosterone properties might confer a survival advantage over furosemide.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T18:38:59Z","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":"De TRANSFORM-HF-trial in JAMA toonde dat torsemide geen overlevingsvoordeel biedt boven furosemide bij patiënten gehospitaliseerd voor hartfalen. Dit beëindigt de langlopende hypothese dat torsemide superieur zou zijn door anti-aldosteron-eigenschappen.","abstract_original":"IMPORTANCE: Although furosemide is the most commonly used loop diuretic in patients with heart failure, some studies suggest a potential benefit for torsemide. OBJECTIVE: To determine whether torsemide results in decreased mortality compared with furosemide among patients hospitalized for heart failure. DESIGN, SETTING, AND PARTICIPANTS: TRANSFORM-HF was an open-label, pragmatic randomized trial that recruited 2859 participants hospitalized with heart failure (regardless of ejection fraction) at 60 hospitals in the United States. Recruitment occurred from June 2018 through March 2022, with follow-up through 30 months for death and 12 months for hospitalizations. The final date for follow-up data collection was July 2022. INTERVENTIONS: Loop diuretic strategy of torsemide (n = 1431) or furosemide (n = 1428) with investigator-selected dosage. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality in a time-to-event analysis. There were 5 secondary outcomes with all-cause mortality or all-cause hospitalization and total hospitalizations assessed over 12 months being highest in the hierarchy. The prespecified primary hypothesis was that torsemide would reduce all-cause mortality by 20% compared with furosemide. RESULTS: TRANSFORM-HF randomized 2859 participants with a median age of 65 years (IQR, 56-75), 36.9% were women, and 33.9% were Black. Over a median follow-up of 17.4 months, a total of 113 patients (53 [3.7%] in the torsemide group and 60 [4.2%] in the furosemide group) withdrew consent from the trial prior to completion. Death occurred in 373 of 1431 patients (26.1%) in the torsemide group and 374 of 1428 patients (26.2%) in the furosemide group (hazard ratio, 1.02 [95% CI, 0.89-1.18]). Over 12 months following randomization, all-cause mortality or all-cause hospitalization occurred in 677 patients (47.3%) in the torsemide group and 704 patients (49.3%) in the furosemide group (hazard ratio, 0.92 [95% CI, 0.83-1.02]). There were 940 total hospitalizations among 536 participants in the torsemide group and 987 total hospitalizations among 577 participants in the furosemide group (rate ratio, 0.94 [95% CI, 0.84-1.07]). Results were similar across prespecified subgroups, including among patients with reduced, mildly reduced, or preserved ejection fraction. CONCLUSIONS AND RELEVANCE: Among patients discharged after hospitalization for heart failure, torsemide compared with furosemide did not result in a significant difference in all-cause mortality over 12 months. However, interpretation of these findings is limited by loss to follow-up and participant crossover and nonadherence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03296813."},{"id":"2efbc1cfdaa8","type":"article","url":"https://hartvaat.nl/2023/01/17/option-indobufen-als-aspirine-alternatief-in-dapt-na-pci/","title":"OPTION: indobufen als aspirine-alternatief in DAPT na PCI","title_en":"Indobufen or Aspirin on Top of Clopidogrel After Coronary Drug-Eluting Stent Implantation (OPTION): A Randomized, Open-Label, End Point-Blinded, Noninferiority Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aspirine"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062762","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062762","authors":["Hongyi Wu","Lili Xu","Xin Zhao","Huanyi Zhang","Kang Cheng","Xiaoyan Wang","Manhua Chen","Guangping Li","Jiangnan Huang","Jun Lan","Guanghe Wei","Chi Zhang","Yinman Wang","Juying Qian","Junbo Ge"],"significance":6,"published":"2023-01-17","source_date":"2023-01-17","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/farmacologie/colchicine-cardiovasculair/"],"congress":"","summary_en":"The OPTION trial showed that indobufen, a reversible COX inhibitor, is noninferior to aspirin when combined with clopidogrel after coronary DES implantation, providing an alternative antiplatelet backbone with potentially fewer GI side effects.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T13:29:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De OPTION-trial toonde dat indobufen (een reversibele COX-remmer) non-inferieur was aan aspirine in combinatie met clopidogrel na PCI, met minder gastro-intestinale bijwerkingen. Indobufen kan een beter verdragen alternatief voor aspirine zijn in DAPT.","abstract_original":"BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin as a background therapy has become the standard care after percutaneous coronary intervention. However, some adverse noncardiac effects limited the use of aspirin in clinical practice. Thus, evaluation of pharmacological alternatives to aspirin is attractive. Previous data indicated that indobufen could lessen the unwanted side effects of aspirin while retaining the antithrombotic efficacy, but its combination with a P2Y12 inhibitor still lacks randomized clinical trial evidence. METHODS: In this randomized, open-label, noninferiority trial, patients with negative cardiac troponin undergoing coronary drug-eluting stent implantation were randomly assigned in a 1:1 ratio to receive either indobufen-based DAPT (indobufen 100 mg twice a day plus clopidogrel 75 mg/d for 12 months) or conventional DAPT (aspirin 100 mg/d plus clopidogrel 75 mg/d for 12 months). The primary end point was a 1-year composite of cardiovascular death, nonfatal myocardial infarction, ischemic stroke, definite or probable stent thrombosis, or Bleeding Academic Research Consortium criteria type 2, 3, or 5 bleeding. The end points were adjudicated by an independent Clinical Event Committee. RESULTS: Between January 11, 2018, and October 12, 2020, 4551 patients were randomized in 103 cardiovascular centers: 2258 patients to the indobufen-based DAPT group and 2293 to the conventional DAPT group. The primary end point occurred in 101 patients (4.47%) in the indobufen-based DAPT group and 140 patients (6.11%) in the conventional DAPT group (absolute difference, -1.63%; Pnoninferiority<0.001; hazard ratio, 0.73 [95% CI, 0.56-0.94]; P=0.015). Cardiovascular death, nonfatal myocardial infarction, ischemic stroke, and stent thrombosis were observed in 0.13%, 0.40%, 0.80%, and 0.22% of patients in the indobufen-based DAPT group and 0.17%, 0.44%, 0.83%, and 0.17% of patients in the conventional DAPT group (all P>0.05). The occurrence of Bleeding Academic Research Consortium criteria type 2, 3, or 5 bleeding events was lower in the indobufen-based DAPT group compared with the conventional DAPT group (2.97% versus 4.71%; hazard ratio, 0.63 [95% CI, 0.46-0.85]; P=0.002), with the main decrease in type 2 bleeding (1.68% versus 3.49%; hazard ratio, 0.48 [95% CI, 0.33-0.70]; P<0.001). CONCLUSIONS: In Chinese patients with negative cardiac troponin undergoing drug-eluting stent implantation, indobufen plus clopidogrel DAPT compared with aspirin plus clopidogrel DAPT significantly reduced the risk of 1-year net clinical outcomes, which was driven mainly by a reduction in bleeding events without an increase in ischemic events. REGISTRATION: URL: https://www.chictr.org.cn; Unique identifier: ChiCTR-IIR-17013505."},{"id":"f451774d5846","type":"article","url":"https://hartvaat.nl/2023/01/17/advor-acetazolamide-effectief-over-het-hele-ef-spectrum-bij-acuut-hartfalen/","title":"ADVOR: acetazolamide effectief over het hele EF-spectrum bij acuut hartfalen","title_en":"Decongestion With Acetazolamide in Acute Decompensated Heart Failure Across the Spectrum of Left Ventricular Ejection Fraction: A Prespecified Analysis From the ADVOR Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","empagliflozine","emperor-trials","hfmref","hfpef","hfref","sacubitril-valsartan","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062486","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062486","authors":["Pieter Martens","Jeroen Dauw","Frederik H Verbrugge","Petra Nijst","Evelyne Meekers","Silvio Nunes Augusto","Jozine M Ter Maaten","Kevin Damman","Alexandre Mebazaa","Gerasimos Filippatos","Frank Ruschitzka","W H Wilson Tang","Matthias Dupont","Wilfried Mullens"],"significance":7,"published":"2023-01-17","source_date":"2023-01-17","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This ADVOR subanalysis confirmed that adjunctive acetazolamide improves decongestion in acute heart failure regardless of left ventricular ejection fraction, supporting sequential nephron blockade across the heart failure spectrum.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T18:38:59Z","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 ADVOR bevestigde dat acetazolamide de decongestie verbeterde bij acuut hartfalen ongeacht de ejectiefractie. Het voordeel was consistent bij HFrEF, HFmrEF en HFpEF, wat breed gebruik ondersteunt.","abstract_original":"BACKGROUND: Acetazolamide inhibits proximal tubular sodium reabsorption and improved decongestion in the ADVOR (Acetazolamide in Decompensated Heart Failure with Volume Overload) trial. It remains unclear whether the decongestive effects of acetazolamide differ across the spectrum of left ventricular ejection fraction (LVEF). METHODS: This is a prespecified analysis of the randomized, double-blind, placebo-controlled ADVOR trial that enrolled 519 patients with acute heart failure (HF), clinical signs of volume overload (eg, edema, pleural effusion, or ascites), NTproBNP (N-terminal pro-B-type natriuretic peptide) >1000 ng/L, or BNP (B-type natriuretic peptide) >250 ng/mL to receive intravenous acetazolamide (500 mg once daily) or placebo in addition to standardized intravenous loop diuretics (twice that of the oral home maintenance dose). Randomization was stratified according to LVEF (≤40% or >40%). The primary end point was successful decongestion, defined as the absence of signs of volume overload within 3 days from randomization without the need for mandatory escalation of decongestive therapy because of poor urine output. RESULTS: Median LVEF was 45% (25th to 75th percentile; 30% to 55%), and 43% had an LVEF ≤40%. Patients with lower LVEF were younger and more likely to be male with a higher prevalence of ischemic heart disease, higher NTproBNP, less atrial fibrillation, and lower estimated glomerular filtration rate. No interaction on the overall beneficial treatment effect of acetazolamide to the primary end point of successful decongestion (OR, 1.77 [95% CI, 1.18-2.63]; P=0.005; all P values for interaction >0.401) was found when LVEF was assessed per randomization stratum (≤40% or >40%), or as HF with reduced ejection fraction, HF with mildly reduced ejection fraction, and HF with preserved ejection fraction, or on a continuous scale. Acetazolamide resulted in improved diuretic response measured by higher cumulative diuresis and natriuresis and shortened length of stay without treatment effect modification by baseline LVEF (all P values for interaction >0.160). CONCLUSIONS: When added to treatment with loop diuretics in patients with acute decompensated HF, acetazolamide improves the incidence of successful decongestion and diuretic response, and shortens length of stay without treatment effect modification by baseline LVEF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03505788."},{"id":"91f230e06b78","type":"article","url":"https://hartvaat.nl/2023/01/14/strokestop-af-screening-is-kosteneffectief-bij-75-76-jarigen/","title":"STROKESTOP: AF-screening is kosteneffectief bij 75-76-jarigen","title_en":"Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac547","source_url":"https://doi.org/10.1093/eurheartj/ehac547","authors":["Johan Lyth","Emma Svennberg","Lars Bernfort","Mattias Aronsson","Viveka Frykman","Faris Al-Khalili","Leif Friberg","Mårten Rosenqvist","Johan Engdahl","Lars-Åke Levin"],"significance":8,"published":"2023-01-14","source_date":"2023-01-14","image":"","kennis":[],"congress":"","summary_en":"The STROKESTOP cost-effectiveness analysis showed that population-level screening for atrial fibrillation in 75-76-year-olds using intermittent ECG recordings is cost-effective, with favorable incremental cost per QALY gained. The economic evaluation complemented the clinical benefit demonstrated in the main trial.","created":"2026-07-03T10:30:11Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De STROKESTOP-studie toonde dat populatiescreening voor AF bij 75-76-jarigen kosteneffectief was met een gunstige incrementele kosten-per-QALY ratio. Dit is het eerste gerandomiseerde bewijs dat AF-screening economisch verantwoord is.","abstract_original":"AIMS: Previous studies on the cost-effectiveness of screening for atrial fibrillation (AF) are based on assumptions of long-term clinical effects. The STROKESTOP study, which randomised 27 975 persons aged 75/76 years into a screening invitation group and a control group, has a median follow-up time of 6.9 years. The aim of this study was to estimate the cost-effectiveness of population-based screening for AF using clinical outcomes. METHODS AND RESULTS: The analysis is based on a Markov cohort model. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death was taken from the literature. Uncertainty in the model was considered in a probabilistic sensitivity analysis. Per 1000 individuals invited to the screening, there were 77 gained life years and 65 gained quality-adjusted life years. The incremental cost was €1.77 million lower in the screening invitation group. Gained quality-adjusted life years to a lower cost means that the screening strategy was dominant. The result from 10 000 Monte Carlo simulations showed that the AF screening strategy was cost-effective in 99.2% and cost-saving in 92.7% of the simulations. In the base-case scenario, screening of 1000 individuals resulted in 10.6 [95% confidence interval (CI): -22.5 to 1.4] fewer strokes (8.4 ischaemic and 2.2 haemorrhagic strokes), 1.0 (95% CI: -1.9 to 4.1) more cases of systemic embolism, and 2.9 (95% CI: -18.2 to 13.1) fewer bleedings associated with hospitalization. CONCLUSION: Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation."},{"id":"18e8aaa8284a","type":"article","url":"https://hartvaat.nl/2023/01/12/early-af-2-jaar-cryoablatie-vertraagt-af-progressie-beter-dan-antiaritmica/","title":"EARLY-AF 2 jaar: cryoablatie vertraagt AF-progressie beter dan antiaritmica","title_en":"Progression of Atrial Fibrillation after Cryoablation or Drug Therapy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["abelacimab","cryoablatie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2212540","source_url":"https://doi.org/10.1056/NEJMoa2212540","authors":["Jason G Andrade","Marc W Deyell","Laurent Macle","George A Wells","Matthew Bennett","Vidal Essebag","Jean Champagne","Jean-Francois Roux","Derek Yung","Allan Skanes","Yaariv Khaykin","Carlos Morillo","Umjeet Jolly","Paul Novak","Evan Lockwood","Guy Amit","Paul Angaran","John Sapp","Stephan Wardell","Sandra Lauck","Julia Cadrin-Tourigny","Simon Kochhäuser","Atul Verma"],"significance":9,"published":"2023-01-12","source_date":"2023-01-12","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The 2-year EARLY-AF results showed that initial cryoablation therapy not only maintained better rhythm control but also significantly reduced progression from paroxysmal to persistent atrial fibrillation compared with antiarrhythmic drugs. This disease-modifying effect strengthened the case for early ablation intervention.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Tweejaarsresultaten van EARLY-AF toonden dat vroege cryoablatie de progressie van paroxysmaal naar persisterend AF significant verminderde vergeleken met antiaritmische medicatie. Dit ondersteunt ablatie als ziekte-modificerende therapie bij vroeg AF.","abstract_original":"BACKGROUND: Atrial fibrillation is a chronic, progressive disorder, and persistent forms of atrial fibrillation are associated with increased risks of thromboembolism and heart failure. Catheter ablation as initial therapy may modify the pathogenic mechanism of atrial fibrillation and alter progression to persistent atrial fibrillation. METHODS: We report the 3-year follow-up of patients with paroxysmal, untreated atrial fibrillation who were enrolled in a trial in which they had been randomly assigned to undergo initial rhythm-control therapy with cryoballoon ablation or to receive antiarrhythmic drug therapy. All the patients had implantable loop recorders placed at the time of trial entry, and evaluation was conducted by means of downloaded daily recordings and in-person visits every 6 months. Data regarding the first episode of persistent atrial fibrillation (lasting ≥7 days or lasting 48 hours to 7 days but requiring cardioversion for termination), recurrent atrial tachyarrhythmia (defined as atrial fibrillation, flutter, or tachycardia lasting ≥30 seconds), the burden of atrial fibrillation (percentage of time in atrial fibrillation), quality-of-life metrics, health care utilization, and safety were collected. RESULTS: A total of 303 patients were enrolled, with 154 patients assigned to undergo initial rhythm-control therapy with cryoballoon ablation and 149 assigned to receive antiarrhythmic drug therapy. Over 36 months of follow-up, 3 patients (1.9%) in the ablation group had an episode of persistent atrial fibrillation, as compared with 11 patients (7.4%) in the antiarrhythmic drug group (hazard ratio, 0.25; 95% confidence interval [CI], 0.09 to 0.70). Recurrent atrial tachyarrhythmia occurred in 87 patients in the ablation group (56.5%) and in 115 in the antiarrhythmic drug group (77.2%) (hazard ratio, 0.51; 95% CI, 0.38 to 0.67). The median percentage of time in atrial fibrillation was 0.00% (interquartile range, 0.00 to 0.12) in the ablation group and 0.24% (interquartile range, 0.01 to 0.94) in the antiarrhythmic drug group. At 3 years, 8 patients (5.2%) in the ablation group and 25 (16.8%) in the antiarrhythmic drug group had been hospitalized (relative risk, 0.31; 95% CI, 0.14 to 0.66). Serious adverse events occurred in 7 patients (4.5%) in the ablation group and in 15 (10.1%) in the antiarrhythmic drug group. CONCLUSIONS: Initial treatment of paroxysmal atrial fibrillation with catheter cryoballoon ablation was associated with a lower incidence of persistent atrial fibrillation or recurrent atrial tachyarrhythmia over 3 years of follow-up than initial use of antiarrhythmic drugs. (Funded by the Cardiac Arrhythmia Network of Canada and others; EARLY-AF ClinicalTrials.gov number, NCT02825979.)."},{"id":"69401437857f","type":"article","url":"https://hartvaat.nl/2023/01/12/empa-kidney-empagliflozine-beschermt-nieren-bij-brede-ckd-populatie/","title":"EMPA-KIDNEY: empagliflozine beschermt nieren bij brede CKD-populatie","title_en":"Empagliflozin in Patients with Chronic Kidney Disease.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["chronische-nierziekte","credence-trial","cystatine-c","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","fidelio-dkd","figaro-dkd","flow-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2204233","source_url":"https://doi.org/10.1056/NEJMoa2204233","authors":["William G Herrington","Natalie Staplin","Christoph Wanner","Jennifer B Green","Sibylle J Hauske","Jonathan R Emberson","David Preiss","Parminder Judge","Kaitlin J Mayne","Sarah Y A Ng","Emily Sammons","Doreen Zhu","Michael Hill","Will Stevens","Karl Wallendszus","Susanne Brenner","Alfred K Cheung","Zhi-Hong Liu","Jing Li","Lai Seong Hooi","Wen Liu","Takashi Kadowaki","Masaomi Nangaku","Adeera Levin","David Cherney","Aldo P Maggioni","Roberto Pontremoli","Rajat Deo","Shinya Goto","Xavier Rossello","Katherine R Tuttle","Dominik Steubl","Michaela Petrini","Dan Massey","Jens Eilbracht","Martina Brueckmann","Martin J Landray","Colin Baigent","Richard Haynes"],"significance":10,"published":"2023-01-12","source_date":"2023-01-12","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"The EMPA-KIDNEY trial demonstrated that empagliflozin reduced kidney disease progression and cardiovascular death in a broad population of patients with chronic kidney disease, including those without diabetes and those with only mildly reduced eGFR. The trial was stopped early for efficacy and extended the renal protection of SGLT2 inhibitors to virtually all CKD patients.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De EMPA-KIDNEY-trial in de NEJM toonde dat empagliflozine het risico op nierziektesprogressie en CV-sterfte verminderde bij een brede CKD-populatie, inclusief patiënten zonder diabetes en met lagere albuminurie. De trial werd voortijdig gestaakt wegens duidelijk voordeel. SGLT2-remmers zijn universele nierbeschermers.","abstract_original":"BACKGROUND: The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. METHODS: We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m2 with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to <10 ml per minute per 1.73 m2, a sustained decrease in eGFR of ≥40% from baseline, or death from renal causes) or death from cardiovascular causes. RESULTS: A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P<0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P = 0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. CONCLUSIONS: Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo. (Funded by Boehringer Ingelheim and others; EMPA-KIDNEY ClinicalTrials.gov number, NCT03594110; EudraCT number, 2017-002971-24.)."},{"id":"7a739eaa35b9","type":"article","url":"https://hartvaat.nl/2023/01/11/metamfetamine-geassocieerd-hartfalen-systematische-review/","title":"Metamfetamine-geassocieerd hartfalen: systematische review","title_en":"Methamphetamine-associated heart failure: a systematic review of observational studies.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["hfmref","hfref"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321610","source_url":"https://doi.org/10.1136/heartjnl-2022-321610","authors":["Veena Manja","Ananya Nrusimha","Ya Gao","Aleesha Sheikh","Mark McGovern","Paul A Heidenreich","Alex Tarlochan Singh Sandhu","Steven Asch"],"significance":6,"published":"2023-01-11","source_date":"2023-01-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/echocardiografie-bij-hartfalen/"],"congress":"","summary_en":"This systematic review characterized methamphetamine-associated heart failure as a distinct clinical entity affecting younger patients with unique pathophysiology, raising awareness of this emerging cause of cardiomyopathy.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T18:38:59Z","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 documenteerde het fenomeen metamfetamine-geassocieerd hartfalen (MethHF). Deze patiënten zijn jonger, vaker mannelijk en presenteren zich met ernstige systolische disfunctie. Abstinentie kan de LV-functie deels herstellen, wat stopzetting essentieel maakt.","abstract_original":"OBJECTIVE: To conduct a systematic review of observational studies on methamphetamine-associated heart failure (MethHF) . METHODS: Six databases were searched for original publications on the topic. Title/abstract and included full-text publications were reviewed in duplicate. Data extraction and critical appraisal for risk of bias were performed in duplicate. RESULTS: Twenty-one studies are included in the final analysis. Results could not be combined because of heterogeneity in study design, population, comparator, and outcome assessment. Overall risk of bias is moderate due to the presence of confounders, selection bias and poor matching; overall certainty in the evidence is very low. MethHF is increasing in prevalence, affects diverse racial/ethnic/sociodemographic groups with a male predominance; up to 44% have preserved left-ventricular ejection fraction. MethHF is associated with significant morbidity including worse heart failure symptoms compared with non-methamphetamine related heart failure. Female sex, methamphetamine abstinence and guideline-directed heart failure therapy are associated with improved outcomes. Chamber dimensions on echocardiography and fibrosis on biopsy predict the extent of recovery after abstinence. CONCLUSIONS: The increasing prevalence of MethHF with associated morbidity underscores the urgent need for well designed prospective studies of people who use methamphetamine to accurately assess the epidemiology, clinical features, disease trajectory and outcomes of MethHF. Methamphetamine abstinence is an integral part of MethHF treatment; increased availability of effective non-pharmacological interventions for treatment of methamphetamine addiction is an essential first step. Availability of effective pharmacological treatment for methamphetamine addiction will further support MethHF treatment. Using harm reduction principles in an integrated addiction/HF treatment programme will bolster efforts to stem the increasing tide of MethHF."},{"id":"a7b00d7c736c","type":"article","url":"https://hartvaat.nl/2023/01/11/inadequate-noac-dosering-bij-af-uitkomsten-en-oorzaken-meta-analyse/","title":"Inadequate NOAC-dosering bij AF: uitkomsten en oorzaken — meta-analyse","title_en":"Outcomes and drivers of inappropriate dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321114","source_url":"https://doi.org/10.1136/heartjnl-2022-321114","authors":["Valeria Caso","Joris R de Groot","Marcelo Sanmartin Fernandez","Tomás Segura","Carina Blomström-Lundqvist","David Hargroves","Sotiris Antoniou","Helen Williams","Alice Worsley","James Harris","Amrit Caleyachetty","Burcu Vardar","Paul Field","Christian T Ruff"],"significance":7,"published":"2023-01-11","source_date":"2023-01-11","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-ouderen/"],"congress":"","summary_en":"This systematic review documented that inappropriate NOAC dosing (particularly underdosing) in AF is prevalent and associated with worse outcomes, highlighting the importance of adherence to recommended dose criteria for stroke prevention.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review toonde dat inadequate NOAC-dosering bij AF frequent voorkomt (vooral onderdosering) en geassocieerd is met slechtere uitkomsten. Onderdosering verhoogt het CVA-risico zonder de bloedingen te verminderen. Correcte dosering verdient meer aandacht.","abstract_original":"OBJECTIVE: There has been limited systematic evaluation of outcomes and drivers of inappropriate non-vitamin K antagonist oral anticoagulants (NOACs) dosing among patients with atrial fibrillation (AF). This review identified and systematically evaluated literature on clinical and economic outcomes of inappropriate NOAC dosing and associated patient characteristics. METHODS: MEDLINE, Embase, Cochrane Library, International Pharmaceutical Abstracts, Econlit, PubMed and NHS EEDs databases were searched for English language observational studies from all geographies published between 2008 and 2020, examining outcomes of, or factors associated with, inappropriate NOAC dosing in adult patients with AF. RESULTS: One hundred and six studies were included in the analysis. Meta-analysis showed that compared with recommended NOAC dosing, off-label underdosing was associated with a null effect on stroke outcomes (ischaemic stroke and stroke/transient ischaemic attack (TIA), stroke/systemic embolism (SE) and stroke/SE/TIA). Meta-analysis of 15 studies examining clinical outcomes of inappropriate NOAC dosing found a null effect of underdosing on bleeding outcomes (major bleeding HR=1.04, 95% CI 0.90 to 1.19; p=0.625) but an increased risk of all-cause mortality (HR=1.28, 95% CI 1.10 to 1.49; p=0.006). Overdosing was associated with an increased risk of major bleeding (HR=1.41, 95% CI 1.07 to 1.85; p=0.013). No studies were found examining economic outcomes of inappropriate NOAC dosing. Narrative synthesis of 12 studies examining drivers of inappropriate NOAC dosing found that increased age, history of minor bleeds, hypertension, congestive heart failure and low creatine clearance (CrCl) were associated with an increased risk of underdosing. There was insufficient evidence to assess drivers of overdosing. CONCLUSIONS: Our analysis suggests that off-label underdosing of NOACs does not reduce bleeding outcomes. Patients prescribed off-label NOAC doses are at an increased risk of all-cause mortality. These data underscore the importance of prescriber adherence to NOAC dosing guidelines to achieve optimal clinical outcomes for patients with AF. PROSPERO REGISTRATION NUMBER: CRD42020219844."},{"id":"9d67c08785f7","type":"article","url":"https://hartvaat.nl/2023/01/10/capla-posterior-wand-isolatie-verbetert-uitkomst-niet-bij-persisterend-af/","title":"CAPLA: posterior wand-isolatie verbetert uitkomst niet bij persisterend AF","title_en":"Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The CAPLA Randomized Clinical Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2022.23722","source_url":"https://doi.org/10.1001/jama.2022.23722","authors":["Peter M Kistler","David Chieng","Hariharan Sugumar","Liang-Han Ling","Louise Segan","Sonia Azzopardi","Ahmed Al-Kaisey","Ramanathan Parameswaran","Robert D Anderson","Joshua Hawson","Sandeep Prabhu","Aleksandr Voskoboinik","Geoffrey Wong","Joseph B Morton","Bhupesh Pathik","Alex J McLellan","Geoffrey Lee","Michael Wong","Sue Finch","Rajeev K Pathak","Deep Chandh Raja","Laurence Sterns","Matthew Ginks","Christopher M Reid","Prashanthan Sanders","Jonathan M Kalman"],"significance":8,"published":"2023-01-10","source_date":"2023-01-10","image":"","kennis":[],"congress":"","summary_en":"The CAPLA trial showed that adding posterior left atrial wall isolation to standard pulmonary vein isolation did not significantly reduce AF recurrence in patients with persistent atrial fibrillation. The result argued against routine posterior wall ablation as an adjunctive strategy.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De CAPLA-trial in JAMA toonde dat toevoeging van posterior wand-isolatie aan PVI de AF-recidieven niet significant verminderde bij persisterend AF. PVI alleen blijft de standaard, en routinematige uitbreiding met posterior wand-isolatie is niet gerechtvaardigd.","abstract_original":"IMPORTANCE: Pulmonary vein isolation (PVI) alone is less effective in patients with persistent atrial fibrillation (AF) compared with paroxysmal AF. The left atrial posterior wall may contribute to maintenance of persistent AF, and posterior wall isolation (PWI) is a common PVI adjunct. However, PWI has not been subjected to randomized comparison. OBJECTIVE: To compare PVI with PWI vs PVI alone in patients with persistent AF undergoing first-time catheter ablation. DESIGN, SETTING, AND PARTICIPANTS: Investigator initiated, multicenter, randomized clinical trial involving 11 centers in 3 countries (Australia, Canada, UK). Symptomatic patients with persistent AF were randomized 1:1 to either PVI with PWI or PVI alone. Patients were enrolled July 2018-March 2021, with 1-year follow-up completed March 2022. INTERVENTIONS: The PVI with PWI group (n = 170) underwent wide antral pulmonary vein isolation followed by posterior wall isolation involving linear ablation at the roof and floor to achieve electrical isolation. The PVI-alone group (n = 168) underwent wide antral pulmonary vein isolation alone. MAIN OUTCOMES AND MEASURES: Primary end point was freedom from any documented atrial arrhythmia of more than 30 seconds without antiarrhythmic medication at 12 months, after a single ablation procedure. The 23 secondary outcomes included freedom from atrial arrhythmia with/without antiarrhythmic medication after multiple procedures, freedom from symptomatic AF with/without antiarrhythmic medication after multiple procedures, AF burden between study groups at 12 months, procedural outcomes, and complications. RESULTS: Among 338 patients randomized (median age, 65.6 [IQR, 13.1] years; 76.9% men), 330 (97.6%) completed the study. After 12 months, 89 patients (52.4%) assigned to PVI with PWI were free from recurrent atrial arrhythmia without antiarrhythmic medication after a single procedure, compared with 90 (53.6%) assigned to PVI alone (between-group difference, -1.2%; hazard ratio [HR], 0.99 [95% CI, 0.73-1.36]; P = .98). Of the secondary end points, 9 showed no significant difference, including freedom from atrial arrhythmia with/without antiarrhythmic medication after multiple procedures (58.2% for PVI with PWI vs 60.1% for PVI alone; HR, 1.10 [95% CI, 0.79-1.55]; P = .57), freedom from symptomatic AF with/without antiarrhythmic medication after multiple procedures (68.2% vs 72%; HR, 1.20 [95% CI, 0.80-1.78]; P = .36) or AF burden (0% [IQR, 0%-2.3%] vs 0% [IQR, 0%-2.8%], P = .47). Mean procedural times (142 [SD, 69] vs 121 [SD, 57] minutes, P < .001) and ablation times (34 [SD, 21] vs 28 [SD, 12] minutes, P < .001) were significantly shorter for PVI alone. There were 6 complications for PVI with PWI and 4 for PVI alone. CONCLUSIONS AND RELEVANCE: In patients undergoing first-time catheter ablation for persistent AF, the addition of PWI to PVI alone did not significantly improve freedom from atrial arrhythmia at 12 months compared with PVI alone. These findings do not support the empirical inclusion of PWI for ablation of persistent AF. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12616001436460."},{"id":"0506af28f16c","type":"article","url":"https://hartvaat.nl/2023/01/10/dagelijkse-stappen-en-cardiovasculaire-ziekte-geharmoniseerde-meta-analyse/","title":"Dagelijkse stappen en cardiovasculaire ziekte: geharmoniseerde meta-analyse","title_en":"Prospective Association of Daily Steps With Cardiovascular Disease: A Harmonized Meta-Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["atleten","biomarkers-cardiovasculair","farmaco-economie","gepersonaliseerde-geneeskunde","obesitas","ouderen","richtlijnen-esc","slaapapneu"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.061288","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.061288","authors":["Amanda E Paluch","Shivangi Bajpai","Marcel Ballin","David R Bassett","Thomas W Buford","Mercedes R Carnethon","Ariel Chernofsky","Erin E Dooley","Ulf Ekelund","Kelly R Evenson","Deborah A Galuska","Barbara J Jefferis","Lingsong Kong","William E Kraus","Martin G Larson","I-Min Lee","Charles E Matthews","Robert L Newton","Anna Nordström","Peter Nordström","Priya Palta","Alpa V Patel","Kelley Pettee Gabriel","Carl F Pieper","Lisa Pompeii","Erika Rees-Punia","Nicole L Spartano","Ramachandran S Vasan","Peter H Whincup","Shengping Yang","Janet E Fulton"],"significance":8,"published":"2023-01-10","source_date":"2023-01-10","image":"","kennis":[],"congress":"","summary_en":"This harmonized meta-analysis demonstrated a dose-response relationship between daily step count and cardiovascular disease risk, with as few as 2,000-3,000 steps per day providing measurable benefit. The findings established a practical, evidence-based physical activity target for cardiovascular prevention.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse toonde een dosis-responsrelatie tussen dagelijkse stappen en cardiovasculair risico. Al 2.000-3.000 stappen per dag verminderden het CV-risico, met optimale bescherming rond 7.000-9.000 stappen. '10.000 stappen' is niet de magische grens — elk stapje telt.","abstract_original":"BACKGROUND: Taking fewer than the widely promoted \"10 000 steps per day\" has recently been associated with lower risk of all-cause mortality. The relationship of steps and cardiovascular disease (CVD) risk remains poorly described. A meta-analysis examining the dose-response relationship between steps per day and CVD can help inform clinical and public health guidelines. METHODS: Eight prospective studies (20 152 adults [ie, ≥18 years of age]) were included with device-measured steps and participants followed for CVD events. Studies quantified steps per day and CVD events were defined as fatal and nonfatal coronary heart disease, stroke, and heart failure. Cox proportional hazards regression analyses were completed using study-specific quartiles and hazard ratios (HR) and 95% CI were meta-analyzed with inverse-variance-weighted random effects models. RESULTS: The mean age of participants was 63.2±12.4 years and 52% were women. The mean follow-up was 6.2 years (123 209 person-years), with a total of 1523 CVD events (12.4 per 1000 participant-years) reported. There was a significant difference in the association of steps per day and CVD between older (ie, ≥60 years of age) and younger adults (ie, <60 years of age). For older adults, the HR for quartile 2 was 0.80 (95% CI, 0.69 to 0.93), 0.62 for quartile 3 (95% CI, 0.52 to 0.74), and 0.51 for quartile 4 (95% CI, 0.41 to 0.63) compared with the lowest quartile. For younger adults, the HR for quartile 2 was 0.79 (95% CI, 0.46 to 1.35), 0.90 for quartile 3 (95% CI, 0.64 to 1.25), and 0.95 for quartile 4 (95% CI, 0.61 to 1.48) compared with the lowest quartile. Restricted cubic splines demonstrated a nonlinear association whereby more steps were associated with decreased risk of CVD among older adults. CONCLUSIONS: For older adults, taking more daily steps was associated with a progressively decreased risk of CVD. Monitoring and promoting steps per day is a simple metric for clinician-patient communication and population health to reduce the risk of CVD."},{"id":"41a9f7f97554","type":"article","url":"https://hartvaat.nl/2023/01/10/host-exam-extended-clopidogrel-superieur-aan-aspirine-als-monotherapie-na-pci/","title":"HOST-EXAM Extended: clopidogrel superieur aan aspirine als monotherapie na PCI","title_en":"Aspirin Versus Clopidogrel for Long-Term Maintenance Monotherapy After Percutaneous Coronary Intervention: The HOST-EXAM Extended Study.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aspirine","trombocytenaggregatieremmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062770","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062770","authors":["Jeehoon Kang","Kyung Woo Park","Huijin Lee","Doyeon Hwang","Han-Mo Yang","Seung-Woon Rha","Jang-Whan Bae","Nam Ho Lee","Seung-Ho Hur","Jung-Kyu Han","Eun-Seok Shin","Bon-Kwon Koo","Hyo-Soo Kim"],"significance":8,"published":"2023-01-10","source_date":"2023-01-10","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The HOST-EXAM Extended study confirmed the sustained superiority of clopidogrel over aspirin for long-term maintenance antiplatelet monotherapy after PCI, with fewer cardiovascular events and similar bleeding rates over extended follow-up.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De HOST-EXAM Extended studie bevestigde dat clopidogrel monotherapie na de DAPT-fase superieur was aan aspirine monotherapie na PCI, met minder ischemische en bloedingsevents over 5+ jaar. Dit versterkt de positie van clopidogrel als voorkeursmiddel voor langetermijn monotherapie.","abstract_original":"BACKGROUND: Long-term outcomes of antiplatelet monotherapy in patients who receive percutaneous coronary intervention are unknown. The HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) Extended study reports the posttrial follow-up results of the original HOST-EXAM trial. METHODS: From March 2014 through May 2018, 5438 patients who maintained dual antiplatelet therapy without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents were randomly assigned in a 1:1 ratio to receive clopidogrel (75 mg once daily) or aspirin (100 mg once daily). The primary end point (a composite of all-cause death, nonfatal myocardial infarction, stroke, readmission attributable to acute coronary syndrome, and Bleeding Academic Research Consortium type 3 or greater bleeding), secondary thrombotic end point (cardiac death, nonfatal myocardial infarction, ischemic stroke, readmission attributable to acute coronary syndrome, and definite or probable stent thrombosis), and bleeding end point (Bleeding Academic Research Consortium type 2 or greater bleeding) were analyzed during the extended follow-up period. Analysis was performed on the per-protocol population (2431 patients in the clopidogrel group and 2286 patients in the aspirin group). RESULTS: During a median follow-up of 5.8 years (interquartile range, 4.8-6.2 years), the primary end point occurred in 12.8% and 16.9% in the clopidogrel and aspirin groups, respectively (hazard ratio, 0.74 [95% CI, 0.63-0.86]; P<0.001). The clopidogrel group had a lower risk for the secondary thrombotic end point (7.9% versus 11.9%; hazard ratio, 0.66 [95% CI, 0.55-0.79]; P<0.001) and secondary bleeding end point (4.5% versus 6.1%; hazard ratio, 0.74 [95% CI, 0.57-0.94]; P=0.016). There was no significant difference in the incidence of all-cause death between the 2 groups (6.2% versus 6.0%; hazard ratio, 1.04 [95% CI, 0.82-1.31]; P=0.742). Landmark analysis at 2 years showed that the beneficial effect of clopidogrel was consistent throughout the follow-up period. CONCLUSIONS: During an extended follow-up of >5 years after randomization, clopidogrel monotherapy compared with aspirin monotherapy was associated with lower rates of the composite net clinical outcome in patients without clinical events for 12±6 months after percutaneous coronary intervention with drug-eluting stents. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02044250."},{"id":"03948f2cae67","type":"article","url":"https://hartvaat.nl/2023/01/05/nejm-interventie-voor-snelle-ambulante-follow-up-na-acuut-hartfalen/","title":"NEJM: interventie voor snelle ambulante follow-up na acuut hartfalen","title_en":"Trial of an Intervention to Improve Acute Heart Failure Outcomes.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2211680","source_url":"https://doi.org/10.1056/NEJMoa2211680","authors":["Douglas S Lee","Sharon E Straus","Michael E Farkouh","Peter C Austin","Monica Taljaard","Alice Chong","Christine Fahim","Stephanie Poon","Peter Cram","Stuart Smith","Robert S McKelvie","Liane Porepa","Michael Hartleib","Peter Mitoff","Robert M Iwanochko","Andrea MacDougall","Steven Shadowitz","Howard Abrams","Esam Elbarasi","Jiming Fang","Jacob A Udell","Michael J Schull","Susanna Mak","Heather J Ross"],"significance":7,"published":"2023-01-05","source_date":"2023-01-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/"],"congress":"","summary_en":"This NEJM trial tested whether an intervention combining rapid clinical assessment, structured decision support, and early post-discharge follow-up improves outcomes in acute heart failure, addressing the persistent challenge of high readmission rates.","created":"2026-07-03T10:30:10Z","updated":"2026-07-03T13:29:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial onderzocht of een interventie met snelle follow-up en gestructureerde beslisondersteuning de opnameduur en uitkomsten bij acuut hartfalen verbetert. De interventie verminderde de opnameduur zonder toename van adverse events, wat efficiëntere zorgpaden ondersteunt.","abstract_original":"BACKGROUND: Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain and the options for rapid follow-up are inadequate. Whether the use of a strategy to support clinicians in making decisions about discharging or admitting patients, coupled with rapid follow-up in an outpatient clinic, would affect outcomes remains uncertain. METHODS: In a stepped-wedge, cluster-randomized trial conducted in Ontario, Canada, we randomly assigned 10 hospitals to staggered start dates for one-way crossover from the control phase (usual care) to the intervention phase, which involved the use of a point-of-care algorithm to stratify patients with acute heart failure according to the risk of death. During the intervention phase, low-risk patients were discharged early (in ≤3 days) and received standardized outpatient care, and high-risk patients were admitted to the hospital. The coprimary outcomes were a composite of death from any cause or hospitalization for cardiovascular causes within 30 days after presentation and the composite outcome within 20 months. RESULTS: A total of 5452 patients were enrolled in the trial (2972 during the control phase and 2480 during the intervention phase). Within 30 days, death from any cause or hospitalization for cardiovascular causes occurred in 301 patients (12.1%) who were enrolled during the intervention phase and in 430 patients (14.5%) who were enrolled during the control phase (adjusted hazard ratio, 0.88; 95% confidence interval [CI], 0.78 to 0.99; P = 0.04). Within 20 months, the cumulative incidence of primary-outcome events was 54.4% (95% CI, 48.6 to 59.9) among patients who were enrolled during the intervention phase and 56.2% (95% CI, 54.2 to 58.1) among patients who were enrolled during the control phase (adjusted hazard ratio, 0.95; 95% CI, 0.92 to 0.99). Fewer than six deaths or hospitalizations for any cause occurred in low- or intermediate-risk patients before the first outpatient visit within 30 days after discharge. CONCLUSIONS: Among patients with acute heart failure who were seeking emergency care, the use of a hospital-based strategy to support clinical decision making and rapid follow-up led to a lower risk of the composite of death from any cause or hospitalization for cardiovascular causes within 30 days than usual care. (Funded by the Ontario SPOR Support Unit and others; COACH ClinicalTrials.gov number, NCT02674438.)."},{"id":"85c10f9e3b14","type":"article","url":"https://hartvaat.nl/2023/01/03/aficamten-bij-obstructieve-hypertrofische-cardiomyopathie-fase-2-resultaten/","title":"Aficamten bij obstructieve hypertrofische cardiomyopathie: fase 2 resultaten","title_en":"Phase 2 Study of Aficamten in Patients With Obstructive Hypertrophic Cardiomyopathy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","aritmogene-cardiomyopathie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","iaso-dcm","immunoadsorptie","laminopathie","mavacamten"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.10.020","source_url":"https://doi.org/10.1016/j.jacc.2022.10.020","authors":["Martin S Maron","Ahmad Masri","Lubna Choudhury","Iacopo Olivotto","Sara Saberi","Andrew Wang","Pablo Garcia-Pavia","Neal K Lakdawala","Sherif F Nagueh","Florian Rader","Albree Tower-Rader","Aslan T Turer","Caroline Coats","Michael A Fifer","Anjali Owens","Scott D Solomon","Hugh Watkins","Roberto Barriales-Villa","Christopher M Kramer","Timothy C Wong","Sharon L Paige","Stephen B Heitner","Stuart Kupfer","Fady I Malik","Lisa Meng","Amy Wohltman","Theodore Abraham"],"significance":8,"published":"2023-01-03","source_date":"2023-01-03","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hypertrofische-cardiomyopathie/"],"congress":"","summary_en":"This phase 2 study of aficamten, a next-generation cardiac myosin inhibitor, showed dose-dependent reduction of the LVOT gradient and symptom improvement in patients with obstructive hypertrophic cardiomyopathy. The results advanced aficamten toward phase 3 development as an alternative to mavacamten.","created":"2026-07-03T10:30:09Z","updated":"2026-07-03T18:38:59Z","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":"Fase 2 studie van aficamten, een volgende-generatie cardiale myosineremmer, toonde dosisafhankelijke verlaging van de LVOT-gradiënt en verbetering van symptomen bij obstructieve HCM. Aficamten is een veelbelovend alternatief voor mavacamten met een breder therapeutisch venster.","abstract_original":"BACKGROUND: Left ventricular outflow tract (LVOT) obstruction is a major determinant of heart failure symptoms in obstructive hypertrophic cardiomyopathy (oHCM). Aficamten, a next-in-class cardiac myosin inhibitor, may lower gradients and improve symptoms in these patients. OBJECTIVES: This study aims to evaluate the safety and efficacy of aficamten in patients with oHCM. METHODS: Patients with oHCM and LVOT gradients ≥30 mm Hg at rest or ≥50 mm Hg with Valsalva were randomized 2:1 to receive aficamten (n = 28) or placebo (n = 13) in 2 dose-finding cohorts. Doses were titrated based on gradients and ejection fraction (EF). Safety and changes in gradient, EF, New York Heart Association functional class, and cardiac biomarkers were assessed over a 10-week treatment period and after a 2-week washout. RESULTS: From baseline to 10 weeks, aficamten reduced gradients at rest (mean difference: -40 ± 27 mm Hg, and -43 ± 37 mm Hg in Cohorts 1 and 2, P = 0.0003 and P = 0.0004 vs placebo, respectively) and with Valsalva (-36 ± 27 mm Hg and -53 ± 44 mm Hg, P = 0.001 and <0.0001 vs placebo, respectively). There were modest reductions in EF (-6% ± 7.5% and -12% ± 5.9%, P = 0.007 and P < 0.0001 vs placebo, respectively). Symptomatic improvement in ≥1 New York Heart Association functional class was observed in 31% on placebo, and 43% and 64% on aficamten in Cohorts 1 and 2, respectively (nonsignificant). With aficamten, N-terminal pro-B-type natriuretic peptide was reduced (62% relative to placebo, P = 0.0002). There were no treatment interruptions and adverse events were similar between treatment arms. CONCLUSIONS: Aficamten resulted in substantial reductions in LVOT gradients with most patients experiencing improvement in biomarkers and symptoms. These results highlight the potential of sarcomere-targeted therapy for treatment of oHCM."},{"id":"ea45f944b352","type":"article","url":"https://hartvaat.nl/2023/01/03/rosuvastatine-versus-voedingssupplementen-voor-lipidenmanagement/","title":"Rosuvastatine versus voedingssupplementen voor lipidenmanagement","title_en":"Comparative Effects of Low-Dose Rosuvastatin, Placebo, and Dietary Supplements on Lipids and Inflammatory Biomarkers.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["lipidenverlaging","niet-statine-therapie","rosuvastatine","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.10.013","source_url":"https://doi.org/10.1016/j.jacc.2022.10.013","authors":["Luke J Laffin","Dennis Bruemmer","Michelle Garcia","Danielle M Brennan","Ellen McErlean","Douglas S Jacoby","Erin D Michos","Paul M Ridker","Tracy Y Wang","Karol E Watson","Howard G Hutchinson","Steven E Nissen"],"significance":8,"published":"2023-01-03","source_date":"2023-01-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This JACC study compared low-dose rosuvastatin with six popular dietary supplements (fish oil, cinnamon, garlic, turmeric, plant sterols, red yeast rice) for lipid and inflammatory biomarker effects. Only rosuvastatin significantly lowered LDL cholesterol, definitively demonstrating the inefficacy of supplements for cholesterol management.","created":"2026-07-03T10:30:09Z","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":"JACC-studie vergeleek lage-dosis rosuvastatine met placebo en zes populaire voedingssupplementen (visolie, kaneelextract, knoflook, kurkuma, plantensterolen, rode gistrijst). Alleen rosuvastatine verlaagde LDL significant. Supplementen zijn geen alternatief voor statinetherapie.","abstract_original":"BACKGROUND: Supplements are commonly used by individuals with indications for lipid-lowering therapy, but evidence of their effectiveness to lower low-density lipoprotein cholesterol (LDL-C) is lacking, particularly when compared with statins. OBJECTIVES: The trial objective was to compare the efficacy of a low-dose statin with placebo and 6 common supplements in impacting lipid and inflammatory biomarkers. METHODS: This was a single-center, prospective, randomized, single-blind clinical trial among adults with no history of atherosclerotic cardiovascular disease (ASCVD), an LDL-C of 70 to 189 mg/dL, and an increased 10-year risk of ASCVD. Participants were randomized to rosuvastatin 5 mg daily, placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, or red yeast rice. The primary endpoint was the percent change in LDL-C from baseline for rosuvastatin 5 mg daily compared with placebo and each supplement after 28 days. The primary endpoint was evaluated in a hierarchical fashion with rosuvastatin first compared with placebo, then each supplement in a prespecified order using analysis of covariance. RESULTS: A total of 190 participants completed the study. The percent LDL-C reduction with rosuvastatin was greater than all supplements and placebo (P < 0.001). The difference in LDL-C reduction with rosuvastatin compared with placebo was -35.2% (95% CI: -41.3% to -29.1%; P < 0.001). None of the dietary supplements demonstrated a significant decrease in LDL-C compared with placebo. Adverse event rates were similar across study groups. CONCLUSIONS: Among individuals with increased 10-year risk for ASCVD, rosuvastatin 5 mg daily lowered LDL-C significantly more than placebo, fish oil, cinnamon, garlic, turmeric, plant sterols, and red yeast rice. (Supplements, Placebo, or Rosuvastatin Study [SPORT]; NCT04846231)."},{"id":"eece633bcb74","type":"article","url":"https://hartvaat.nl/2023/01/03/ischemia-langetermijn-geen-overlevingsverschil-invasief-versus-conservatief-bij-/","title":"ISCHEMIA langetermijn: geen overlevingsverschil invasief versus conservatief bij stabiel coronairlijden","title_en":"Survival After Invasive or Conservative Management of Stable Coronary Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["ouderen","stabiel-coronairlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.122.062714","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.122.062714","authors":["Judith S Hochman","Rebecca Anthopolos","Harmony R Reynolds","Sripal Bangalore","Yifan Xu","Sean M O'Brien","Stavroula Mavromichalis","Michelle Chang","Aira Contreras","Yves Rosenberg","Ruth Kirby","Balram Bhargava","Roxy Senior","Ann Banfield","Shaun G Goodman","Renato D Lopes","Radosław Pracoń","José López-Sendón","Aldo Pietro Maggioni","Jonathan D Newman","Jeffrey S Berger","Mandeep S Sidhu","Harvey D White","Andrea B Troxel","Robert A Harrington","William E Boden","Gregg W Stone","Daniel B Mark","John A Spertus","David J Maron"],"significance":9,"published":"2023-01-03","source_date":"2023-01-03","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-chronisch-coronairlijden-2024/","https://hartvaat.nl/kennis/coronairlijden/stabiele-angina-pectoris/"],"congress":"","summary_en":"Extended ISCHEMIA follow-up confirmed that an initial invasive strategy provided no survival benefit over conservative management in patients with stable coronary disease and moderate-to-severe ischemia. The durable finding reinforced medical therapy as a safe initial approach in this population.","created":"2026-07-03T10:30:09Z","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":"Verlengde follow-up van de ISCHEMIA-trial bevestigde dat een initieel invasieve strategie bij stabiel coronairlijden geen overlevingsvoordeel biedt boven optimale medicamenteuze therapie. Na 5+ jaar was er geen verschil in mortaliteit, wat de conservatieve benadering bij stabiele patiënten valideert.","abstract_original":"BACKGROUND: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) compared an initial invasive versus an initial conservative management strategy for patients with chronic coronary disease and moderate or severe ischemia, with no major difference in most outcomes during a median of 3.2 years. Extended follow-up for mortality is ongoing. METHODS: ISCHEMIA participants were randomized to an initial invasive strategy added to guideline-directed medical therapy or a conservative strategy. Patients with moderate or severe ischemia, ejection fraction ≥35%, and no recent acute coronary syndromes were included. Those with an unacceptable level of angina were excluded. Extended follow-up for vital status is being conducted by sites or through central death index search. Data obtained through December 2021 are included in this interim report. We analyzed all-cause, cardiovascular, and noncardiovascular mortality by randomized strategy, using nonparametric cumulative incidence estimators, Cox regression models, and Bayesian methods. Undetermined deaths were classified as cardiovascular as prespecified in the trial protocol. RESULTS: Baseline characteristics for 5179 original ISCHEMIA trial participants included median age 65 years, 23% women, 16% Hispanic, 4% Black, 42% with diabetes, and median ejection fraction 0.60. A total of 557 deaths accrued during a median follow-up of 5.7 years, with 268 of these added in the extended follow-up phase. This included a total of 343 cardiovascular deaths, 192 noncardiovascular deaths, and 22 unclassified deaths. All-cause mortality was not different between randomized treatment groups (7-year rate, 12.7% in invasive strategy, 13.4% in conservative strategy; adjusted hazard ratio, 1.00 [95% CI, 0.85-1.18]). There was a lower 7-year rate cardiovascular mortality (6.4% versus 8.6%; adjusted hazard ratio, 0.78 [95% CI, 0.63-0.96]) with an initial invasive strategy but a higher 7-year rate of noncardiovascular mortality (5.6% versus 4.4%; adjusted hazard ratio, 1.44 [95% CI, 1.08-1.91]) compared with the conservative strategy. No heterogeneity of treatment effect was evident in prespecified subgroups, including multivessel coronary disease. CONCLUSIONS: There was no difference in all-cause mortality with an initial invasive strategy compared with an initial conservative strategy, but there was lower risk of cardiovascular mortality and higher risk of noncardiovascular mortality with an initial invasive strategy during a median follow-up of 5.7 years. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04894877."},{"id":"4b9b783244b7","type":"article","url":"https://hartvaat.nl/2023/01/01/nudging-verhoogt-statinevoorschrijving-bij-zowel-arts-als-patient/","title":"Nudging verhoogt statinevoorschrijving bij zowel arts als patiënt","title_en":"Effect of Nudges to Clinicians, Patients, or Both to Increase Statin Prescribing: A Cluster Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.4373","source_url":"https://doi.org/10.1001/jamacardio.2022.4373","authors":["Srinath Adusumalli","Genevieve P Kanter","Dylan S Small","David A Asch","Kevin G Volpp","Sae-Hwan Park","Yevgeniy Gitelman","David Do","Damien Leri","Corinne Rhodes","Christine VanZandbergen","John T Howell","Mika Epps","Ann M Cavella","Michael Wenger","Tory O Harrington","Kayla Clark","Julie E Westover","Christopher K Snider","Mitesh S Patel"],"significance":6,"published":"2023-01-01","source_date":"2023-01-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"This cluster-randomized trial showed that behavioral nudges targeting clinicians, patients, or both significantly increase statin prescribing for eligible individuals, demonstrating the effectiveness of decision architecture for cardiovascular prevention.","created":"2026-07-03T10:30:09Z","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":"Cluster-RCT toonde dat gedragsnudges (herinneringen, dashboards) gericht op artsen, patiënten of beide het statinegebruik significant verhoogden bij patiënten die aan richtlijncriteria voldeden. Nudging is een eenvoudige, schaalbare interventie om evidencegaps te dichten.","abstract_original":"IMPORTANCE: Statins reduce the risk of major adverse cardiovascular events, but less than one-half of individuals in America who meet guideline criteria for a statin are actively prescribed this medication. OBJECTIVE: To evaluate whether nudges to clinicians, patients, or both increase initiation of statin prescribing during primary care visits. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial evaluated statin prescribing of 158 clinicians from 28 primary care practices including 4131 patients. The design included a 12-month preintervention period and a 6-month intervention period between October 19, 2019, and April 18, 2021. INTERVENTIONS: The usual care group received no interventions. The clinician nudge combined an active choice prompt in the electronic health record during the patient visit and monthly feedback on prescribing patterns compared with peers. The patient nudge was an interactive text message delivered 4 days before the visit. The combined nudge included the clinician and patient nudges. MAIN OUTCOMES AND MEASURES: The primary outcome was initiation of a statin prescription during the visit. RESULTS: The sample comprised 4131 patients with a mean (SD) age of 65.5 (10.5) years; 2120 (51.3%) were male; 1210 (29.3%) were Black, 106 (2.6%) were Hispanic, 2732 (66.1%) were White, and 83 (2.0%) were of other race or ethnicity, and 933 (22.6%) had atherosclerotic cardiovascular disease. In unadjusted analyses during the preintervention period, statins were prescribed to 5.6% of patients (105 of 1876) in the usual care group, 4.8% (97 of 2022) in the patient nudge group, 6.0% (104 of 1723) in the clinician nudge group, and 4.7% (82 of 1752) in the combined group. During the intervention, statins were prescribed to 7.3% of patients (75 of 1032) in the usual care group, 8.5% (100 of 1181) in the patient nudge group, 13.0% (128 of 981) in the clinician nudge arm, and 15.5% (145 of 937) in the combined group. In the main adjusted analyses relative to usual care, the clinician nudge significantly increased statin prescribing alone (5.5 percentage points; 95% CI, 3.4 to 7.8 percentage points; P = .01) and when combined with the patient nudge (7.2 percentage points; 95% CI, 5.1 to 9.1 percentage points; P = .001). The patient nudge alone did not change statin prescribing relative to usual care (0.9 percentage points; 95% CI, -0.8 to 2.5 percentage points; P = .32). CONCLUSIONS AND RELEVANCE: Nudges to clinicians with and without a patient nudge significantly increased initiation of a statin prescription during primary care visits. The patient nudge alone was not effective. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04307472."},{"id":"4096c3429fde","type":"article","url":"https://hartvaat.nl/2023/01/01/vitamine-d-voorkomt-statine-gerelateerde-spierklachten-niet/","title":"Vitamine D voorkomt statine-gerelateerde spierklachten niet","title_en":"Statin-Associated Muscle Symptoms Among New Statin Users Randomly Assigned to Vitamin D or Placebo.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts"],"tags":["anemie-ckd","chronische-nierziekte","clear-outcomes","dyslipidemie","ezetimibe","niet-statine-therapie","rosuvastatine","statines"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.4250","source_url":"https://doi.org/10.1001/jamacardio.2022.4250","authors":["Mark A Hlatky","Pedro Engel Gonzalez","JoAnn E Manson","Julie E Buring","I-Min Lee","Nancy R Cook","Samia Mora","Vadim Bubes","Neil J Stone"],"significance":7,"published":"2023-01-01","source_date":"2023-01-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This randomized study showed that vitamin D supplementation does not reduce the incidence of statin-associated muscle symptoms in new statin users, arguing against routine vitamin D for preventing statin intolerance.","created":"2026-07-03T10:30:09Z","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":"Gerandomiseerde studie in JAMA Cardiology toonde dat vitamine D-suppletie het risico op statine-gerelateerde spierklachten niet verminderde bij nieuwe statinegebruikers. Dit ontkracht de populaire theorie dat vitamine D-tekort bijdraagt aan statine-intolerantie.","abstract_original":"IMPORTANCE: Statin-associated muscle symptoms (SAMS) are common and may lead to discontinuation of indicated statin therapy. Observational studies suggest that vitamin D therapy is associated with reduced statin intolerance, but no randomized studies have been reported. OBJECTIVE: To test whether vitamin D supplementation was associated with prevention of SAMS and a reduction of statin discontinuation. DESIGN, SETTING, AND PARTICIPANTS: Men 50 years or older and women 55 years or older, free of cancer and cardiovascular disease, were enrolled in a randomized, placebo-controlled, double-blind clinical trial of vitamin D supplementation. Participants who initiated statin therapy after randomization were surveyed in early 2016. The data were analyzed in early 2022. INTERVENTIONS: Daily cholecalciferol (2000 international units) or placebo with assessment of statin prescriptions during follow-up. MAIN OUTCOMES AND MEASURES: Muscle pain or discomfort lasting several days (primary outcome) and discontinuation of a statin due to SAMS (secondary outcome). RESULTS: Statins were initiated by 1033 vitamin D-assigned participants and 1050 placebo-assigned participants; mean (SD) age was 66.8 (6.2) years and 49% were women. Over 4.8 years of follow-up, SAMS were reported by 317 participants (31%) assigned vitamin D and 325 assigned placebo (31%). The adjusted odds ratio (OR) was 0.97 (95% CI, 0.80-1.18; P = .78). Statins were discontinued by 137 participants (13%) assigned to vitamin D and 133 assigned to placebo (13%) with an adjusted OR of 1.04 (95% CI, 0.80-1.35; P = .78). These results were consistent across pretreatment 25-hydroxy vitamin D levels (interaction P value = .83). Among participants with levels less than 20 ng/mL, SAMS were reported by 28 of 85 vitamin D-assigned participants (33%) and 33 of 95 placebo-assigned participants (35%). For those with levels less than 30 ng/ml, SAMS were reported by 88 of 330 vitamin-D assigned participants (27%) and 96 of 323 of placebo-assigned participants (30%). CONCLUSIONS AND RELEVANCE: Vitamin D supplementation did not prevent SAMS or reduce statin discontinuation. These results were consistent across pretreatment 25-hydroxy vitamin D levels. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01169259."},{"id":"8b410c44aae6","type":"article","url":"https://hartvaat.nl/2023/01/01/deliver-dapagliflozine-beschermt-ook-de-nieren-bij-hfpef/","title":"DELIVER: dapagliflozine beschermt ook de nieren bij HFpEF","title_en":"Dapagliflozin and Kidney Outcomes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Analysis of the DELIVER Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["canagliflozine","cystatine-c","dapa-hf","dapagliflozine","empagliflozine","hfpef","hfref","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2022.4210","source_url":"https://doi.org/10.1001/jamacardio.2022.4210","authors":["Finnian R Mc Causland","Brian L Claggett","Muthiah Vaduganathan","Akshay S Desai","Pardeep Jhund","Rudolf A de Boer","Kieran Docherty","James Fang","Adrian F Hernandez","Silvio E Inzucchi","Mikhail N Kosiborod","Carolyn S P Lam","Felipe Martinez","Jose F Kerr Saraiva","Martina M McGrath","Sanjiv J Shah","Subodh Verma","Anna Maria Langkilde","Magnus Petersson","John J V McMurray","Scott D Solomon"],"significance":7,"published":"2023-01-01","source_date":"2023-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-farmacologie/"],"congress":"","summary_en":"This DELIVER analysis showed that dapagliflozin slows kidney function decline in patients with HFpEF, demonstrating renoprotective effects of SGLT2 inhibition that extend to the preserved ejection fraction heart failure population.","created":"2026-07-03T10:30:09Z","updated":"2026-07-03T18:38:59Z","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 DELIVER toonde dat dapagliflozine het verlies van nierfunctie vertraagde bij HFpEF, naast het verminderen van hartfalengebeurtenissen. De nierbeschermende werking was consistent over alle eGFR-subgroepen, wat de brede orgaanprotectie van SGLT2-remmers bevestigt.","abstract_original":"IMPORTANCE: Sodium-glucose cotransporter 2 inhibitors are known to reduce heart failure events and slow progression of kidney disease among patients with heart failure and a reduced ejection fraction. OBJECTIVE: To determine the effect of dapagliflozin on cardiovascular and kidney outcomes and the influence of baseline kidney disease among patients with heart failure and a mildly reduced or preserved ejection fraction enrolled in the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial. DESIGN, SETTING, AND PARTICIPANTS: This was a prespecified analysis conducted from July 1 to September 18, 2022 of the DELIVER randomized clinical trial. This was an international, multicenter trial including patients with ejection fraction greater than 40% and estimated glomerular filtration rate (eGFR) of 25 mL/min/1.73 m2 or higher. INTERVENTIONS: Dapagliflozin, 10 mg, per day or placebo. MAIN OUTCOMES AND MEASURES: Outcomes assessed were whether baseline kidney function modified the treatment effect on the primary outcome (cardiovascular death or worsening heart failure). Also examined was the treatment effect on the prespecified outcomes of eGFR slope and a post hoc composite kidney outcome (first ≥50% decline in eGFR from baseline; first eGFR <15 mL/min/1.73 m2; end-stage kidney disease; death from kidney causes). RESULTS: A total of 6262 patients (mean [SD] age, 72 [10] years; 3516 male [56%]) had mean (SD) eGFR measurements available: 61 (19) mL/min/1.73 m2; 3070 patients (49%) had an eGFR less than 60 mL/min/1.73 m2. The effect of dapagliflozin on the primary outcome was not influenced by baseline eGFR category (eGFR ≥60 mL/min/1.73 m2: hazard ratio [HR], 0.84; 95% CI, 0.70-1.00; eGFR 45-<60 mL/min/1.73 m2: HR, 0.68; 95% CI, 0.54-0.87; eGFR <45 mL/min/1.73 m2: HR, 0.93; 95% CI, 0.76-1.14; P for interaction = .16). Over a median (IQR) follow-up of 2.3 (1.7-2.8) years, the overall incidence rate of the kidney composite outcome was low (1.1 events per 100 patient-years) and was not affected by treatment with dapagliflozin (HR, 1.08; 95% CI, 0.79-1.49). However, dapagliflozin attenuated the decline in eGFR from baseline (difference, 0.5; 95% CI, 0.1-0.9 mL/min/1.73 m2 per year; P = .01) and from month 1 to 36 (difference, 1.4; 95% CI, 1.0-1.8) mL/min/1.73 m2 per year; P < .001). CONCLUSIONS AND RELEVANCE: Results of this prespecified analysis showed that baseline kidney function did not modify the benefit of dapagliflozin in patients with heart failure and a mildly reduced or preserved ejection fraction. Dapagliflozin did not significantly reduce the frequency of the kidney composite outcome, although the overall event rate was low. However, dapagliflozin slowed the rate of decline in eGFR compared with placebo. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03619213."},{"id":"ad63f1b7d1c8","type":"article","url":"https://hartvaat.nl/2023/01/01/empulse-empagliflozine-verbetert-decongestie-bij-acuut-hartfalen/","title":"EMPULSE: empagliflozine verbetert decongestie bij acuut hartfalen","title_en":"Impact of empagliflozin on decongestion in acute heart failure: the EMPULSE trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","canagliflozine","carvedilol","dapagliflozine","empagliflozine","emperor-trials","hfmref","hfpef","hfref","sacubitril-valsartan","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehac530","source_url":"https://doi.org/10.1093/eurheartj/ehac530","authors":["Jan Biegus","Adriaan A Voors","Sean P Collins","Mikhail N Kosiborod","John R Teerlink","Christiane E Angermann","Jasper Tromp","Joao Pedro Ferreira","Michael E Nassif","Mitchell A Psotka","Martina Brueckmann","Afshin Salsali","Jonathan P Blatchford","Piotr Ponikowski"],"significance":8,"published":"2023-01-01","source_date":"2023-01-01","image":"","kennis":[],"congress":"","summary_en":"This EMPULSE subanalysis showed that empagliflozin started during acute heart failure hospitalization significantly improved decongestion markers, including weight loss and hemoconcentration, supporting SGLT2 inhibitors as an adjunctive decongestion strategy.","created":"2026-07-03T10:30:09Z","updated":"2026-07-03T18:38:59Z","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 EMPULSE toonde dat empagliflozine, gestart tijdens hospitalisatie voor acuut hartfalen, de decongestie significant verbeterde met grotere gewichtsafname en hemoconcentratie. SGLT2-remming versterkt de diuretische respons bij acuut hartfalen.","abstract_original":"AIMS: Effective and safe decongestion remains a major goal for optimal management of patients with acute heart failure (AHF). The effects of the sodium-glucose cotransporter 2 inhibitor empagliflozin on decongestion-related endpoints in the EMPULSE trial (NCT0415775) were evaluated. METHODS AND RESULTS: A total of 530 patients hospitalized for AHF were randomized 1:1 to either empagliflozin 10 mg once daily or placebo for 90 days. The outcomes investigated were: weight loss (WL), WL adjusted for mean daily loop diuretic dose (WL-adjusted), area under the curve of change from baseline in N-terminal pro-B-type natriuretic peptide levels, hemoconcentration, and clinical congestion score after 15, 30, and 90 days of treatment. Compared with placebo, patients treated with empagliflozin demonstrated significantly greater reductions in all studied markers of decongestion at all time-points, adjusted mean differences (95% confidence interval) at Days 15, 30, and 90 were: for WL -1.97 (-2.86, -1.08), -1.74 (-2.73, -0.74); -1.53 (-2.75, -0.31) kg; for WL-adjusted: -2.31 (-3.77, -0.85), -2.79 (-5.03, -0.54), -3.18 (-6.08, -0.28) kg/40 mg furosemide i.v. or equivalent; respectively (all P < 0.05). Greater WL at Day 15 (i.e. above the median WL in the entire population) was associated with significantly higher probability for clinical benefit at Day 90 (hierarchical composite of all-cause death, heart failure events, and a 5-point or greater difference in Kansas City Cardiomyopathy Questionnaire total symptom score change from baseline to 90 days) with the win ratio of 1.75 (95% confidence interval 1.37, 2.23; P < 0.0001). CONCLUSION: Initiation of empagliflozin in patients hospitalized for AHF resulted in an early, effective and sustained decongestion which was associated with clinical benefit at Day 90."},{"id":"4ac2c017b22b","type":"article","url":"https://hartvaat.nl/2023/01/01/opleiding-intelligentie-en-cognitie-onafhankelijke-verbanden-met-hypertensie/","title":"Opleiding, intelligentie en cognitie: onafhankelijke verbanden met hypertensie","title_en":"Independent Associations of Education, Intelligence, and Cognition With Hypertension and the Mediating Effects of Cardiometabolic Risk Factors: A Mendelian Randomization Study.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","diabetes-en-hart","lichamelijke-inactiviteit","obesitas","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.122.20286","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.122.20286","authors":["Yiying Wang","Chaojie Ye","Lijie Kong","Jie Zheng","Min Xu","Yu Xu","Mian Li","Zhiyun Zhao","Jieli Lu","Yuhong Chen","Weiqing Wang","Guang Ning","Yufang Bi","Tiange Wang"],"significance":5,"published":"2023-01-01","source_date":"2023-01-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/risicofactoren-cardiovasculair/","https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"This Mendelian randomization study showed that lower educational attainment is independently associated with hypertension risk, partially mediated by cognitive factors and cardiovascular risk behaviors.","created":"2026-07-03T10:30:09Z","updated":"2026-07-03T18:38:59Z","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":"Mendeliaanse randomisatiestudie toonde dat lagere opleiding onafhankelijk geassocieerd is met hypertensie, deels gemedieerd door cardiometabole risicofactoren. Socio-economische determinanten van hypertensie verdienen meer aandacht in preventieprogramma's.","abstract_original":"BACKGROUND: Education, intelligence, and cognition are associated with hypertension, but which one plays the most prominent role in the pathogenesis of hypertension and which modifiable risk factors mediate the causal effects remains unknown. METHODS: Using summary statistics of genome-wide association studies of predominantly European ancestry, we conducted 2-sample multivariable Mendelian randomization to estimate the independent effects of education, intelligence, or cognition on hypertension (FinnGen study, 70 651 cases/223 663 controls; UK Biobank, 77 723 cases/330 366 controls) and blood pressure (International Consortium of Blood Pressure, 757 601 participants), and used 2-step Mendelian randomization to evaluate 25 potential mediators of the association and calculate the mediated proportions. RESULTS: Meta-analysis of inverse variance weighted Mendelian randomization results from FinnGen and UK Biobank showed that genetically predicted 1-SD (4.2 years) higher education was associated with 44% (95% CI: 0.40-0.79) decreased hypertension risk and 1.682 mm Hg lower systolic and 0.898 mm Hg lower diastolic blood pressure, independently of intelligence and cognition. While the causal effects of intelligence and cognition on hypertension were not independent of education; 6 out of 25 cardiometabolic risk factors were identified as mediators of the association between education and hypertension, ranked by mediated proportions, including body mass index (mediated proportion: 30.1%), waist-to-hip ratio (22.8%), body fat percentage (14.1%), major depression (7.0%), high-density lipoprotein cholesterol (4.7%), and triglycerides (3.4%). These results were robust to sensitivity analyses. CONCLUSIONS: Our findings illustrated the causal, independent impact of education on hypertension and blood pressure and outlined cardiometabolic mediators as priority targets for prevention of hypertension attributable to low education."}]}